IUI for HIV Positive Couple

IUI for HIV Positive Couple

Can you opt for IUI when having HIV infetion?                                  

The answer is yes, you can undergo IUI treatment even if you or your partner is having HIV infection. It will be advisable to undergo IVF treatment if you want to minimise transmitting the infection to your partner or your baby. But if it is not suitable for you, IUI can be an alternative option. But certain precautions are necessary while doing IUI for HIV positive couple.

What are sero- discordant couple?

When an infertile couple have HIV-positive man and the woman is HIV- negative, they are called HIV-discordant. On the average, an HIV-positive man, who does now no longer participate in high-risk activities, will transmit HIV to a woman partner one in each one thousand acts of sex without a condom. To reduce transmission of HIV, HIV-discordant couples are counseled to avoid sex altogether, or to use condoms during every act of sex. In order to have a child, those patients can use donor insemination. If they want to have a natural child of the infected man, they could use a combination of medication of the man to reduce the quantity of virus in his semen, and condom use except at the time of ovulation while the female produces an egg.   

What are the chances of infecting your partner?

                IUI with washed sperm reduces the risk of infecting the female. However research have shown that about 4% of female could be still infected HIV. Alternatively, they could use in-vitro fertilization (IVF) with intra cytoplasmic sperm injection (ICSI). In this preocess, eggs are collected from the female after hormone-stimulation and are fertilized in the laboratory. ICSI method follows injecting a single washed sperm from her husband into every egg. The resulting embryos may be transferred to the wife’s uterus and/or frozen for later use.  

When IUI is advised to HIV infected couple?

                 IVF/ICSI techniques are believed to limit the risk of HIV transmission (although the number of cases is low). But is very expensive and aren’t an option for everyone. A simpler technique used for over 15 years is to collect the person’s semen, wash the sperm in the laboratory. Before placing it in the female’s uterus (intrauterine insemination; IUI) we can check for HIV. The risk of HIV transmission to the female is possibly not zero with this approach. However, over 4000 inseminations have not shown contamination of any woman patients or resulting children.

Both partner positiveIUI can be done, IVF PreferrableBaby is at risk of infection
Male partner positiveIUI with sperm washLow risk for both baby and mother
Female partner positiveIUI when CD4 count is high and viral load lowRisk of infecting baby high
Risk of Transmission in IUI

How do you get HIV?

              HIV is a virulent disease which may be passed on from one individual to any other through particular body fluid,

  • Blood
  •  Semen
  • Preseminal Fluids
  •  Fluids withinside the rectum
  •  Fluids withinside the vagina
  •  Brest milk

HIV in semen

                 Semen is the body fluid that carries the second one highest concentration of HIV. During sexual intercourse, HIV-infected men transmit HIV through their semen, which includes free-floating virus in addition to HIV-infected leukocytes. Traces of HIV had been detected on sperm as well. However, the function of sperms in viral transmission has been a matter of debate. After all, partner with vasectomies can transmit HIV. It attaches to the surface of sperm and that those HIV carriers pass at the virus to different HIV targets.

HIV in vaginal fluid

               While HIV can unfold through vaginal fluids, the virus has a tendency to exist in smaller concentration. Alternatively, it prefers blood and semen. It isn’t clear why it happens so. However, it appears that hormones and the kinds of cells in the genital tract may play a function.

Preparation before IUI for HIV positive couple

                         Serodiscordant couples with HIV seropositive men need to be in correct general health and clinically asymptomatic. Their CD4 count should be more than 200 cubic mm with a stable blood viral load for 4 months. Men with Azoospermia or severe oligospermia cannot undergo this procedure. Because, in those cases sperm preparation techniques can not retrieve any sperms. Female partners should be tested for HIV and are required to be seronegative. All women should be aware that their companions are HIV seropositive. Couples need to be using condoms and practicing secure sex.

Method of sperm preparation

                  Semen samples collection is done right into a sterile container after three days of sexual abstinence. After 30 min liquefaction, standard assessment of semen samples is followed according to the World Health Organization (WHO) guidelines. An improved washing method is used to collect HIV free spermatozoa from the semen of HIV positive males. Diluted semen turned into layered over a Percoll solution with a non-prevent density gradient. Gradient of 45-90% is mixed and centrifuged at 350 g for 15-20 minutes. This method will separate motile spermatozoa from non-sperm cells, immotile spermatozoa and seminal plasma.

                    The spermatozoa in the pellet is mixed with 2mL medium. It is then centrifuged at 3 hundred g for 8-10 minutes. Later, observed by adding 1mL medium to pellet and resuspended gently. Subsequently, the suspension is divided in two, 1/2 of turned into frozen with liquid nitrogen with our standard freezing protocol. It is then stored in our sperm tank followed by periodic check for HIV RNA and DNA. Sperm may be used for insemination if HIV RNA and DNA regarded to be negative.

Method of IUI for HIV positive couple

                      Before IUI is scheduled, you may be given Clomiphene citrate (from day 2 till day 6 of the cycle). Your doctor may use gonadotropin beginning on day 2 or three of the cycle. Ovulation and stimulation are through ultrasound to measure the follicle diameter. In addition, it can measure endometrial growth. Follicular monitoring is followed from day nine of the cycle till the follicle reached 18–20 mm in diameter. Human chorionic gonadotropin (HCG, 10000 IU) is given to release egg when your lead follicles reach 18–20 mm in diameter. IUI procedure is performed only once, 24 or 36 hour after HCG administrated.

Conclusion

           Intrauterine insemination in HIV discordant couple and Serodiscordant couples seems to be effective and secure technique to achieve pregnancy.

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