Getting Pregnant: HIV-Positive Man and HIV-Negative Woman (Serodiscordant)
May 27, 2015
There are several different options for reducing the chances of passing on HIV while trying to get pregnant. If you are a man living with HIV and an HIV-negative woman seeking information on getting pregnant, the options below will help you understand what might be the best for you, and to prepare for discussions with your health care provider. (For other options, you can return to the main "Getting Pregnant and HIV" page.)
Check for STDs and Analyze Semen
Treating any sexually transmitted diseases (STDs) before trying to get pregnant is a great first step to lower your chances of passing HIV between partners. The US Department of Health and Human Services (DHHS) also recommends semen analysis for men living with HIV before trying to get pregnant. Men living with HIV may have fertility problems more often than HIV-negative men. Making sure his sperm is fertile before you start trying to get pregnant can help you and your partner choose the best method for getting pregnant.
Analyzing semen for fertility (ability to achieve pregnancy) is a simple procedure that requires a urine specimen. However, it can sometimes be difficult to find a facility willing to analyze the semen of a man living with HIV (see below for help finding facilities and providers). In the US, this analysis is usually not covered by insurance and costs $100 to $250.
Viral Suppression of Partner Living With HIV
One of the best things that the male partner living with HIV can do in this situation is take HIV drugs regularly and maintain a suppressed viral load, even when he 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.
It is important to remember that no matter how low the viral load of the partner living with HIV -- 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 intend to have unprotected sex, it is important to tell your sexual partner that you are living with HIV. Exposing someone to HIV without telling them you are HIV+ can result in serious legal action being taken against you.
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). 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:
Pre-Exposure Prophylaxis (PrEP)
HIV-negative members of serodiscordant or serodifferent couples can now consider using Viread (tenofovir) or Truvada (tenofovir/emtricitabine) as Pre-Exposure Prophylaxis, or PrEP. PrEP involves taking HIV drugs before being exposed to HIV to prevent yourself from becoming infected. While having an undetectable viral load can greatly reduce your chances of getting or spreading HIV, you may not be able to be sure your partner is taking his or her medication. PrEP allows you to be in control of your own protection against HIV.
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. It is recommended that PrEP be taken every day, not just right before you have sex. The US Department of Health and Human Services (DHHS) now recommends that serodiscordant couples consider using Truvada as PrEP as an additional tool to help reduce sexual transmission of HIV while trying to conceive.
In 2014, the US Public Health Service released clinical practice guidelines suggesting that health care providers now discuss PrEP as one of several options for protecting HIV-negative partners in serodiscordant couples when they are interested in getting pregnant. Not all health care providers are comfortable or knowledgeable about prescribing PrEP. However, you can advocate for yourself by telling your health care provider that you are interested in taking PrEP and asking them to write you a prescription for it.
We are not certain yet how useful PrEP is in further reducing the risk of spreading HIV to the uninfected partner when the partner living with HIV is already virally suppressed on HIV drugs. Some recent research has shown that PrEP may not give much added protective benefit when the partner living with HIV is already virally suppressed and unprotected sex is limited to the woman's fertile period (also called timed intercourse).
Both Viread and Truvada, when used as PrEP for HIV-negative women, appear safe in early pregnancy. Information from the Partners PrEP study conducted among serodiscordant heterosexual couples in Africa showed that babies conceived when the mother was taking either Viread or Truvada did not experience negative effects on birth outcomes or infant growth. Women living with HIV have been taking these HIV drugs safely during pregnancy for many years to prevent their babies from getting HIV.
Sperm washing refers to a process in which sperm is separated from seminal fluid (semen = sperm + seminal fluid). Since HIV exists in seminal fluid but not in sperm, 'washing' the sperm clean of the seminal fluid lowers the risk of HIV transmission. See "Understanding the Science" for more information. Any of the types of assisted reproduction listed below can be used with washed sperm to get the HIV-negative woman pregnant.
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 patients living with HIV, and few health insurance plans cover it. There are several types of assisted reproduction that can be used with washed sperm:
- Intra-uterine insemination (IUI): Washed sperm is drawn up into a narrow tube, which is then inserted through the cervix into the uterus (womb). The sperm 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.
