Getting Pregnant: HIV-Positive Woman and HIV-Positive Man (Seroconcordant)

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+ man 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.)

Home Insemination With Donor Sperm

This involves using donor 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. 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.

Depending on the state in which you live, you may be able to use donor sperm from a sperm bank for home insemination. Sperm banks collect and store samples from sperm donors. Donors 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. 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.

It is more effective to use home insemination 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

Sperm Washing

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 infection. See "Understanding the Science" for more information. Washed sperm can be used with the assisted reproductive techniques described below.

Assisted Reproduction

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.

Uprotected Sex

It is important to remember that no matter how low your viral load -- even if it is undetectable -- there is always some risk of superinfection when having unprotected sex. Superinfection -- sometimes called reinfection -- is infection with an HIV strain different and possibly stronger or more drug-resistant than the HIV strain you already have. 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).