Efficacy and safety of intrauterine insemination and assisted reproductive technology in populations serodiscordant for human immunodeficiency virus A systematic review and meta analysis

Capsule:
A systematic review and meta-analysis for outcomes with intrauterine insemination and in vitro fertilization for HIV-serodiscordant couples found no seroconversions and similar outcomes to HIV-seronegative infertility patients.

Authors:
Arti Barnes, M.D., M.P.H., Daniel Riche, Pharm.D., B.C.P.S., C.D.E., Leandro Mena, M.D., M.P.H., Thérèse Sison, B.A., Lauren Barry, M.D., Raveena Reddy, M.D., James Shwayder, M.D., J.D., Preston Parry, M.D., M.P.H.

Volume 102, Issue 2, Pages 424–434

Abstract:

Objective:
To assess procreative outcomes for HIV-positive men and women with seronegative partners.

Design:
Systematic review and meta-analysis.

Setting:
Not applicable.

Patient(s):
Twenty-four studies with extractable data for HIV-serodiscordant couples undergoing intrauterine insemination (IUI) or in vitro fertilization (IVF).

Intervention(s):
None.

Main Outcome Measure(s):
Primary outcomes: HIV transmission to a seronegative partner and per cycle fecundability; secondary outcomes: analysis of multiple gestation rates, miscarriage rates, and cancellation rates.

Result(s):
For serodiscordant couples, HIV-positive men or women undergoing IUI and IVF treatment had a 17%, 30%, 14%, and 16% per cycle fecundability, respectively. Multiple gestation rates were 10%, 33%, 14%, and 29%, respectively. Miscarriage rates were 19%, 25%, 13%, and 20%, respectively. No HIV transmission was observed in 8,212 IUI and 1,254 IVF cycles, resulting in 95% confidence that the true rate is 4.5 transmissions per 10,000 IUI cycles or less.

Conclusion(s):
In serodiscordant couples, IUI and IVF seem effective and safe based on the literature. Evidence-based practice and social justice suggest that our field should increase access to care for HIV-serodiscordant couples.

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