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PEP and Pregnancy
Mar 18, 2007

My HIV+ husband and I (HIV-) are discussing a plan for pregnancy. We wanted to know if an OB-GYN would prescribe PEP as a precaution to be used once we had unprotected sex as a means to reduce transmission of the virus? I have read that PEP can cause side effects during pregnancy, but is this the case so early on? Any information you can provide is greatly appreciated.

Response from Dr. Frascino

Hello,

PEP should not be used as you suggest. Yes, certain medications in some PEP regimens definitely should not be used if you are pregnant (Sustiva, for example). There are ways to conceive a child safely with your HIV-positive husband (see below), but unprotected sex followed by PEP is not one of them!

Good luck!

Dr. Bob

Seropositive Couple Mar 5, 2007

I recently met a wonderful woman and two weeks later found out that I was HIV+, amazingly she was ok with going further. I can tell that she wants a family if things became more serious and I was wondering if you could elaborate a few things; first what are the safe activities a couple like this can do initmately, for example kissing, etc. - Second what are the ways one can go about having a child in a situation like this. Thank you in advance for taking the time to answer these questions.

Response from Dr. Frascino

Hello,

First off, you are not really a "seropositive couple." That would indicate you are both HIV positive. Rather, you are a magnetic couple (one positive, one negative). The issue of what's safe or what's safe enough for magnetic couples comes up often in this forum. I've addressed the topic numerous times. Consequently, I'll refer you to the archives to review that information. There is an entire section devoted to "magnetic couples." If you have additional specific questions after digesting that information, please write back.

Regarding magnetic couples safely conceiving children, again this topic has been raised many times. I'll reprint some of those questions and my responses below.

Finally, I'll advise you that I, too, am in a magnetic coupling with my partner Steve (Dr. Steve, the expert in The Body's Tratamientos forum) and from 13 years' experience, I can assure you the age-old adage that opposites attract is an understatement!

Good luck in your new relationship!

Dr. Bob

Can we Plan for child Nov 2, 2006

I am HIV -ve my husband is +ve. We love each other a lot. Not able to find out reason behind the infection.we want to have our own child is it possible to have child by any method like test tube baby or something very advanced. who will be not HIV infected

Response from Dr. Frascino

Hello,

Another question that comes up frequently. See below.

Good luck!

Dr. Bob

sperm washing .... and Bush Jul 24, 2006

Dr. Bob,

I'm part of a magnetic couple here in NYC. What's the latest on my chances to conceive a bambino safely with my HIV positive hubby?

I'm not a Bush fan but don't you think the homeland security department are makng good decisions to keep us safe?

Times Square Sally

Response from Dr. Frascino

Hey Times Square Sally,

I'll post a question from the archives below that addresses this topic.

In addition, there has been a report from Japanese researchers recently describing an improvement in the method of sperm-washing that appears to remove even the theoretical risk of HIV infection for an HIV-negative woman wanting to conceive a child with an HIV-positive guy. The report appeared a few months ago in the medical journal "AIDS." The researchers revised the "swim-up" method of sperm washing and designed an Ultrasensitive HIV RNA/DNA test to confirm that the sperm of all 48 HIV-positive men in the study was completely free of HIV, including the proviral HIV DNA that we had previously theorized could pose a risk for HIV transmission. So this is great news! Your husband's HIV specialist would be able to provide you with a referral to an HIV-knowledgeable OB/GYN specialist to help organize the sperm washing and in vitro fertilization procedures.

Now, turning to the homeland security issue, do you really feel safe with Michael Chertoff in charge??? Yikes!!! Have you seen Chertoff's current list of potential terrorist targets??? Guess which state has the absolute most number of potential terrorist targets in the newly released 2006 National Asset Database, according to the Department of Homeland Security??? Give up? It's Indiana!!!! Yep, Indiana! Indiana clocked in with 8,591 potential terrorist targets!!! My favorite on that list is the Amish Country Popcorn Factory! (Honest! It's really on there!) Now take a look at the number of potential targets in New York State. It registered only 5,687. And what about my state, California, the most populous state in the nation? Well, we only rated 3,212 potential targets.

So, um, Times Square Sally, if you really want the Department of Homeland Security to protect you, you better consider moving to the Amish Country Popcorn Factory in Indiana because guess what?!? Times Square in New York City didn't even make the terrorist target list! Oh yea, that Chertoff is doing a hell of a job.

