In a retrospective study that reviewed 10 years of fertility care experience in HIV-seropositive men, researchers from Columbia University have added further credence to the safety and efficacy of ICSI in achieving pregnancy with minimal risk of viral transmission. The findings of the recent study have been published in the journal, Fertility and Sterility.
Mark V. Sauer and coworkers from the College of Physicians and Surgeons, Columbia University, New York, conducted the study on 181 HIV-serodiscordant couples (seropositive males with seronegative partners), who had undergone 355 fresh and 65 frozen cycles of ICSI with sperm washing. The main outcomes measured included IVF performance, infection rates, pregnancy rates, and obstetrical outcomes. The researchers reported a cancellation rate of stimulations of 16%, owing to poor ovarian response. Additionally, the following observations were made during the study.
• Oocytes collected per retrieval: 15.0 ± 0.5
• Mature oocytes appropriate for ICSI: 12.1 ± 0.5
• Embryos obtained per couple: 9.0 ± 0.3
• Overall clinical pregnancy rate/embryo transfer: 45%
• Ongoing/delivered pregnancy rate/embryo transfer: 37%
Multiple gestations were noted as the most common obstetric complication in 41% of the subjects, with 5% having high order multiple births. The preterm delivery rate was high, with 43% prematurely born babies. However, there was no occurrence of maternal or neonatal HIV infection or death. The findings suggested the benefit of using ICSI in HIV-serodiscordant couples (SDC) in order to help them conceive with minimum risk of viral infection.
A similar retrospective case-control study was conducted by Melo et al (Fertility and Sterility, 2008) to analyze the embryo quality and ICSI outcome between 30 HIV type 1 SDCs with men diagnosed as seropositive, and 79 control couples with tubal-factor infertility, not affected with HIV-1. The main interventions performed in both the groups include controlled ovarian hyperstimulation, sperm wash, and ICSI procedure.
The study results showed a lack of variation in the two groups with respect to fertilization and cleavage rates, days 2- and 3-embryo development and embryo features, and day 3-mean number of optimal embryos. Similar comparable findings were reported in the study and control groups for day 6-mean number of optimal blastocysts, the count of cryopreserved and transferred embryos, and rates of implantation, pregnancy, multiple pregnancy or miscarriage. Based on the findings, the investigators concluded that the embryo development or ICSI outcome is not negatively affected by HIV-1 infection in SDCs.
A recent review article by Feinstein and Seidman (Harefuah, 2008) suggested that the only safe alternative available to HIV-infected couples for fulfilling their need for offspring, is adoption or use of donor sperms in cases of HIV positive males. They further proposed that IUI is effective in preventing horizontal infection in HIV-positive women, while sperm washing in HIV-infected males may help reduce the chances of infection in the healthy partner.
According to the latest statistics published in July 2008 by the Joint United Nations Program on HIV/AIDS (UNAIDS) and the World Health Organization (WHO), more than 33 million people were estimated to be globally afflicted with HIV infection, with around 2.7 million newly infected cases in 2007. The advent of potent therapeutic strategies, improved prognosis and life expectancy in HIV-infected individuals, have further increased the number of such patients seeking various reproductive options. Although ART has the potential to assist HIV serodiscordant couples in achieving pregnancy with minimal risk of viral transmission, there are controversies and ethical implications surrounding the use of infertility treatment in such patients.
As per the Ethics Committee of the American Society for Reproductive Medicine (ASRM), people infected with chronic viral infections, inclusive of HIV, should not be ethically deprived of fertility treatment if the centers have the required resources for providing care. A recent report from the Practice Committee of the ASRM (Fertility and Sterility, 2008) recommends counseling of infertile couples with HIV on the possibility of viral transmission during ART, though the exact magnitude of risk is unclear. Further, the report suggests the use of sperm-wash methods in SDC, with HIV-afflicted males, to decrease the risk of infection, and periodic monitoring of the uninfected partner during treatment and pregnancy.
References
1. Sauer MV, Wang JG, Douglas NC, et al. Providing fertility care to men seropositive for human immunodeficiency virus: reviewing 10 years of experience and 420 consecutive cycles of in vitro fertilization and intracytoplasmic sperm injection. Fertil Steril. 2009 Jun;91(6):2455-60. Epub 2008 Jun 13.
2. Melo MA, Meseguer M, Bellver J, Remohí J, Pellicer A, Garrido N. Human immunodeficiency type-1 virus (HIV-1) infection in serodiscordant couples (SDCs) does not have an impact on embryo quality or intracytoplasmic sperm injection (ICSI) outcome. Fertil Steril. 2008 Jan;89(1):141-50.
3. Feinstein S, Seidman DS. Infertility treatment in HIV serodiscordant couples. Harefuah. 2008 Jan;147(1):38-42, 94.
4. Practice Committee of American Society for Reproductive Medicine. Guidelines for reducing the risk of viral transmission during fertility treatment. Fertil Steril. 2008 Nov;90(5 Suppl):S156-62.
