Nowadays with modern treatment of HIV, those living with the virus can expect to live as long as any other person and therefore they can live their lives fully. However, when it comes to starting a family, young couples living with HIV have unique reproductive challenges.
Couples where one partner is HIV-positive are referred to as ‘discordant’. A discordant couple might hesitate to pursue a pregnancy because they are afraid they might transmit the disease to the uninfected partner, or to the unborn child. There are other concerns about the effect of HIV and its treatment on reproduction capacity. These matters raise anxiety when those affected with HIV start thinking about starting a family.
1. Consult a doctor
Once a couple decides to pursue a pregnancy, it’s best for them to consult with the supervising HIV physician initially. This is to ensure optimal HIV control, good overall health status, and to plan for continued care during pregnancy. There should then be a subsequent referral to a fertility specialist with expertise in dealing with discordant individuals.
Basic fertility evaluation may initially be done depending on individual parameters. Then a plan for safe conception is drawn up. Whoever is living with the virus should have undetectable viral load prior to embarking on conception. HIV therapy should not be stopped, and the regime used should only be changed with the advice of the HIV specialist.
2. Weigh the options
Several strategies can be devised. Timed unprotected intercourse can be done at the time of ovulation, when conception is most likely. This limits exposure to the uninfected partner.
Unprotected intercourse may also be combined with preventive HIV medication for the uninfected partner. If the male is infected, a technique known as sperm washing can also be an alternative. This is then combined with a technique called insemination and limits potential HIV transmission.
If fertility evaluation mandates recommendation for advanced fertility treatment, this can also be done. Several advanced fertility treatment techniques aimed at preventing HIV transmission already exist.
3. Take the precautions
There are additional precautions during pregnancy when the female is the one living with the virus. This further limits the risk of HIV transmission to the developing baby. Antenatal care must be done under the supervision of both the HIV specialist and an obstetrician. Most women will still be suitable for a normal vaginal delivery. Further preventive strategies are usually advised once the baby is delivered.
Current HIV treatment and safer conception strategies equate to hardly any transmission to HIV-negative partners. Similar safer conception principles apply when both partners are living with the virus. The ideal is a planned pregnancy rather than a random conception. This ensures conception when the risk of HIV transmission is negligible and unlikely.
Affected couples who don’t want to conceive should use effective contraception. Even though condoms provide dual protection, they may not be as effective for pregnancy prevention. Long term contraceptive methods are very effective, and are suitable for most couples. You should always discuss with your HIV care team about contraceptive methods that best suit you.
Dr Alfred Murage is a Consultant Gynecologist and Fertility Specialist. [email protected]