The use of low complexity Assisted Reproduction Techniques in positive HIV (Human Inmunodeficience Virus) males serodiscordant couples.

PAPIER SERGIO; LIPOWICZ RUBÉN; RAWE VANESA; MIASNIK SANDRA; ESPAÑOL ALEJANDRO; NODAR FLORENCIA

Montreal, Quebec, Canadá

Workshop; 61 Annual Meeting of the American Society for Reproductive Medicine; 2005

Critical advances in the treatment of HIV have dramatically improved patients’ response and survival, changing substantially their fertility prospective. A low complexity Assisted Reproduction Program (Intrauterine Insemination) has been established in our Institution for HIV serodiscordant couples in whom the male partner is HIV positive (ELISA, quimioluminescence and Western blot). The core of the program aims to eliminate the semen viral load and use it to perform artificial homologous intrauterine insemination in the wife, minimizing the risk of  disease transmission. Objective: To critically review the clinical findings and treatment results in our program. Design: Patient retrospective observational study in IVF private clinic affiliated to University of Buenos Aires. Material and methods: Fourteen patients were entered over a five year period (1999-2005). Fresh semen samples, collected by masturbation, were processed by centrifugation through two  discontinuous Percoll gradients (45% and 90%). Resuspension of the pellet was made using 1 cc of one of three media (GPM, H-HAM o H-HTF) depending upon de culture medium used in the ART laboratory at the time. One ml of Tes yolk-buffer medium was then added as a cryoprotectant. The resuspended pellet was divided in four aliquots and cryopreserved. One of the cryopreserved aliquots was sent to the virology laboratory for HIV-RNA PCR particles investigation and detection (Amplicor® Roche Laboratories). A load of fifty viral copies present in the specimen was used as a cut-off figure to identify positive and negative samples. At least three samples from each patient were cryopreserved for a total of 61 samples.  Routine intrauterine insemination was then performed using only the negative samples. Results: (See Table). Thirty-eight cycles of intrauterine insemination were performed in fourteen couples. Average number of cycles per patient was 2.71. Eight single, one double and a triple pregnancy were obtained. Pregnancy rate per cycle and per patient were 26.3% and 71.4% respectively.  There were 2 clinical abortions.  Mothers were investigated for HIV particles at least three times during pregnancy. None of them turned out positive. Newborns were also investigated in spite of mothers been HIV particles negative; all of them were also negative. Table Number of patients  14 Number of processed and cryopreserved samples 61 Number of inseminations 38 Total number of pregnancies 10 Pregnancy rate/cycle  26.31% ( 10/38 ) Pregnancy rate/patient  71.42% ( 10/14 ) Average of insemination cycles/patient                                                                             2.71     ( 38/14 ) Clinical abortions               2  (1 single, 1 double)     ( 20% ) Single pregnancies               8    ( 80% )         Double pregnancies               1    ( 10% ) Triple pregnancies               1    ( 10% )  Maternal/newborn transmission                0 Conclusion: Although patients should know that 100% prevention of viral transmission after semen sample processing, can not be guaranteed, our results and those published in the literature seem to indicate that the procedure it is an adequately safe procedure to be used in clinical practice.