In the past two decades, the life expectancy and view of life expectations for men and women with HIV have dramatically changed. With that has come a shift in how these men and women are able to look at building a family of their own.
HIV infection used to predict a dim and difficult future, but with the introduction of highly active antiviral therapy (HAART) and medical attention, it has become a chronic manageable disease. Today people with HIV can look forward to long, full lives, complete with all the opportunities that men and women hope to experience. That includes having biological children of their own.
In the 1990s, medical professionals recommended that individuals with HIV avoid pregnancy because of the risk of transmitting the virus to their sexual partner and the baby. It was considered unethical to allow conception when the life expectancy of the prospective parents would be tragically short and the offspring would begin their lives with a dangerous viral infection. Some HIV positive women chose to terminate their pregnancies to avoid the risk to their offspring. And those who chose to carry to full term were plagued with doubts about who would care for their children if they died. Laws were written that prohibited physicians from performing assisted reproductive procedures such as in vitro fertilization for couples with HIV.
Fortunately, the outlook for men and women with HIV infection has dramatically changed.
For HIV-positive men interested in having children, the first step is to find a fertility specialist experienced in working with men with HIV. All men with HIV looking to have a biological child should be on antiviral medication. Men with low or undetectable serum viral loads are much more likely to have undetectable levels of virus in their semen.
Medical studies have demonstrated that HIV viral particles are present in semen and infected white blood cells, but not in sperm. Assisted reproductive procedures use washed semen specimens in which sperm are separated from the seminal fluid and blood cells. Clinical studies have established sperm wash protocols to minimize the risk of viral particles being present in washed semen specimens. The washed and virus-free sperm samples may then be used for insemination, or for in vitro fertilization preceding embryo transfer into a gestational carrier.
Additional steps to minimize the risk of viral transmission include testing semen specimens for the presence of HIV virus before the sperm wash procedure, or testing the washed sperm sample for HIV viral particles after the sperm wash process. Both of these procedures have been applied in clinical trials and have been shown to prevent the transmission of HIV infection to the recipients of the sperm or embryos, and to the offspring resulting from these treatment cycles. The results of over 8,000 treatment cycles have been published in the medical literature with no reports of HIV infection in the recipients or newborn children.
For women with HIV, the introduction of HAART and good prenatal care has essentially eliminated the transmission of virus from mother to child during pregnancy. Women can now enjoy their pregnancy without fear of causing infection of their future baby.
Bringing this education to light despite the longtime stigmas can be tricky. Even when people see the evidence, they still often have doubts.
Last year the American Fertility Association honored Sir Elton John and David Furnish with an award for sharing their family-building story, which serves to educate others about egg donation and surrogacy. Now the Elton John AIDS Foundation has funded a grant to the AFA to provide educational materials on family-building treatment options to men and women with HIV. This has allowed us to bring seminars to Nashville and Boston in the last year, and to stream it online for anyone in the world to watch.
HIV is not an obstacle to becoming a mom or dad but a small challenge to overcome with advanced fertility care. Through our combined efforts we hope to bring optimism about future parenthood to individuals with HIV who desire to have children of their own.
Dr. Guy Ringler has been working in the fertility field for more than 20 years, specializing in helping same-sex couples and individuals with HIV build the families of their dreams. He lives in Los Angeles with his husband, Mark Rios. You can find him on Twitter @gayfertility or at, CaliforniaFertilityPartners.com.