Over the last 15 years our Medical Director, Dr Carole Gilling-Smith, has been a pioneer in the UK in developing fertility treatments for patients with viral infections such as HIV, and hepatitis B and C, to allow safe conception and the lowest possible risk of transmission of any disease to their future child. Drawing on her expertise and on the current NICE guidelines published in 2013, the Agora offers a rational, safe and sensitive approach for couples seeking to explore their options of avoiding transmission risk to their uninfected partner or future child, where one or both partners has a viral illness.
Natural Conception or sperm washing for men with HIV – which treatment is right for me?
The medical treatment of viral illness has made huge leaps over the last decade and is now fine-tuned to minimise – or completely remove – detectable virus in the blood. Most men and women infected with HIV will be taking drugs known as HAART (highly activated anti-retroviral therapy) which will mean the virus cannot be detected in the blood. If this has been the case for over six months, HIV specialists will usually advise that natural conception (unprotected intercourse) limited to the time of the month when the woman is ovulating is a perfectly safe and reasonable option; this is provided you are taking your medication correctly and you have no other infections.
Sperm washing, where sperm is first treated to separate the sperm from the semen, is offered to couples who don’t meet the above criteria or who would prefer not to choose the natural conception route. The sperm can then be used in intrauterine insemination if there are no fertility issues with the couple or IVF or ICSI if there are identified fertility issues. There is currently no clear evidence to suggest that sperm washing may reduce the risk of HIV transmission any further in couples where the man is taking HAART and has a sustained undetectable viral load, and indeed the process of sperm washing may reduce the man’s natural fertility.
Hepatitis B & C – do I need sperm washing?
There is no evidence that sperm washing will reduce the transmission risk in men with hepatitis B or C. If you have hepatitis B or C you should be under the care of a specialist as the virus can damage your liver. There are treatment options that can help clear the virus from the blood.
If you have hepatitis B, the best way of protecting your uninfected partner or child is to ensure your uninfected partner is offered the hepatitis B vaccination. Otherwise the virus could be passed on through unprotected sexual intercourse.
If you have hepatitis C the risk of transmitting the virus through unprotected intercourse is very low. Unfortunately there is no vaccination to protect your uninfected partner from hepatitis C. Women with hepatitis C should seriously consider having treatment to clear the virus from their blood before they conceive to avoid passing it on to their unborn child during pregnancy.
Does having a viral illness affect my chances of conceiving through IVF?
There is no clear evidence to show that having a viral illness will reduce your chances of conceiving if you have a fertility issue and need IVF. Many centres will not treat patients with viral illness because they do not have the expertise or facilities. Here at the Agora we aim to offer treatment to all patients with viral illness after consultation with your viral specialist and careful assessment of your wellbeing and the risks. Our laboratory facilities will ensure your safety and the safety of all our patients at all times.
Fertility screening and monitoring for couples wishing to conceive naturally
We advise all couples with a viral illness to book an appointment with Dr Carole Gilling-Smith to evaluate your fertility and discuss your options for conceiving safely. We provide fertility screening and follicle tracking if you would like to try and conceive naturally with timed unprotected intercourse.