Effectiveness of semen washing to prevent human immunodeficiency virus HIV transmission and assist pregnancy in HIV discordant couples A systematic review and meta analysis

Capsule:
Semen washing appears to be effective and safe, significantly reducing the risk of human immunodeficiency virus (HIV) transmission in HIV-discordant couples attempting to become pregnant by means of assisted reproduction.

Authors:
Maryam Zafer, M.S., Hacsi Horvath, M.A., Okeoma Mmeje, M.D., Sheryl van der Poel, M.D., Augusto Semprini, M.D., George Rutherford, M.D., Joelle Brown, Ph.D.

Volume 105, Issue 3, Pages 645-655

Abstract:

Objective:
To evaluate the effectiveness of semen washing in human immunodeficiency virus (HIV)–discordant couples in which the male partner is infected.

Design:
Systematic review and meta-analysis.

Setting:
All countries.

Patient(s):
Forty single-arm open-label studies among HIV-discordant couples that underwent intrauterine insemination (IUI) or in vitro fertilization (IVF) with or without intracytoplasmic sperm injection (ICSI) using washed semen.

Intervention(s):
Semen washing followed by IUI, IVF, or IVF/ICSI.

Main Outcome Measure(s):
Primary outcome: HIV transmission to HIV-uninfected women; secondary outcomes: HIV transmission to newborns and proportion of couples achieving a clinical pregnancy.

Result(s):
No HIV transmission occurred in 11,585 cycles of assisted reproduction with the use of washed semen among 3,994 women. Among the subset of HIV-infected men without plasma viral suppression at the time of semen washing, no HIV seroconversions occurred among 1,023 women after 2,863 cycles of assisted reproduction with the use of washed semen. Studies that measured HIV transmission to infants reported no cases of vertical transmission. Overall, 56.3% of couples (2,357/4,184) achieved a clinical pregnancy with the use of washed semen.

Conclusion(s):
Semen washing appears to significantly reduce the risk of transmission in HIV-discordant couples desiring children, regardless of viral suppression in the male partner. There are no randomized controlled studies or studies from low-income countries, especially those with a large burden of HIV. Continued development of lower-cost semen washing and assisted reproduction technologies is needed. Integration of semen washing into HIV prevention interventions could help to further reduce the spread of HIV.

  • msamplaski

    This review obviously has major clinical applications, particularly for a disease state for which we have no cure. Were the authors able to look at different serotypes of HIV? Also, did the immunosuppression regimen seem to change outcomes? Were any of the mothers treated with antiretrovirals at the time of embryo transfer?

    • Joelle Brown

      Thank you for your important questions. In response, we did not find stratification of outcomes by HIV serotype or immunosuppression regime. The studies reviewed did not report HIV status by serotype. Therefore it was not possible to correlate outcomes with different HIV serotypes. Additionally, of the included studies that reported whether or not patients were placed on an immunosuppression regimen, nearly all reported adherence to “HAART” without further specifying the drug-combination used. Two studies provided an exception: a 1998 study by Marina et al. reported that patients were “receiving antiretroviral treatment with one or more of the following drugs: zidovudine, didanosine, zalcitabine, lamivudine, and stavudine,” and a 2001 case series by Loutradis et al. reported that patients were being treated with lamivudine, stavudine, and indinavir. Based on the majority of included studies, it was difficult to correlate outcomes to immunosuppression regimen. Lastly, reviewing the studies showed that assisted reproduction procedures did not include treating mothers with antiretrovirals at the time of embryo transfer, or place pregnant women on antiretrovirals during gestation or delivery.

  • I think this is a wonderful study that clearly demonstrates how effective sperm washing is in clearing off infectious diseases. Infertility HIV Mothers desiring pregnancy now can proceed with IVF with less fear of transmitting HIV to their children.

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