My spouse is HIV positive and we are trying to get pregnant?

Question

My spouse is HIV positive how can I get pregnant by him?

Answer

A variety of methods can be used to assist in becoming pregnant while decreasing the risk of transmitting HIV. There are several studies of assisted reproduction techniques that have resulted in successful pregnancy without HIV transmission to the mother or child. There are 3 established techniques to remove HIV from seminal fluid: sperm washing, density gradient centrifugation, and the "swim up" method. These prepared specimens of sperm are then used for artificial insemination, in vitro fertilization (IVF), or intracytoplasmic sperm injection (ICSI). Although these techniques are not "guaranteed" to prevent HIV infection, the available evidence from several studies indicates no cases of HIV transmission in small numbers of couples. The assisted reproduction techniques are very expensive, available in only some medical centers and are associated with higher rates of twins.

For couples in which the man is HIV+ and the woman is HIV-, there are other ways of increasing the chance of pregnancy and decreasing the risk of HIV transmission. The risk of transmitting HIV is decreased if the HIV+ man is taking HAART and has an undetectable viral load and CD4 count > 400. There are also recognized ways of targeting intercourse to the period of highest fertility, including basal body temperature, calendar calculation, serial ovarian ultrasound, hormones in urine, and vaginal discharge. These methods help to improved the chance of pregnancy from a single act of unprotected intercourse.

For couples in which the man is HIV- and the woman is HIV+, pregnancy can be safely accomplished by self-insemination, in which a woman inseminates herself with freshly ejaculated semen using a syringe (without the needle). Of course, a pregnant HIV+ woman needs careful prenatal care to prevent mother-to-child transmission.