Women infected with human immunodeficiency virus type 1 have poorer assisted reproduction outcomes A case control study

Capsule:
Human immunodeficiency virus 1 infection in women is associated with poorer assisted reproductive technology (ART) outcomes in a match-paired, case-control study, which indicates no ART delay in cases with HIV-1 controlled infection.

Authors:
Camille Stora, M.D., Sylvie Epelboin, M.D., Emmanuel Devouche, Ph.D., Sophie Matheron, M.D., PhD., Loïc Epelboin, M.D., Chadi Yazbeck, M.D., Florence Damond, M.D., Pascale Longuet, M.D., Frederick Dzineku, M.D., Mandovi Rajguru, M.D., Lucie Delaroche, M.D., Laurent Mandelbrot, M.D., Ph.D., Dominique Luton, M.D., Ph.D., Catherine Patrat, M.D., Ph.D.

Volume 105, Issue 5, Pages 1193-1201

Abstract:

Objective:
To compare the efficacy of assisted reproductive technology (ART) in women infected with human immunodeficiency virus type 1 (HIV-1) versus HIV-negative controls.

Design:
Retrospective case-control study.

Setting:
University hospital ART unit.

Patient(s):
Eighty-two women infected with HIV-1 and 82 women as seronegative controls.

Intervention(s):
Ovarian stimulation, oocytes retrieval, standard in vitro fertilization (IVF) or intracytoplasmic sperm injection, embryo transfer.

Main Outcome Measure(s):
Clinical pregnancies and live-birth rates.

Result(s):
After oocyte retrieval, all women infected with HIV-1 infected were matched 1:1 to HIV-negative controls according to the following criteria: date of ART attempt, age, parity, main cause of infertility, ART technique, and rank of attempt. Only the first IVF cycle during the study period was considered for each couple. We found no statistically significant differences between the two groups for ovarian stimulation data, fertilization rate, or average number of embryos transferred. The clinical pregnancy rate per transfer was statistically significantly lower for the cases compared with the controls (12% vs. 32%), as were the implantation rate (10% vs. 21%) and the live-birth rate (7% vs. 19%).

Conclusion(s):
In one of the largest studies to pair six factors that influence the results of ART, HIV infection in women was associated with poorer outcomes after ART. These results suggest that women with controlled HIV-1-infection should be counseled not to delay ART in cases of self-insemination failure or other causes of infertility. Fertility preservation by vitrification of oocytes in women whose pregnancy should be delayed may be an important future consideration.

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