“Although sperm washing techniques for assisting HIV serodiscordant couples wishing to have children have been utilized for almost 20 years, the US healthcare system has been slow to embrace the methodology,” lead author Dr. Mark V. Sauer told Reuters Health. Dr. Sauer directs Columbia’s Division of Reproductive Endocrinology, whose 12 years of experience providing services for such couples provides the basis for the report.
“Our center uses IVF with ICSI of prepared sperm to separate cellular and fluid components known to harbor virus from the virus free sperm fraction,” Dr. Sauer said. “Our findings failed to detect any transmission to patients or their offspring.”
The study, reported in the June issue of Fertility and Sterility, featured 181 couples who underwent 355 fresh IVF-ICSI cycles and 65 frozen-embryo transfer cycles. Sixteen percent of stimulations were canceled due to poor ovarian response.
On average, 15.0 oocytes were collected per retrieval, resulting in 12.1 mature oocytes suitable for ICSI, yielding 9.0 embryos per couple, the report indicates.
The overall clinical pregnancy rate/embryo transfer was 45% and the ongoing/delivery pregnancy rate/embryo transfer was 37%, the authors state.
Multiple gestation was the most frequent obstetrical complication, at a rate (41%) similar to those reported for the general population of patients undergoing IVF-ICSI, and high-order multiple birth was seen in 5%. Preterm delivery was also common (43%). There was no evidence of maternal or neonatal HIV transmission and no deaths occurred.
“Since abnormal sperm profiles are common in HIV-infected men, and IVF/ICSI negates the need to test various subfractions of the specimens used for HIV, we feel it is a reasonable alternative to insemination methods currently touted in Europe, and at least as safe,” Dr. Sauer concluded. “Finally, IVF/ICSI does not specifically violate recommendations against ‘insemination’ of HIV discordant couples as stated by the CDC and many state laws in this country.”
Fertil Steril 2009;91:2455-2460.