Getting Pregnant: HIV-Positive Woman and HIV-Negative Man (Serodiscordant)
There are several different options for reducing the chances of passing on HIV while trying to get pregnant. If you are an HIV+ woman and an HIV-negative man seeking information on getting pregnant, the options below will help you understand what might be the best for you, and prepare for discussions with your health care provider. (For other options, you can return to the main "Getting Pregnant and HIV" page.)
This is a cheap and simple way of getting pregnant. It involves having the man ejaculate (cum) into a clean cup or condom. If using a condom, be sure to use a condom without spermicide; after sex, pull the penis out of the vagina with the condom still on (you can also masturbate into a condom or cup, without vaginal sex). Then, using a syringe (without a needle) or baster, you suck up the semen and insert the syringe or baster deep inside the vagina. Once the syringe or baster is deep inside the vagina, you squeeze out and deposit the semen. You can get non-needle syringes at almost any pharmacy as they are commonly used to give medicines to babies. Your HIV provider may also have some to give you.
It is more effective to use this method when a woman is fertile, or when she is ovulating. Ovulation occurs when an egg is released from the woman's ovary and usually happens about two weeks before a woman starts her menstrual period. Insemination during the "fertile window" -- usually one to two days before ovulation and one day after ovulation -- has a greater chance of success. For more information on understanding and tracking your fertility, visit:
- Fertility Awareness Center
- Pinpointing Fertile Days
- Bay Area Perinatal AIDS Center: Home Insemination for HIV+ Female Discordant Couple
This means that a sperm fertilizes an egg with the help of a medical technique or therapy. Assisted reproduction (sometimes called "assisted reproductive technology" or ART) is useful when the future parent(s) require help to prevent HIV transmission between partners, are using donor sperm, or are having difficulty getting pregnant at home because of fertility issues. Unfortunately, few facilities offer assisted reproduction to HIV+ patients, and few health insurance plans cover it. There are several types of assisted reproduction:
- Intra-vaginal insemination (IVI): Very similar to home insemination, only done in a clinic.
- Intra-uterine insemination (IUI): Semen (sperm and seminal fluid) is drawn up into a narrow tube, which is then inserted through the cervix into the uterus (womb). The semen is deposited in the uterus, where fertilization of the egg can occur.
- In-vitro fertilization (IVF): The woman takes fertility drugs to help her prepare eggs (also called ripening her eggs). When eggs are ready (or ripe), they are removed from the ovary and put in a dish with sperm. Once there is a fertilized egg (embryo), it is put back in the woman's uterus.
- Intra-cytoplasmic sperm injection (ICSI): This is a specific type of IVF in which a sperm is injected directly into an egg using a very thin needle. When a fertilized egg occurs, it is returned to the woman's uterus. This method is used when a man's sperm do not swim well or are not normally shaped.
It is important to remember that no matter how low the HIV+ partner's viral load -- even if it is undetectable -- there is always some risk of passing HIV to the uninfected partner with any type of unprotected sex. If you choose this method, the risk of passing on HIV is lower if you only have unprotected sex when the woman is ovulating (when she is most likely to get pregnant).
The risk of passing HIV to an uninfected partner may also be reduced when the HIV+ member of the couple takes HIV drugs (continuous combination antiretroviral treatment), even when he or she has no symptoms and a relatively healthy immune system. Recent studies of serodiscordant heterosexual ("straight") couples showed that HIV drugs were very effective in preventing HIV transmission to the uninfected stable partner of someone with HIV.
Another way to reduce the risk of passing HIV to your uninfected partner is to have the HIV-negative partner take Truvada (tenofovir/emtricitabine) as Pre-Exposure Prophylaxis, or PrEP. PrEP means taking medicine before being exposed to something to prevent yourself from getting a disease or condition. In July 2012, the US Food and Drug Administration (FDA) approved the daily use of Truvada as PrEP for sexually active adults at risk for HIV infection. The US Department of Health and Human Services (DHHS) now recommends that serodiscordant couples consider using PrEP as an additional tool to help reduce sexual transmission of HIV while trying to conceive.
If you intend to have unprotected sex, it is important to tell your sexual partner that you are HIV+. Exposing someone to HIV without telling them you are HIV+ can result in serious legal action being taken against you.
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