So bottom line: In vitro fertilization and sperm washing for magnetic couples wanting to conceive is safe! But the United States of America, under Dubya and Chertoff, is anything but safe (unless you happen to like Amish popcorn).

Stay well.

Dr. Bob

Want to NOT end this...

Jul 1, 2006

Dear Dr Bob,

I posted on June 18 a rather bleak outlook for my newly HIV positive life. I took your advice and now I feel great. I found comfort in reading the 'Just Diagnosed' section of this website.

My psychiatrist hooked me up with a paedeatric oncologist - I think that basically means a doctor who deals with children who have cancer. I was taken through the wards and all of a sudden my problems seemed completely insignificant.

My psychiatrist also hooked me up with a great HIV specialist doc - she really knows her stuff and was really supportive. My initial numbers indicate that I am 'progressing normally'. So far I don't require medicine and she said probably not for a while!!

I found a new employer and even ennrolled in college. My family is taking me on a trip to NYC as well and my girlfriend and I are back to talking.

I have realised that there is still a great deal I want to do with this life like travel, career, charity work, even have a family (my HIV doc says this is possible - though I don't see how if my semen is infected won't my child and / or wife be as well - please explain?).

I now feel as though there is not enough time on the planet rather than before when I dreaded every future moment with anxiety and a 'feel sorry for myself' attitude.

So thank you because you, at least in part, got me motivated enough to start this new 'virally enhanced' life!!!

Peace out - David.

Response from Dr. Frascino

Hey David!

Welcome back! Looks like you not only took my advice, but also that of Patti Labelle! Remember her song "New Attitude?"

"I'm feelin' good from my head to my shoes Know where I'm goin' and I know what to do I tidied up my point of view I got a new attitude Runnin' hot, runnin' cold I was runnin' into overload It was extremes, ex-ex-ex-ex-ex-extreme It took it so high, so low So low, there was nowhere to go Like a dream Somehow the wires uncrossed, the tables were turned Never knew I had such a lesson to learn I'm feelin' good from my head to my shoes . . . ."

And I think there are a lot of ooh, ooh, ooh, oohs in there as well . . . .

At any rate, I'm delighted with your new positive outlook on being positive!

As for the feasibility of your having a family, your HIV doctor is correct. With new sperm washing techniques coupled with in vitro fertilization, there is no reason why you should have to forgo the pleasures of fatherhood! I'll repost a question from the archives that addresses this topic.

Be well. Stay well, David!

Dr. Bob

HIV+ person wants children Mar 13, 2006

Hey Dr. Bob I have a client who found out recently that his boyfriend is HIV+. He asked me a question about the possibility of his boyfriend having children in the future. I told him that because it would probably be in vitro fertilization and a surrogate mother I couldn't see much risk of the child being +. Then I realized that I didn't really know what I was talking about so I decided to ask you. Can you clear this up for us? Health Educator in DC

Response from Dr. Frascino

Hi DC Health Educator,

The issue of HIV+ men wanting to conceive children safely and decrease the likelihood their mate or offspring will acquire the virus is a complex topic. I'll repeat a question from the archives that summarizes our current recommendations.

Dr. Bob

HIV + male HIV - female Feb 12, 2006

Dr. I have a question concerning having children. I have asked my HIV specialist and I am getting mixed answers. I am HIV pos and my wife is HIV neg. we really want to have a child, is it really possible to have a child without endangering her life and the child life. We decided against adoption and artificial reproduction (sperm banks). These were options to us. Is it really safe? Please give a yes or no answer if possible. I haven't received an answer.

Response from Dr. Frascino

Hello,

I'll repost a response form Dr. Sharon Lee below that addresses this problem.

Good luck!

Dr. Bob

Resources for Positive Men & Negative Women Who Want a Baby Oct 16, 2004 Response from Dr. Lee

Several people have written recently asking for information about sperm washing and their hopes about having a baby when the man is positive and the woman is negative. There are a growing number of places that provide information and that provide these services. Here is a comment and list of general resources:

Studies have suggested that HIV is not present in the sperm themselves but it is in the fluid which surrounds them (Semen). Sperm washing consists of removing the semen (and presumably the HIV) from the sperm and then using the "washed" sperm for insemination. There are currently three ways to attempt pregnancy using washed sperm. A common method used for years is intravaginal insemination, which involves holding a cervical cap full of live sperm near a woman's cervix and allowing them to swim into the uterus. Another is to directly insert the washed sperm into the uterus through a cannula (or plastic tube) placed through the cervix into the uterus. The safest method is in vitro fertilization, which only exposes the woman to fertilized eggs, and not to live sperm cells. In this technique the sperm cells and the egg are brought together in a laboratory and the fertilized eggs are implanted directly into the woman's uterus.

