Human immunodeficiency virus (HIV) and infertility treatment A committee opinion

Capsule:
Fertility clinics with the necessary resources to provide care should offer services to human immunodeficiency virus (HIV)-infected individuals and couples who are willing to use recommended risk-reducing therapies.

Authors:
Ethics Committee of the American Society for Reproductive Medicine

Volume 104, Issue 1, Page e1–e8

Abstract:

Human immunodeficiency virus (HIV) is a serious but manageable chronic disease that affects persons of reproductive age, many of whom express a desire for biologic parenthood. This document is a revision of the original document of the same name, last published in 2010 (Fertil Steril 2010;94:11–5).

  • Dear Members of the ASRM Committee on Human immunodeficiency virus (HIV) and infertility treatment:

    We applaud your revised Committee Opinion on HIV and infertility services for its up-to-date, evidence-based approach to sexual and occupational HIV transmission risk. In particular, we celebrate how the report recognizes the diversity of HIV-affected individuals and couples who want to create a family, including women living with HIV and those desiring surrogacy. While new studies provide reassuring data on the powerful effect of antiretrovirals to reduce HIV transmission during sexual exposure through both treatment as prevention and/or pre-exposure prophylaxis, many HIV-affected individuals and couples desire or require fertility treatments to achieve pregnancy. Assisted reproductive technology is an essential option for many with HIV and minimizing barriers to these services is critical. Lower cost and lower technology assisted reproductive methods (such as sperm washing and home insemination or sperm washing and intrauterine insemination/IUI) must be more accessible to meet the parenting needs and desires of individuals affected by HIV.

    With decades of collective experience caring for HIV-affected men and women who wish to have a child, we urge ASRM members and providers of assisted reproductive technologies to follow the updated guidance and provide equal access to family building opportunities to HIV-affected individuals. This care includes options of co-parenting and surrogacy. As stated in the Committee Opinion, “Unless health-care workers can show that they lack the skill and facilities to treat HIV-infected patients safely or that the patient refused reasonable testing and treatment, they may be legally, as well as ethically, obligated to provide requested reproductive assistance.” We recognize many facilities have previously considered augmenting their facilities to expand the reproductive services offered to HIV-infected couples, however, given the major scientific achievements over the past five years, we encourage ASRM providers to reassess their ability to process and store gametes from HIV-affected couples. We urge you to join us and many other providers, and those who support them, from a variety of backgrounds around the U.S. who provide evidence-based, high-quality care and support HIV-affected individuals in achieving their family-building goals.

    Sincerely,

    Shannon Weber, MSW, University of California San Francisco

    Deborah Cohan, MD, MPH, University of California San Francisco

    Dominika Seidman, MD, University of California San Francisco

    Patricia Garcia, MD, MPH, Northwestern University

    Cheryl Walker, MD, University of California, Davis

    Adriana Weinberg, MD, University of Colorado, Denver

    Okeoma Mmeje, MD, MPH University of Michigan

    Mary Jo Hoyt, MSN, François-Xavier Bagnoud (FXB) Center

    Emily S Miller, MD, MPH, Northwestern University

    Meg Sullivan, MD, Boston University

    Jan M. Kriebs, CNM, MSN, FACNM, University of Maryland, Baltimore

    Rana Chakraborty MD, MSc, FRCPCH, DPhil, Emory University

    Risa M. Hoffman, MD, University of California, Los Angeles

    Sarah Finocchario-Kessler, PhD MPH, University of Kansas Medical Center

    Pooja Mittal, DO, University of California, San Francisco

    Judy Levison, MD, MPH, Baylor College of Medicine

    Ted Ruel, MD, University of California, San Francisco

    Matthew Sachs, San Francisco AIDS Foundation

    David Evans, Project Inform

    Robert M. Grant, MD, MPH, University of California San Francisco

    Joelle Brown, PhD, MPH, University of California San Francisco

    Shari Margolese, Canadian HIV Pregnancy Planning Guidelines

    Mark H. Yudin, MD, MSc, FRCSC University of Toronto

    Lisa Rahangdale, MD, MPH, University of North Carolina

    Jonthan Fuchs, MD, MPH, San Francisco Department of Public Health

    Jenell Coleman, MD, MPH, Johns Hopkins University

    Amy Garlin, MD, East Bay AIDS Center

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