Open AccessCost and safety of assisted reproductive technologies for human immunodeficiency virus-1 discordant couples
Author(s) -
MingJung Wu,
Hong Nerng Ho
Publication year - 2015
Publication title -
world journal of virology
Language(s) - English
Resource type - Journals
ISSN - 2220-3249
DOI - 10.5501/wjv.v4.i2.142
Subject(s) - sperm washing , medicine , seroconversion , intracytoplasmic sperm injection , in vitro fertilisation , artificial insemination , gynecology , viral load , sperm , semen , obstetrics , fertility , assisted reproductive technology , human immunodeficiency virus (hiv) , pregnancy , insemination , andrology , immunology , infertility , population , biology , environmental health , genetics
Due to significant advances in the treatment of human immunodeficiency virus type-1 (HIV-1), HIV-1 infection gradually has become a treatable chronic disease. Successfully treated HIV-positive individuals can have a normal life expectancy. Hence, more and more HIV-1 discordant couples in Taiwan and the rest of the world are seeking fertility assistance. Pre-treatment of highly active antiretroviral therapy (HAART) combined with sperm washing and RT-polymerase chain reaction examination for HIV-1 viral load has become the standard procedure to assist them to conceive. However, in order to reduce the transmission risk to the lowest level for the couple and to diminish the cost of health care for the insurance institutes or government, in vitro fertilization (IVF)-intracytoplasmic sperm injection (ICSI) therapy provides the ideal solution for HIV-1 discordant couples with infected men. Intrauterine insemination (IUI) theoretically introduces more than 10(7) times of sperm counts or semen volume to uninfected women vs IVF-ICSI. However, since some regimens of HAART may significantly decrease the sperm motility, compared to IVF-ICSI, IUI only produces 1/5 to 1/2 pregnancy rates per cycle. Given the risk of seroconversion of HIV infection which actually happens after successful treatment, IVF-ICSI for these HIV-1 seropositive men is more cost-effective and should be the first line treatment for these cases.