Conception, pregnancy and HIV

However, these days it’s become much simpler for a couple to plan and achieve a pregnancy safely if one or both of you have HIV.

There are several different scenarios when it comes to getting pregnant.

If the male partner has HIV and the woman is HIV negative

In this situation, men used to be advised to have a procedure called sperm washing to avoid passing on HIV to their partner. This is where sperm is removed from the seminal fluid (which contains HIV) and then used to inseminate the woman. This is likely to be through intrauterine insemination (IUI) which is where the sperm sample is put into the woman’s womb where it will be ready to fertilise her egg(s) after ovulation.

Recent proposed changes to the National Institute for Health and Clinical Excellence (NICE) fertility guidelines suggest that sperm washing is no longer necessary and unprotected sex can be used to attempt to conceive, providing the man: 

• Is complying with his HIV medication. 
• Has a viral load lower than 50. 
• Has no other infections. 
• Only has unprotected intercourse with his partner around ovulation.

If not all of these conditions are met, the draft guidelines recommend testing the viral load in the semen and then use sperm washing if necessary.

This is great news for couples who thought their only chance of conceiving was through sperm washing – not everyone was able to access this procedure on the NHS and it can be expensive if you have to pay privately. The guidelines also propose that the female partner no longer needs to take PEP treatment after having unprotected sex to conceive, if the advice is followed correctly.

If both partners have HIV

Although the draft NICE guidelines only address couples where the man is HIV positive, there is also good news for other couples. If both of you have HIV, your clinician will be able to advise you on the best was to conceive.

You may be advised that it is safe to have unprotected sex provided neither of you has any other STIs or drug resistant strains of HIV. If both partners have different drug resistant strains of HIV, sperm washing may be advised to prevent superinfection.

If the woman has HIV and the man is HIV negative

In this situation, self insemination can be used around the time of ovulation. This is where a syringe (without a needle) is used to inject your partner’s sperm into your vagina. Your clinic will be able to provide syringes.

Whichever category you fall into, it is a good idea for both of you to go and talk to a nurse or doctor in your clinic. Some clinics have specialist HIV midwifes who can talk you through your options and advise you about the best way you can safely conceive.

If you are an HIV positive woman, once you are pregnant, you will be advised about the best ways to prevent your baby from being born with HIV. In the UK, if you follow medical advice, the chances of mum-to-baby transmission are less than 1 per cent. This will mean taking HIV medication during pregnancy and labour.

You may have to have a Caesarean birth if your viral load is high- although many women with HIV now have vaginal births. After the birth, your baby will have to take HIV medicine for a few weeks and you mustn’t breastfeed.

Good luck with your conception – soon you’ll hopefully have a happy healthy baby in your arms.

Read more about pregnancy and conception in the current edition of HIV Treatment Update by NAM.