Safe Pregnancy for People with HIV: How IVF and ICSI Help Them

The combination of embryology knowledge and HIV treatment protocols has today created a completely safe path for conception for affected couples, where the risk of virus transmission is practically reduced to zero. Advanced techniques such as IVF and ICSI not only help resolve infertility issues but also act as a powerful defense barrier against the transmission of the virus to the fetus and sexual partner.

Generally, in this process, by utilizing precise sperm washing techniques and fertilization in an isolated laboratory environment (Intracytoplasmic Sperm Injection or ICSI), the agent of disease transmission is eliminated, and a healthy embryo is transferred to the mother’s uterus to ensure the health of the future generation. To understand the details of each of these methods, the preparation stages before treatment, and the success rates of these approaches, please continue reading this specialized article.

Why Do People with HIV Need Assisted Reproductive Technology?

One of the commonly asked questions is “Can someone with HIV get pregnant naturally?” The answer is yes, but unfortunately, the virus can be transmitted to the partner and the baby. In other words, HIV spreads through direct contact with infected blood (the fetus) or semen (sex partner). Therefore, most doctors recommend using assisted reproductive technologies (ARTs) to make pregnancy safer for both the baby and the parents. In these treatments, the sperm fertilizes the egg in a lab instead of inside the body. This reduces the risk of transmitting the virus to the partner and the baby to almost 0%.

What Is IVF?

In vitro fertilization (usually called IVF) is a fertility treatment that has been widely used in recent years. In this method, egg and sperm are mixed in a lab environment to create a healthy embryo. The embryo is then placed in the woman’s womb, where it can grow normally. This method is especially useful when one or both partners have HIV, because the egg and sperm do not reach each other inside the body. If the male partner carries the virus, doctors can wash the sperm (separating healthy sperm) and use the healthiest ones for fertilizing the egg. During IVF, embryos are also carefully checked, and the healthiest one is chosen for transfer to the uterus.

What Is ICSI?

ICSI is another assisted reproductive technology for couples who have trouble getting pregnant naturally. This method is different from IVF and has three main steps:

1. The semen is carefully examined in the lab until one healthy, motile, and high-quality sperm is found.
2. Then, this sperm is directly injected into the egg using a needle.
3. When the embryo is made, it is transferred to the mother’s uterus.

This method is usually used for couples where the male partner has HIV or weak sperm. Since the semen and egg do not encounter, the risk of passing the virus to the mother or the baby is almost zero in this method.

5 Steps of IVF and ICSI for Patients with HIV

IVF and ICSI for infected people are more complex and require extra planning because the virus can be transmitted easily. The ARTs for patients with HIV have 5 main steps, including:

1. Consultation and evaluation

Before starting the procedure, both partners should take a full checkup. At these tests:

• The amount of virus in the blood and the CD4 cell count are measured.
• The patient’s medications are reviewed to make sure they are safe for pregnancy.
• Fertility tests are done to check the quality of the sperm and eggs.

Also, the patient must undergo antiviral treatments before starting IVF and ICSI. They should take certain medication until the virus level in their blood reaches the lowest level (undetectable in blood tests). The patient should probably be under medication for months, but it is worth it because when the level of the virus reduces, the risk of passing it to the baby drops.

2. Ovarian stimulation

In the second step, the doctor prescribes ovulation induction medicines, such as gonadotropins, to stimulate the ovaries. These medicines increase the number of eggs and help them mature faster. For women living with HIV, the type and dose of these medicines are chosen very carefully so they do not interfere with antiviral drugs. During this time, the doctor orders multiple ultrasounds and blood tests to check how the egg follicles are developing.

3. Retrieving eggs and sperm

When the eggs are mature enough, the doctor retrieves them using a catheter. This procedure is simple, outpatient, and painless. A sperm sample is also collected from the father-to-be. If the male partner has HIV, the doctor first washes the sperm in the lab to separate healthy ones from the semen.

4. Fertilization

In IVF, the reproductive endocrinologist mixes the sperm and eggs in a petri dish. In ICSI, the doctor uses a microscope to inject a single healthy sperm directly into an egg. After a few days, the embryos that form are checked, and the strongest, healthiest ones are transferred to the mother’s womb.

Note: The difference between these two methods is that in IVF, the sperm itself penetrates the egg, while in ICSI, the sperm is manually injected into the egg.

5. Embryo transfer

In the last step, the embryo is transferred to the mother’s uterus four or five days after fertilization. If her body is not ready to hold the baby at that time, the embryo is frozen and transferred later.

Benefits of IVF and ICSI for People with HIV

The ARTs have many advantages for couples with HIV:

• There is no contact between the male and female, so the risk of passing the virus to the spouse is almost zero.
• The sperm washing reduces the amount of virus in semen to near zero percent.
• Preimplantation genetic testing (PGT) can be done to check the embryo’s chromosomes before it is transferred.
• IVF and ICSI increase the chance of a successful pregnancy, especially for couples who already have fertility problems.

hat to Do after Embryo Transfer

If you want to have a safe embryo transfer and a successful pregnancy, consider your doctor’s advice and the following tips:

• Get enough rest for the first few days after the transfer, but avoid total bed rest.
• Take a pregnancy test 10 to 14 days later.
• Take antiviral medications exactly as prescribed and do not stop them on your own.
•  The level of the virus should be checked regularly during pregnancy.
• Choose a well-equipped hospital for delivery.
• Both an obstetrician and an infectious disease specialist should be present when you are giving birth.
• Maintain a healthy lifestyle during pregnancy. In other words, avoid smoking and drinking alcohol, eat a balanced diet, get enough rest, and be physically active.

The Last Notes

Pregnancy is no longer a far-fetched dream for people living with HIV. Today, by utilizing modern treatments such as antiviral drugs, sperm washing, surrogacy, and assisted reproductive technologies like ICSI and IVF in Iran, these individuals can experience a safe and healthy pregnancy. The key to success in this path lies in collaborating with an expert team of infectious disease specialists, fertility experts, and embryologists, along with the patience and full support of the couple throughout the process.

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FAQs

Can you have a healthy baby if you have HIV?

Yes, you can. However, you need special medical treatments and medications to have healthy children.

Is ICSI better than IVF for HIV-positive people?

ICSI is usually safer for HIV-positive people because there is no direct contact between semen and the egg. Only one healthy sperm is directly injected into the egg.

How much does IVF or ICSI cost for people living with HIV (PLHIV)?

The price of IVF and ICSI for people living with HIV is almost the same as what other patients pay. The only difference is that PLHIV should pay for antiviral medications and additional treatments such as sperm washing or egg/embryo freezing.

Is a natural pregnancy risky for HIV-positive women?

If the virus is not controlled or she has stopped getting antiviral treatments, a natural pregnancy increases the risk of passing the virus to the baby.