Hello Dr. Pavia,

Was very interested to read the detailed info you provided to the discordant couple that were interested in safe ways to conceive a child. My wife and I are in the same situation. Could you kindly elaborate on why in vitro fertilization is so safe? I am confused since the positive male's sperm would still be used to fertilize the negative female's egg even though this woudl occur outside the body. Wouldn't this expose the female and/or child to HIV infection? Many thanks in advance for taking the time to address this topic.

The reason in vitro fertilization is so safe is also part of the reason it is technically difficult and expensive. In in vitro, the sperm fertilizes the egg in a "test tube" - actually a petri dish. The fertilized egg is then suspended in nutrient broth and allowed to grow to a very early embryo before being implanted. The woman is not exposed to significant amounts of semen.

The virus is in the semen - specifically in the liquid portion (seminal plasma) and in some of the cells in semen. The fertilized egg should not carry any HIV. If an early embryo were to be infected, it seems extremely unlikely that it could survive the destructive power of the virus. While nothing about this disease is certain until you do the research, it seems that in vitro almost completely gets around the risk. Costs and medical hassles are very, very high, however.

ATP