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Sperm Washing for Pregnancy in HIV
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Intrauterine insemination in HIV- serodiscordant couple for male HIV infection
V. Savasi, T. Persico, M. Oneta, C. Lanzani, M. Crivelli, M. Di Grandi, J.A.
Morgan, E. Ferrazzi Department of Obstetrics and Gynaecology, Luigi Sacco
Clinical Sciences Institute, University of Milan Medical School, via GB
Grassi 74, 20157, milano, Italy [MoOrE1070]
Now that HIV-infected persons are living improved lives many couples are
interested in having babies. In her abstract Savasi sad that today, with the
use of combined antiretroviral therapies, the life expectancy of HIV-infected
patients is 30 years. These couples lead a practically normal life, which
includes the wish to conceive a child.
In the past sperm washing was available but new. At this yearıs Barcelona
Intl AIDS Conference Valeria Savasi from the University of Milan presented
her latesr results from their sperm washing insemination program. It is my
understanding that Columbia-Presbyterian Medical Cener in New York City has a
similar program. She did not discuss cost.
Savasi reported that his programıs goal is to assist HIV infected males and
their seronegative female partners wishing to have a child by offering timed
intrauterine insemination after sperm washing. The desire of a child is
spontaneous in a stable couple and today HIV discordant couples should be
considered as people that live a chronic illness.
Savasi reported that in her Clinic they have assisted 400 HIV-1 discordant
couples (HIV+ men, HIV- women) from 1999 to 2001.Infertility screening is
conducted for each couple.It is important to make sure infertility should be
ruled out first before starting insemination program. Intrauterine
insemination is performed the same day ovulation is assessed by ultrasound
checking. The semen sample is collected by masturbation in a sterile vial and
within two hours the semen is washed by a combined method: centrifugation on
a discontinuous gradient, washing and migration by swim-up at 37°C and 5% CO2
for 1 hour. The motile spermatozoa that migrate to the top of the sperm
medium after 1 hour are divided into two aliquots, one aliquot is used for
the insemination, the other is tested for the presence of HIV-1 RNA by PCR.
They have carried out 449 intrauterine inseminations in 175 couples, of which
240 had stimulated cycles and 209 had spontaneous cycles. The pregnancy rate
in both cases resulted to be 10%. None of the female patients had a
seroconversion.According to Savasi, she has conducted 4,000 inseminations for
1,500 couples.
Savasi concluded that infertility screening, treatment of genital tract
infections, sperm washing, intrauterine insemination reduce the risk of
sexual transmission in order to achieve a conception.
Finally Savasi said that in order to reduce the risk of HIV-sexual
transmission in serodiscordant couples through unprotected intercourse, also
avoiding transmission to the child, it is necessary to recur to an assisted
reproduction. Our results suggest that the most adequate method for a safe
pregnancy is the sperm washing technique.
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