Ready to procreate.

I am a HIV negative female married to a HIV positive male. He has a very low count, that is not detectable by a test.

What are our options, if any???? I have heard of several couples having children with the same circumstances. Not only one but two and three! No one wants to talk about this, I can't find any information about it. Only something on the Italians being successful with sperm washing, but that no one in the US is willing to try because of possible cost and law suits.

Desperate for information. It is obviously being done, are these just oops situations? Help....

Dear Ready,

A lot of our patients are facing the same dilemma. There are no clear answers out there, but people end up making decisions in the absence of clear answers, which is all you can do.

The question is how you can get pregnant without getting HIV infected. I'll list them as best I can.

1. Use a sperm donor. I know it sounds a bit cold and even "icky" but many people are doing it with less compelling reasons than trying to avoid HIV. You can now look for donors who look like your husband, or even use one of his relatives. You probably have thought about this.

2. The safest approach would be in vitro fertilization. An egg of yours and his sperm "get together" outside of your body. The fertilized egg (actually the embryo) is implanted in your uterus. There would be no contact with infected sperm and this technique is quite safe and can be done by most fertility centers. The downside is that it is horrendously expensive (more than $10,000) and not usually covered by insurance, and you have to go through an egg harvest -- a minor surgical procedure done with a laparoscope, somewhat the way tubal ligations are done.

3. There is sperm washing. This is relatively low tech, but the Italians apparently report over 200 pregnancies without any infections. I do not know for sure of any US fertility center that is doing it yet, but many are considering it if there is more scientific proof.

4. If none of these are possible and you are committed to having your husband's baby, don't just throw away the condoms. Maybe the best way to reduce risk is to find a sympathetic OB/GYN with some experience. You both should have a baseline checkup for any infectious diseases, and you may want to check your husband's sperm count before exposing yourself. Then, what couples have chosen to do is to learn to track ovulation and your most fertile time. Then, you have unprotected sex once during that time (ideally after a few days of total abstinence to raise the sperm count...)You would need to have frequent HIV tests during the pregnancy.

This is still a risky approach. The risk of getting infected from a partner with a very low viral load is still not zero. It is probably between 1/100 and 1/1000 acts of intercourse. You need to really think it through, but whatever you decide, your providers should be able to help you and stick with you. Good luck

ATP