Outcomes from the first assisted reproduction program for HIV-serodiscordant couples in Australia

Objective: To describe the clinical outcomes for all HIV‐serodiscordant couples attending an assisted reproduction program. Design, setting and participants: Retrospective review of demographic, clinical and outcome data for all HIV‐serodiscordant couples who attended an assisted reproduction program at a tertiary hospital in Melbourne, between its commencement in 2003 and June 2010. Main outcome measures: Pregnancies, miscarriages, births, HIV transmission to the HIV‐negative partner, semen quality and detection of HIV (HIV RNA and HIV DNA) in semen. Results: As of June 2010, 39 HIV‐positive clients had proceeded to assisted reproduction after the initial consultation in the program. There were 162 completed cycles, with 26 pregnancies (clinical pregnancy rate per cycle, 16.2% for HIV‐positive men with an HIV‐negative partner, and 15.4% for HIV‐positive women). Of all 222 tested semen samples, 18 (8%) had HIV RNA detected despite these men receiving antiretroviral therapy and having an undetectable HIV viral load in plasma. Sperm velocity was significantly lower in HIV‐positive clients receiving combination antiretroviral therapy than in a control group of recipient‐recruited sperm donors (P = 0.01); there were no other significant differences in sperm quality between the two groups. No HIV transmission to babies or HIV‐negative partners occurred. Conclusion: Our findings show detectable HIV in 8% of semen samples from men with an undetectable HIV viral load in plasma, but confirm the safety of assisted reproduction for HIV‐serodiscordant couples within a program with strict protocols for HIV treatment and testing of all semen before use.