Parenthood Help for Men With HIV

When Sally Morrison and Paul Corser of Manhattan went to local fertility doctors for help to have a baby, everywhere they went they were turned down, for Mr. Corser was HIV-positive. It took them three years, until 1998, to find a clinic in the United States that would help them. Many clinics still would not help couples like them, who are in a quandary: if men with HIV have unprotected sex, they risk infecting their partners and their babies; using condoms, they are sterile. But with sophisticated fertility methods, they hope, it should be possible to minimize the risk by separating sperm from the virus, which is in the seminal fluid.

Only in February did the ethics committee of the American Society for Reproductive Medicine say it was acceptable to offer such services. Several states -- including California, Florida and Illinois -- prevent doctors from using HIV-infected semen in attempts at insemination. While no statistics indicate how many of the nation's nearly 400 fertility clinics offer services to men with HIV, interviews with doctors and couples seeking help suggest that the number is miniscule -- and that such clinics are hard to find, as they tend to shun publicity.

Many fertility doctors say they are torn over treating infected men. Whether to treat women or infected couples is even more controversial, because an infected woman is more likely to pass on the virus to the baby. While new methods can minimize the transmission risk from an infected man to an uninfected woman and from her to the baby, too few procedures have been done to ascertain the precise risks. Many doctors worry that they may be liable if infection does occur, and they fear for the safety of those who handle the sperm. Many also fear that healthy patients will avoid clinics that treat infected patients, out of concern that HIV could contaminate their embryos.

In the competitive world of fertility centers, at least one clinic, at Columbia University, sees providing treatment to men with HIV as a way of helping unserved patients while gaining a market niche. The clinic's director, Dr. Mark Sauer, decided a few years ago that he could greatly reduce the chances of transmitting the virus by using a technique called intracytoplasmic sperm injection, injecting a single sperm into an egg. Sauer said his clinic had treated 54 infected men. He has made more than 103 attempts at producing pregnancies and, so far, 29 women have had their babies or are more than halfway through their pregnancies. Thirty babies have been born, with nearly half the women having twins, as is typical in fertility treatment.

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