My husband is HIV+ and I am negative. I knew this when I married him. We are looking for information on having a baby. My husband's viral load is 'undetectable' and he is on HIV meds. Is there any technology you could tell us about that may lessen our chances of having an HIV- child. We are aware of the risks, but would try anything that would lessen the chances of an HIV+ child. I have heard of a procedure like 'sperm washing'. Is there such a thing, and, if so, where is this procedure being performed?

There are several options for having a baby. Let's start by talking about the safest for you or how to avoid becoming infected. If your husband was willing not to be the biological father, you could be artificially inseminated with another man's sperm. Some women choose to use a related donor such as a brother, father or cousin of their husband. Also, adoption would be another way.

If you and your husband have decided that the above are out of the question, then you will have to take the risk of becoming HIV positive. There are some investigational procedures being studied such a sperm washing as you mentioned. These studies are currently being conducted in Italy. I know there were some United States centers considering this but at this time I am unaware of any studies being done in the US.

Your husband has an undetectable HIV viral load in is blood which is a good start. The question is whether he is undetectable in his seminal fluid. Some centers are studying the amount of HIV in genital secretions. I would advise you to see if there is a HIV research center near you that would be interested in examing your husband's semen for HIV. If his semen has an undetectable HIV viral load then that would make me believe that the risk of you contracting HIV is less. Next I would recommend that you seek the care of an obstetrician (OB) who can help you determine when you are ovulating (the best time to get pregnant). You could either have sexual intercourse or be artificially inseminated with your husband's sperm at the time of ovulation. This would limit the number of times you would be exposed to your husband's semen. Some experts have suggested doing artificial insemination as they can collect several samples from your husband potentially increasing the number of sperm you would be exposed to. I do not have any information regarding this and again I would have to refer you to an OB-HIV expert.

Another option that I am aware of is giving the woman HIV medications prior to the insemination or having intercourse. This is extremely controversial. So, the woman would take HIV medications for 3-4 days prior to ovulation. Then have sexual intercourse or artificial insemination. What we do not know is how long you would need to take them afterwards. We also do not know if this would decrease your likelihood of infection. We give HIV medications to women who are HIV positive when they desire pregnancy to reduce the risk of transmitting HIV to the baby so we know that the drugs are relatively safe however there have been some concerns that HIV medications may cause side effects in babies. The point is that I cannot tell you that taking HIV medicines at time of conception is 100% safe.

I have given you my thoughts, all of which are based on other suggestions I have heard. No scientific support. My best advice would be to go to an OB-HIV expert and discuss your options. Again the only sure way to protect you from getting HIV is by artificial insemination from a HIV negative donor or adoption. I understand the desire of having "our own" baby and only you and your husband can make that decision. This is not an easy decision. Make sure you take the time to go over the options I suggested above.I wish you the best with your decision.