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Women living with HIV can conceive safely in a number of ways
The choice of how we want to conceive is very personal. We should take time to think about it and discuss it with our partner, our peer group and our healthcare team.
Finding the right daddy: sperm donation for lesbian couples
Some women in this situation want to try and start a family of their own and therefore face decisions about sperm donors. Some choose to use the sperm of someone they know, rather than using a sperm bank. If a woman is thinking about using a sperm donor to get pregnant, she needs to be aware of the potential donor’s detailed medical history and any possible risk factors including drug use and sexual history. It is also important that the donor has taken an HIV test.
Encouraging a healthy conception when both partners have HIV
If both partners have HIV and have unprotected sex, there is a small possibility that this may result in passing on a drug-resistant strain of the virus. However, there is mounting evidence that if both partners are taking ART properly, have consistently undetectable viral loads with no other STIs and are in a monogamous relationship, then the risk of passing on HIV and/or different strains is significantly reduced (but is not zero).[i]
However, things which alter the health and condition of the vagina, such as certain genital infections, taking the pill (i.e. oral contraceptives), and pregnancy, may be associated with increased presence of HIV in the vaginal fluids.[ii] Your viral load and the health of your immune system will also have an impact. The varied and unpredictable nature of genital tract shedding – i.e. presence of the virus in vaginal fluid or sperm (even in those of us with undetectable HIV viral loads) makes it difficult to assess the real risk of passing on HIV.[ii] Discuss your options and the risks in depth with your doctor and healthcare team before you make a decision to have unprotected sex.
Sperm Washing: Reducing the Risk of HIV Transmission When the Man is Living with the Virus
Where it is available, “sperm washing” can also be used by couples who want to get pregnant, if you both have HIV and want to eliminate risk. It can also be used in mixed-status relationships where the man has HIV.
Sperm washing is a procedure performed in a laboratory. The process separates the seminal fluid, which contains HIV, from the sperm, which does not contain HIV. The remaining sperm are placed in a liquid and inserted into your vagina when you are ovulating (at the time when you are most fertile).
Although it can not be guaranteed that no HIV remains in the semen, sperm washing is considered very safe. A study of sperm washing carried out in several different clinics demonstrated this method to be effective in leading to pregnancy and also in significantly reducing the risk of passing on HIV from the male to the female partner.[iii]Unfortunately, sperm washing is not widely available and you may have to pay for this service. Your family doctor or HIV doctor can give you more information or answer any queries you may have regarding sperm washing.
[i] Gazzard and Garnett. Risk of HIV transmission in discordant couples. The Lancet. 2008. 372(9635):270-271.
[ii] Cu-Uvin S et al. Genital tract HIV-1 RNA shedding among women with below detectable plasma viral load. AIDS. 2010. 24:2489-2497.
[iii] Bujan et al. Safety and efficacy of sperm washing in HIV-1-serodiscordant couples where the male is infected: results from the European CREAThE network. AIDS. 2007. 21:1909-1914.
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