Objective: To examine the safety and effectiveness of assisted reproduction using sperm washing for HIV-1-serodiscordant couples wishing to procreate where the male partner is infected.
Design and methods: A retrospective multicentre study at eight centres adhering on the European network CREAThE and involving 1036 serodiscordant couples wishing to procreate. Sperm washing was used to obtain motile spermatozoa for 3390 assisted reproduction cycles (2840 intrauterine inseminations, 107 in-vitro fertilizations, 394 intra-cytoplasmic sperm injections and 49 frozen embryo transfers). An HIV test was performed in female partners at least 6 months after assisted reproduction attempt. The outcome measures recorded were number of assisted reproduction cycles, pregnancy outcome and HIV test on women post-treatment.
Results: A total of 580 pregnancies were obtained from 3315 cycles. Pregnancy outcome was unknown in 47 cases. The 533 pregnancies resulted in 410 deliveries and 463 live births. The result of female HIV testing after assisted reproduction was known in 967 out of 1036 woman (7.1% lost to follow-up). All tests recorded were negative. The calculated probability of contamination was equal to zero (95% confidence interval, 0–0.09%).
Conclusion: This first multicentre retrospective study of assisted reproduction following sperm washing demonstrates the method to be effective and to significantly reduce HIV-1 transmission risk to the uninfected female partner. These results support the view that assisted reproduction with sperm washing could not be denied to serodiscordant couples in developed countries and, where possible, could perhaps be integrated into a global public health initiative against HIV in developing countries.
From the aUniversity Toulouse III Paul Sabatier, EA 3694, Research Group on Human Fertility and CECOS Midi-Pyrénées, Toulouse, France
bESMAN Medical Consulting, Milan, Italy
cDepartment of Obstetrics and Gynaecology, Chelsea & Westminster Hospital, London, UK
dAPHP, Hôpital Cochin – Université Paris Descartes, Unité de Médecine de la Reproduction Service de Gynécologie-obstétrique, Paris, France
eInfectious Diseases, Department of Medicine. Kantonsspital, St Gallen, Switzerland
fCentre d'AMP de Strasbourg, Service de Gynécologie-Obstétrique, CMCO-SIHCUS, Schiltigheim, France
gDepartment Obstetric and Gynaecology, University Hospital of Mannheim, Leopoldina-Krankenhaus, Schweinfurt, Germany
hFertility Clinic, Department of Obstetrics and Gynaecology, Erasme Hospital and Laboratory for Research in Human Reproduction, Medicine Faculty, Free University Brussels, Belgium.
*for REproductive Assistance Techniques for HIV in Europe.
Received 15 February, 2006
Revised 27 April, 2007
Accepted 4 May, 2007
Correspondence to Louis Bujan, MD, University Toulouse III Paul Sabatier, EA 3694, Research Group on Human Fertility and CECOS Midi-Pyrénées, Hôpital Paule de Viguier, 330 avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse Cedex 9, France. E-mail: firstname.lastname@example.org