JBRA Assist. Reprod. 1999;03(03):36-36
ARTICLE
doi: 10.5935/1518-0557.1999.3.3.08
*AGN and Associates. Mexico
**Dept. of Obstetrics and UCLA School of Calilornia USA
***Laboratory of Virai Oncology and AIDS Research. USC School of Medicine. Los Angeles. USA
The issue of fertility among HIV-1 serodiscordant couples, in which the man is seropositive while his female paner is seronegative, has raised controversial issues incluing the ethics and right to procreate, the detection and re moval of the HIV-1 virus from semen ad the safety of specific treatment among others (Semprini et al., 1997 e Lasheeb et al., 1997) Most serodiscordant couples that desire fertility have been treated with intrauterine inseminations (IUI) using washed sperm (Semprini et al., 1997). However, rcent reports have suggested that the sperm washing techniques may not always be as safe as previously envisioned (Brechard et al., 1997; Chrystie et al., 1998 e Lasheeb et al., 1997).
Herein, we report a case of an HIV-1 serodiscordant couple who sought fertility treatment in four centers in the USA but were rejected and attempted ovarian stimulation and IUI in European clinic without success.
The woman is a 39 years old HIV-1 seronegative, while he is a 36 years old seropositive mano They manied 4 years ago, and had always sexual intercourse with condom protection. He acquired HIV from a heterosexual contact 9 years ago. At the time of semen testing the viraI load in blood was 1454 HV-1 RNA copies/ml, his CD4T-cell count was 1000/ml. He re mained CDC category Al with no history of opportunistic infections. His treatment consisted of double nucleoside with either DDC, AZT, DDI or D4T. Other treatments included Crisxian, hidroxyurea and IL. The couple gave informed consentin writing for the fertility treatment. Ovarian stimulation using GnRH-a (Ieuprolide acetate), recombinant FSH (Puregon) and HMG (Humagon) was followed by transvaginal ultrasound aspiration of ten oocytes. During the last 12 months prior to the procedure HIV-1 DNA and RNA PCR were perfomed in seminal plasma and cells, with cultures of semen for HIV; ali tests being negative. Some specimens tested were frozen and used on the day of procedure. The sperm were processed by discountinuous Percoll gradients (45-50% and 90%).
Post capacitation sperm count was 20.00 with 50% motility (slow progression) and 10% normal morphology. Intracytoplasmatic sperm injection (ISCI) was canied out resulting in 4 embryos of good quality. Embryos were transfered 42 hours later to the uterus, and after 14 days a serum β-hCG was 250 mID/ml.
During pregnancy, the woman’s blood was tested four times for HIV-1 and ali tests were negative. At 14 weeks of gestation an amniocentesis was performed, and a normal male karyotype was determined. Both DNA and RNA PCR as well as direct cultures fom the amniotic f1uid were negative for HIV-1 The gestation was uncomplicated and a spontaneous vaginal delivey occurred 255 days after the embryo transfer (APGARS 8/9 and weight 3300 gr.). HIV-1 testing performed on the baby and the mother after the first week of the child” birth were negative by ELISA and DNA PCR.
To our knowledge, this is the first report of a healthy life birth in case of a HIV-1 discordant couple using the technique of semen screening and ICSI with embryo transfer. The use of a single sperm after semen screening shoud drastically reduce the chances of HIV-1 infection of both , the mother and the child.