Donor sperm comes from a sperm bank or from someone you know who does not have HIV. Sperm donors to sperm banks are most often anonymous, and they are tested for fertility and diseases to make sure the sperm is safe and able to result in pregnancy. This involves no risk of HIV transmission to your partner.
Donor sperm is often used in an assisted reproductive technique called intra-vaginal insemination (IVI). In this procedure, sperm are placed deep inside the vagina by a health care provider. This is very similar to home insemination, only done in a clinic. Donor sperm can also be used in any of the other assisted reproductive techniques listed above.
This involves using donor sperm from someone you know who does not have HIV. Depending on the state in which you live, you may be able to use donor sperm from a sperm bank for home insemination. If using donor sperm from a sperm bank for home insemination is possible in your state, ask your sperm bank for instructions on how to use the sperm at home.
If using sperm from someone you know who does not have HIV, have the man ejaculate (cum) into a clean cup or condom. If using a condom, be sure to use a condom without spermicide. 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.
It is often recommended that the woman lie down for 20 minutes after inserting the semen to improve fertility. It is also more effective to use home insemination when a woman is fertile, or when she is ovulating. You can get non-needle syringes at most any pharmacy as they are commonly used to give medicines to babies. Your HIV provider may also have some to give you.
Offering a permanent family to a parentless child may be an option if having biologic offspring is not a good choice for you. Adoptions can be done within the US or internationally. Some agencies and/or countries may have prejudices against people living with HIV adopting children.
Finding a Provider and Building a Support Network
When choosing to have a child as a person living with HIV, it is important to be an advocate for yourself and your future child. Finding the right health care provider who is supportive of your plans to get pregnant is a big first step! A friendly health care provider can talk with you about many issues around pregnancy and having children: which conception option is right for you, appropriate HIV treatments for you and/or your partner, whether to disclose your HIV status to others (including other providers, your child's pediatrician, additional friends and family), and how to handle the stigma and fear around living with HIV and being pregnant.
When The Well Project's Founder, Dawn Averitt, asked providers about getting pregnant over 14 years ago, she faced some very negative reactions before she found a wonderful provider who supported her desire to have children. While her original experience in getting pregnant and having two healthy HIV-negative daughters is discussed in the three articles listed below, Dawn recently posted a blog about Getting Pregnant while Living with HIV in 2015. Here's part of what she said:
My own children are now 11 and nearly 13, and in most urban settings, no one raises an eyebrow when they say "my mom has HIV." I wish I could say this was universal, but it isn't. Many health care providers are not familiar enough with the information about HIV to know that HIV-positive women can choose to become pregnant, and that, with access to good prenatal care and HIV treatment, their risk of transmitting HIV to their infants is less than two percent. This is why it is so important to find a health care provider who is knowledgeable about HIV and pregnancy -- they are definitely out there! Dawn Averitt, Getting Pregnant while Living with HIV in 2015
For more about Dawn's experience in trying to get pregnant, please explore the links below:
- HIV and Pregnancy: Tough Choices and the Right to Choose(Journal of the Associate of Nurses in AIDS Care, Vol. 13, No. 3, May/June 2002, 11-12 courtesy of the Sophia Forum)
- Breaking the Taboos: Pregnancy Planning and Fertility Issues for PLWHAs in the US (transcript from presentation at AIDS 2010 in Vienna, Austria, courtesy of TheBody.com
- Baby Love (POZ magazine, December 2002)
The Well Project has started a list of friendly family planning providers in the US who are informed about pregnancy planning for people living with HIV. Even though the providers listed might not be in your area or town, it might be worth a call or email to answer any questions you might have or for possible referrals. Pregnant women living with HIV, their exposed infants, and HIV-affected couples seeking safer conception options can also contact Shannon Weber (Shannon.Weber@ucsf.edu) at HIVE for referrals to local providers.
Given the existing stigma against people living with HIV having children, you may encounter judgmental responses from others. Therefore, it is important that you build a strong support network of loving family, friends, and providers. Your support network can help you make good decisions and get through the negative, sometimes disheartening moments. If you do not have a good number of friends and family who support you, you may consider starting your own support group; for more information, see our article on Starting a Support Group.
Ultimately, you get to choose when and whether to have children. You deserve to be treated with respect and given access to the information necessary to make an informed decision and plan for your future.
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