HYDERABAD: The immense joy and satisfaction of parenthood should not be denied to anybody. But in some couples, ethical concerns pop up and kill the desire to have a biological child. In the case of couples, who are seroconcordant (both partners are HIV positive) or serodiscordant (one partner is HIV positive), the yearning for a child gets laden with guilt, fear, uncertainty and hopelessness.
The parenthood dream gets overpowered by the fear of women getting infected during the process of conception or vertical transmission (transfer of HIV from mother to child) either during the time of delivery or during breastfeeding. So, should couples with HIV infection give up their dream of having a biological child? Not necessary in today’s era of advanced medical management. Newer treatments and assisted reproductive techniques can help them become happy parents with healthy children
Does HIV impact fertility?
HIV-positive women are prone to gynecological diseases such as pelvic inflammatory disease and cervical dysplasia, which can impact fertility or increase the risk of complications during pregnancy. Sperm motility and morphology is affected in the case of HIV-positive men. Also, hypogonadism, impotence and erectile dysfunction are observed more commonly in these men
Can HIV couples conceive naturally?
Of course, yes. Preconception counselling plays a crucial role as it helps the couple get a clear picture of the risks involved and the possible outcomes. If the male partner is HIV-positive while the female partner is unaffected, he would be advised to take up anti-retroviral therapy to reduce the viral load and she can go for PrEP (pre-exposure prophylaxis) to protect herself from the transmission.
Children born to them have a very high chance of being HIV-negative. PrEP is another new treatment process that can be beneficial, but we have to wait and watch
If only the woman is HIV- positive with her viral load being undetectable, she can try for pregnancy through self-insemination during the time of ovulation. Elective cesarean delivery, neonatal prophylaxis and avoidance of breastfeeding are shown to reduce the transmission from mother to child
Fertility treatment options
The assisted reproductive technique is the best and safest method that can avoid sexual transmission
of the disease
Sperm washing technique for men eliminates the risk of transmission to a great extent after which IUI (Intra-uterine Insemination) or IVF (In Vitro Fertilisation)/ICSI (Intracytoplasmic Sperm Injection) is performed
HIV-infected individuals have the right to know the possible treatment options and risks involved that can help them make informed decisions regarding their reproductive desires. Adoption is also one of the options
If pregnancy is not achieved, then the couple can go in for assisted reproductive techniques
(Dr Durga G Rao, co-founder & medical director of Oasis Fertility)