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Sperm Washing Technique in France: ART May Allow HIV-Infected Men to Father
Children Without Infecting Their Partners
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Laurie Barclay, MD, Medscape; www.medscape.com
Sperm washing is available in the US and in London at clinics and major
hospital centers.
May 30, 2003 - Assisted reproductive technology (ART) may allow HIV-infected
men to father children without risking infecting their partners, according to
the results of a study published in the June issue of Human Reproduction. But
in this study, ART was rarely effective in HIV-positive women.
"I was very pleased by the good results for men, but surprised at the poor
results for women, which I did not expect," lead author Jeanine Ohl, from Centre
d'AMP de Strasbourg in France, says in a news release. "One explanation may
be that the men did not have any fertility problems but the women did. The
women were significantly older than the partners of the seropositive men and some
had waited a long time for this treatment, which only became possible because
of changes in the law in France two years ago."
This French decree extended permission to offer ART to serodiscordant couples
in which the woman is infected with HIV. Although rules on treating
HIV-positive patients differ in different countries, several countries allow ART for
HIV-positive men, but few allow it in infected women.
For HIV-positive men with HIV-negative partners, Dr. Ohl's group washed the
sperm using two successive techniques to separate motile sperm from semen, and
they inseminated the women only with sperm that tested negative.
Among 57 serodiscordant couples, 12 of 39 in which the male was infected
parented a total of 14 children, and none of the women partners converted to
HIV-seropositivity. Injection of the egg with a single sperm (ICSI) was the most
successful ART technique, resulting in pregnancies in 48.8% of all transferred
embryos. In-vitro fertilization was less successful, and eight attempts at
intrauterine insemination (IUI) did not result in any pregnancies.
Of the 10 HIV-positive women treated, only one became pregnant, which Dr. Ohl
attributed to possible premature ovarian failure. Treatment is ongoing for 37
couples, and her group is planning an observational study of ovarian function
in HIV-positive women. Although some studies provide evidence for premature
ovarian failure in HIV-infected women, young infected women in developing
countries become pregnant easily.
Dr. Ohl points out that more than half of those infected with HIV are of
child-bearing age, and that thanks to progress in treatment, infection often does
not progress beyond a chronic stage.
"Patients can thus make life plans and even envisage having children. This
pressing desire for children is legitimate and any other conclusion would
discriminate against these patients," she says. "A cultural revolution is taking
place, especially in the medical profession."
Hum Reprod. 2003;18:1244-1249
Reviewed by Gary D. Vogin, MD
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