Sunday, September 13, 2009

You're HIV + and you want to have a baby?


I have had a few queries from around the country, asking specifically about pregnancy and HIV. To be more specific, to ask how to fall pregnant when one or both partners are HIV +. It is actually a simple process, but it's the emotional aspects that make this so complicated, and just like any couple trying to fall pregnant, results are not guaranteed.

The decision to try and fall pregnant can be a strongly emotional one, and cannot always be rationalised. It is a deeply personal decision and a human's desire for children needs to be respected at all times. Adoption is an option to be encouraged (speaking as an adoptive mother, this is close to my heart) and discussed but will not be a solution for all couples. The reality we face is that HIV is a chronic disease that affects young people. And it is normal to want to have a family and to plan a future. But, do it as safely and as responsibly as possible.At the end of the day we hope for a healthy couple and a healthy (HIV negative) baby who have a future to look forward to .


In general, the couples I see who want to fall pregnant do not have fertility problems, they have 'transmission troubles' ( i.e. they do not want to infect/reinfect each other). Unfortunately, some gynaecologists respond to this by treating the couple as if they are infertile, which brings in huge (and sometimes unnecessary) costs. It is very important to establish both partners fertility history and her history of pregnancies and any past womb infections to establish if there is any underlying fertility problem.

You should both be examined for any STI's (Sexually Transmitted Infections), and she should have a pap smear to demonstrate a healthy cervix (mouth of the womb) before falling pregnant. Invest in getting your CD4 count up, your Viral Load down (undetectable virus is what we aim for), your health improved and ovulation predictable : all these are the important puzzle pieces to put into place before attempting to conceive (fall pregnant).

There are ways to fall pregnant that pose no risk at all to either partner, however, this is a more medical approach and may be expensive. If he is positive and she is not, then you will need to get a sperm sample and have it 'washed' at a laboratory (which may cost around R500) so that the virus is removed and the remaining washed sample is safe. Then, through artificial insemination (AI), the sperm can be introduced into the woman's vagina or cervix (see links below). This process offers about a 30% chance of successful conception (ie. falling pregnant). The artificial insemination can be done in a doctor's rooms or at home.


If she is positive and he is negative, artificial insemination can be done without the need for sperm washing. In this case, the man produces a sperm sample into a clean container. This sperm is drawn up into a syringe and introduced into the vagina. The best position for AI is for the woman to be on her hands and knees, shoulders down and hips up high. This helps the sperm to be positioned close to the cervix.

These are really the only methods which put both partners at no risk. All other methods still have a risk, and the risk ranges from low to high. If you are considering falling pregnant this should be carefully discussed with your doctor.

If you are positive:

You need to consider taking ARVs around the time of conception and make sure that your viral load is undetectable (ideally less than 50 copies) so that the chance of you passing the virus to your partner is maximally reduced. (This applies if your partner is positive or negative)

Then, it is an option to consider timed unprotected sex - timed according to her menstrual cycle and ovulation. There is less success when have unprotected sex at unplanned time intervals but some couples opt to do this. Ideally, you need to spend two to three months charting her periods and temperature (see links below) so that you have a good idea of her ovulation.


If you are negative: 
and you opt for unprotected sex, speak to your doctor about the option of using Pre Exposure Prophylaxis (PrEP) and Post Exposure Prophylaxis (PEP)  drugs around the time of the unprotected sex. For example, a drug like Truvada taken continuously until conception is an option to really reduce the already very low risk. It takes 21 days before the Truvada reaches steady levels in the genital tissues. This, is where the drug is needed most, to "zap" up any virus should there be virus actually getting into the genital cells. This means that it really needs to be taken continuously month to month until pregnancy is confirmed. Before taking this medication, an HIV test must be confirmed negative and kidney function must be proven to be normal.


If he is negative and she is positive: 

it is an option to use a non medicated condom (ie no spermicide contained in the condom) and put a needle through the tip to allow semen transfer.
Or, have protected sex using a non medicated condom and remove the condom in time for ejaculation. This is a very low risk method.


I would love to hear your suggestions, do you have questions, or topics you'd like to see covered? Check out the site http://www.hivsupport.co.za/ . You can email me at drgail.ashford@gmail.com
Links with helpful info:

sperm washing and freezing: http://www.cryobank.co.za/content/contactUs.html
when am I ovulating? http://www.therainbowbabies.com/HowDoIKnowWhenImOvulating.html

at home insemination (refers to lesbians who are hiv-, but the info still applies)http://www.therainbowbabies.com/At-HomeInsemination.html

safe conception: http://img.thebody.com/legacyAssets/48/16/conception.pdf
Twitter:@drgail3
FB: HIV Support South Africa

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