American Society for Reproductive Medicine Releases New Guidelines on Fertility Treatment for HIV-Positive Patients
The Ethics Committee of the American Society for Reproductive Medicine has released new guidelines for fertility treatments for HIV-positive patients. The guidelines, which are published in the February issue of the ASRM journal Fertility and Sterility, state that fertility specialists "have the same obligation to treat HIV-positive patients as patients suffering from any other chronic disease" and should not deny fertility treatment to HIV-positive patients. Since the ASRM's ethics committee last released HIV treatment guidelines in 1994, the advent of antiretroviral drugs and advanced fertility techniques such as sperm washing have reduced the risk of vertical HIV transmission and prompted fertility doctors to re-evaluate how to provide assisted reproductive technology treatments to HIV-positive patients.
Guideline Recommendations
The ASRM guidelines recommend that fertility specialists fully inform their HIV-positive patients of the potential risks of vertical HIV transmission and recommend the safest ART procedures for conception and delivery. Among the acceptable fertilization procedures are in vitro fertilization and intracytoplasmic sperm injection, as well as artificial insemination in cases where the woman is HIV-positive and artificial insemination with sperm washing techniques if the man is HIV-positive. Risk of vertical transmission can also be lowered by HIV-positive pregnant women delivering via planned caesarean section and by administering antiretroviral drugs to women during the second and third trimesters and to infants for six weeks after birth. The guidelines also recommend that couples be advised of the "absolute safest" options for avoiding vertical HIV transmission, which include adoption, conception with donated sperm or not having children. Fertility treatments should only be denied if the fertility clinic lacks the skills and facilities to manage HIV-positive patients, the guidelines state (ASRM release, 2/13).
