Improvements in treatments and techniques of assisted reproduction have made it possible to limit and even cancel the risk of viral transmission in the cases of those couples in which one of their members is a carrier of the AIDS virus, something that was not possible. only a few years

"The effectiveness of antiretroviral treatments has increased the hope and quality of life of these patients, which has led to a growing demand for assisted reproduction techniques in HIV-serodiscordant couples who want have children without risk of infection", Explained Dr. Elikn Muñoz, director of IVI Vigo, in the framework of the VI Current Course in Diagnostic Procedures in Obstetrics and Gynecology and in Assisted Reproduction Techniques held in the Galician city on April 28 and 29.

HIV infection affects people of all ages, but it is especially common in the young population. In fact, it is estimated that three of every four people infected with the virus are of childbearing age.

Three of every four people infected with the virus are of childbearing age

After two years of experience with these treatments, IVI has not produced a single case of transmission of the infection, which demonstrates its safety at present. It also shows that security is that the current legislation does not wield reasons to deny assisted reproduction treatments to any person carrying the virus, unless they are in advanced stage of the disease. "The risk", according to Dr. Muñoz, "is considered acceptable and comparable to that assumed in other assisted reproduction treatments, such as the case of women of advanced age."

Currently, the risk of contracting HIV in an unprotected sexual relationship for a woman is between 0.5 and 1%, if there are no other associated infections. According to Dr. Muñoz, "the risk of seroconversion with coitus programmed exclusively in the fertile period reaches 4%." The risk of infection increases if the viral load of the carrier member is high, or if the non-carrier has a concomitant genital infection, inflammation or abrasions.

Also hepatitis C, which affects more than one in every hundred people in the world, the children are infected in 2.7% of cases. Your virus is found in semen in 5% to 30% of men with HIV and can cause sterility. The risk of sexual transmission in serodiscordant couples is 2.5% in ten years, and in women increases with years of exposure.

When the HIV carrier is the man

If the man infected with HIV is man, there are methods that reduce the viral load and the probability of transmitting the virus to the baby. The seminal wash is one of them. It consists of isolating the most suitable sperm to fertilize the ovule, which is where most of the virus is concentrated.

Although it tends to be believed otherwise, "the semen quality of patients with HIV is normal, and only in advanced cases of the disease decreases the number and mobility. Nor do antiretrovirals have any negative effect on their quality ", according to the expert.

There are methods that reduce the viral load and the probability of transmission of the virus to the baby

With the technique of Traditional In Vitro Fertilization or Intracytoplasmic Sperm Injection (ICSI), associated with semen washing, the exposure of women to potentially dangerous sperm is reduced. In addition, the washing is done by freezing half the sample, which allows the retesting of the analyzes.

For all these reasons, Dr. Muñoz explains that, "although there are not enough data to ensure that artificial insemination has an HIV transmission rate lower than sexual intercourse, it seems likely that this is the case".

Non-invasive prenatal diagnosis

Another issue addressed in this course organized by IVI Vigo is non-invasive prenatal diagnosis thanks to the analysis of maternal blood. Currently, when the woman is pregnant, the standard method to detect if the fetus is a carrier of a disease is to perform an invasive test, which always involves a danger.

"Although small, any invasive test carries a risk of causing an abortion. It is estimated that this risk is 0.5 and 1% in the case of amniocentesis, between 1 and 3% in the case of corial biopsy and between 2 and 7% when a umbilical cord puncture", According to Dr. Julio Martín, director of the PGD laboratory at IVI Valencia.

Faced with this risk, the finding of genetic material (DNA or RNA) of the fetus in the mother's blood. This discovery allows to identify and quantify millions of DNA fragments and separate the normal fetuses from those carriers of disease."While waiting for conclusive studies on its validity for the diagnosis of aneuploidy or changes in chromosomes, it is intuited that the use of this non-invasive technique will be universal soon," says Dr. Martín.

Recently, this technique has been successfully used to determine the sex of the fetus (this can prevent diseases of both sexes), and is being investigated especially in the diagnosis of aneuploidy, especially the diagnosis of aneuploidy. trisomy 21 that causes Down syndrome.

Source: IVI Medical Institution

How in vitro fertilization (IVF) works - Nassim Assefi and Brian A. Levine (November 2019).