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HIV-positive men father children through ICSI. (Sperm Washing Cuts Transmission Risk).

WASHINGTON -- Intracytoplasmic sperm injection with washed sperm in a Columbia University study has allowed 23 HIV-1 seropositive men to father healthy infants while maintaining the HIV-negative status of the infants' mothers.

"HIV-1 infection occurs primarily in young men who might normally desire to have children," said Dr. Mark V. Sauer during the Third World Congress on Controversies in Obstetrics, Gynecology, and Infertility. "For those who desire a family, it's usually been the end of the road.

"But HIV infection is now considered a chronic disease rather than a death sentence, with [highly active antiretroviral treatment] slowing progression and decreasing deaths. Today, the emphasis is on maintaining a healthy, normal, productive life, and for many, 'normal' means having kids."

The HIV-1 Cost and Services Utilization Study conducted last year demonstrated that 29% of 2,864 HJV-1-infected adults desired to have children, said Dr. Sauer, professor of obstetrics and gynecology and director of reproductive, endocrinology at Columbia University, New York.

Until recently, only a few European centers offered assisted reproductive therapy to HIV-1 serodiscordant couples. Preliminary reports from those centers, which primarily performed intrauterine insemination with washed sperm, showed no seroconversions in the mothers or babies.

However, Dr. Sauer said, it is difficult to ensure that washing removes all viral particles; the risk of infecting the woman remains, especially since with intrauterine insemination, millions of sperm are placed above the immunologic barrier of the cervix.

In 1997, Columbia University initiated a study using intracytoplasmic sperm injection (ICSI) with washed sperm from HIV-1 serodiscordant couples.

"Using this technique, you are able to lower the risk of infection down to just one cell," Dr. Sauer explained at the meeting.

The preliminary study recruited 43 couples. Men were HIV-1 seropositive with stable CD4 status, and most were taking antiviral medication. Female partners were HIV-1 seronegative. Couples were required to use male condoms when having sex.

Dr Sauer used standard assisted reproductive technology precycle procedures for screening the women.

Fresh semen samples were washed using density gradient centrifugation followed by swim-up to remove all non-motile cells.

HIV-1 tests were performed on all mothers and babies at delivery and at 3 months. Women who miscarried or did not conceive were also tested 3 months and 6 months after the procedure.

Nine of the women canceled treatment because they had no response to follicle stimulation. The cumulative delivery rate was 53%, with most pregnancies occurring in the first three cycles of treatment.

To date, 57 couples have undergone IVF-ICSI at Columbia with an average of three embryos transferred per procedure.

The ongoing delivered pregnancy rate averages 35% per embryo transfer, with rates approaching 50% per transfer in younger women.

Twenty-three deliveries have occurred, resulting in 34 babies born.

There were no seroconversions noted in any of the mothers or babies

Dr. Sauer reported that although the mothers were generally compliant with the follow-up HIV-1 blood testing, several of them were resistant to the 6-month samples.
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Author:Sullivan, Michele G.
Publication:OB GYN News
Date:Aug 15, 2002
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