Sperm-washing combined was reported to be the source of one man passing the virus to his partner, though it remains unclear whether her infection was caused by the procedure. (A lawsuit is underway.) Health care professionals willing to undertake the sperm-washing venture are quick to remind their patients that it is only a risk-reduction method, and that no procedure is entirely risk-free. There are several places in the United States that utilize sperm washing. However, due to quite variable policies, you will need to contact fertility specialists in your individual area to find a doctor or to be referred.

Resources

1. American Society for Reproductive Medicine. Visit www.asrm.org.

2. Bay Area Perinatal AIDS Center (BAPAC), at the University of California, San Francisco's (UCSF) Positive Health Program in San Francisco General Hospital. Offers pre-conception counseling and infertility work-up to seroconcordant and discordant couples (both partners positive or one partner is positive). Also conducts prenatal care to HIV-positive women. Call (415) 206-8919. Visit http://php.ucsf.edu/bapac.

3. Center for Women's Reproductive Care, at Columbia University in New York City. Conducts IVF for serodiscordant couples. Call (646) 756-8282.

4. Duncan Holly Biomedical. Operates the Special Program of Assisted Reproduction (SPAR), started in 1994 as a support group for couples living with incurable sexually transmitted virus diseases such as HIV. Developed a mail-in product for shipping sperm-washed samples to fertility clinics around the country, as well as an HIV testing kit for sperm that can be mailed to you at home. Complete details and in-depth articles available on its Web site, including the story of Baby Ryan, the first baby conceived through SPAR. Call (781) 665-0750 or (617) 623-7447, or visit www.duncanholly.com/idi/spar/spar_main.html

5. Reproductive Lab Service, 233 East Erie St. Suite 309, Chicago, IL 60611. Call toll-free: (877) REPROLAB (737-7652). Visit www.reprolab.org

6. SMART (Sisterhood Mobilized for AIDS/HIV Research & Treatment), New York City, provides treatment and prevention education and support for women impacted by HIV/AIDS. Call (917) 593-8797, write smartuniv@aol.com or visit www.smartuniversity.org.

7. "Sperm Washing: Reducing the Risk of Father-to-Mother Transmission." Comprehensive article, although written in 2001. Visit http://hivinsite.ucsf.edu.

8. Women Organized in Response to Life-Threatening Diseases (WORLD), 414 13th Street, 2nd floor, Oakland, CA 94612. Call (510) 986-0340. Visit www.womenhiv.org. Unfortunately, not all copies of their excellent newsletter and articles are available on-line. However, an abbreviated version of their article "Reducing the Risks of Conception: Getting Pregnant When One or Both Partners is HIV positive," is available at www.PositiveWords.com. The article is very easy to understand and extremely detailed.

To each of the couples who are concerned about this issue: our best wishes for wellness for you and your families!

Doc Can I be a daddy??? May 25, 2003

Hi Doctor Bob

I've been reading this board for over 2 months and I'd like to say i think... i mean I know you are one of theeeee smartest and wittiest Docs around to be honest most are quite the zzzzzzzzzzzzzzzz.

Anyhow... is it at all possible for a HIV POZ man to ever become a father without infecting the mother or the baby????

Thanks a billion and keep being YOU.

Response from Dr. Frascino

Hey possible future Dad,

I'm glad you don't find this forum a zzzzzzzzzzzz!

Is it possible for us positoids to be dads without infecting the mom or baby? Yes, it's possible, but it's not completely without risk. It involves a medical technique called "sperm washing." Now before you start thinking about having sex in your Maytag, let me explain. Using various techniques, sperm can be separated from the other fluids in cum. These other fluids carry the vast majority of HIV. The washed sperm is then used for artificial insemination or in-vitro fertilization. This technique drastically reduces the risk of HIV transmission. There are a variety of medical centers around the world studying this technique (Milan, Italy, for example). In the US, there are programs at Tufts University/New England Medical Center in Boston. Although it's a bit dated, check out the article in the Washington Post called "Seeking a Safe Path Toward Fatherhood." It can be found at http://washingtonpost.com/wp-dyn/articles/A99181-1999Apr18.html

Good luck! If it's a boy, can you name him Dr. Bob?

Dr. Bob



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