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Step-by-step: Sperm Washing
compiled by Enid Vázquez
1. Find a sensitive medical
provider
- See resources
at the end. Ask members of your support system, such as
other people living with HIV and your medical providers.
- Be aware that your doctor may
have to sign a statement verifying that you’re in good
health. The wording of these statements varies among the
fertility clinics (example: “Does this individual have
a life-threatening disease?”). Many doctors will feel
able to say “no” in good conscience.
2. Get money
- Reproductive services are expensive.
If your insurance won’t cover the costs or you don’t
have insurance, you will need to pay out-of-pocket at the
time of the service.
3. Check for fertility
problems in both partners before proceeding
4. Lower viral load
- The lower the man’s viral
load, the lower the risk of infection.
- Research has found that plasma
viral load differs from viral load in seminal fluid. Someone
who has an undetectable viral load in their blood may have
detectable viral load in their genital fluids, and vice
versa (this is true for the female genital tract as well).
Please note that “undetectable” means not able
to be detected with the test used. HIV is still there.
- At least one study has found
protease inhibitors to have different effectiveness in the
genital tract.
5. Look for other STDs
- The presence of other sexually
transmitted diseases should be looked for and treated. They
increase the risk of both HIV transmission and infertility.
They may also increase seminal viral load even if there
is no change in the plasma viral load.
- If the male also has hepatitis
A or B, the woman should be vaccinated against those viruses.
- If the male has hepatitis C,
for which there is no vaccine, it should be eliminated during
sperm washing at the same time as the HIV and the sample
tested for its presence afterwards (just as with HIV). It
is currently unclear whether hepatitis C is transmitted
easily during sex.
6. Use sperm washing
- Sperm washing is a procedure
long used to help couples trying to conceive without passing
on diseases or genes for disease. Sperm are separated from
the surrounding seminal fluid by a centrifuge, a device
that separates components of a liquid as it spins at high
speed. The sperm are then washed twice in a solution, in
an effort to remove the undesirable materials.
- Not all reproductive service
laboratories can conduct sperm washing for HIV.
7. Test the sperm sample
- Not all reproductive service
laboratories can test sperm samples for HIV after it’s
been washed—a step considered key to safer conception.
- PCR (polymerase chain reaction),
the same technology behind viral load testing, is used to
test the sperm sample. There are different PCR tests that
can be used. The best test to use is not established.
8. Store the sperm sample
- The sample is frozen and stored
until the HIV test results come back. It may also be stored
for use during the woman’s next fertility cycle if
she is past ovulation when the results come back.
- There is a cost for storage.
9. Fertilization
- In vitro fertilization (IVF)
represents the “test tube” baby. Eggs are removed
from the woman’s ovary and fertilized with sperm in
a petri dish, resulting in zygotes (or “pre-embryos”)
that are placed in the woman’s uterus or stored for
later use. IVF is considered the safest method for conceiving
with HIV.
- Intracytoplasmic sperm injection
(ICSI—pronounced “icksy”) is another type
of IVF. ICSI is when a single sperm cell is used to fertilize
the egg. It is an additional step that can be taken, so
it’s more expensive. However, it also increases the
level of safety. It is especially useful with a low sperm
count when the fertilization otherwise would not occur.
10. Insemination
- Intra-Uterine Insemination (IUI)
- Washed sperm is placed directly
into the cervix or the uterus itself.
- Sperm washing with IUI may be
just as safe and less expensive than other insemination
methods.
- Cervical cup. The Duncan Holly
Clinic offers an oligospermic cup, inserted over the cervix
by a doctor. The washed sperm then travels into the uterus.
Anti-HIV medication is given at the time of insertion. The
safety in preventing transmission of HIV is not well-established.
For example, there might be the potential for microscopic
tears of the vagina.
Low-tech methods at home
- PEP stands for “post-exposure
prophylaxis.” It’s HIV medicine that can be taken
to prevent transmission following exposure. In this case,
it can also stand for “pre-exposure prophylaxis”
(or “PREP”) meaning that the woman takes medicine
to prevent transmission before exposure to HIV. This is
where knowledge of HIV medicine comes in handy (see past
issues of Positively Aware). Many HIV specialists are willing
to prescribe PREP to serodiscordant couples (where one partner
is HIV positive and the other is not) who are trying to
conceive. Cost will likely be out-of-pocket, and you may
want to avoid using your insurance because it could raise
red flags on your coverage that may haunt you later. Some
organizations may clandestinely have limited quantities
of pills for HIV therapy available for free. It is illegal
to give prescription medicine to someone other than the
person for whom it was prescribed. These services make use
of leftover pills for situations such as a gap in refills
or for out-of-towners who forgot their medicines at home.
There are also programs that send medications abroad. You
can check with them.
- The effects of PEP or PREP on
fetuses and children born to women who used either PEP or
PREP, if any, are currently unknown.
- Ovulation kits can help a woman
determine when she is most likely to conceive, thereby limiting
sexual exposure to this time. Kits are available at most
drugstores at an affordable price.
- Do-it-yourself insemination
(the “turkey baster” method) can be done with
a syringe (without the needle) and washed sperm or unwashed
semen. According to WORLD, “It’s best if the woman
is on her hands and knees, shoulders down and hips in the
air, and stays there as long as possible [after insemination].”
Even after sperm washing,
there’s no 100% guarantee that HIV will not be transmitted.
Ironically, sperm doesn’t seem to be infected by HIV;
however, HIV may be present in the seminal fluid surrounding
the sperm. In addition, while sperm washing and testing may
be relatively simple and inexpensive, the processes and procedures
involved with in vitro fertilization, zygote implantation,
and clinical insemination are complex and expensive. These
are, however, the safest ways to conceive. Please note that
the clinics listed have differences of opinion in which procedure
is best to use. The websites or a consultation will clarify
those differences.
Using a turkey baster or
syringe (without the needle) at home is more risky. Here,
too, is another irony: the risk of infection with one act
of vaginal intercourse is relatively low. The risk of infection
increases with the presence of other sexually transmitted
diseases or lesions, repeated unprotected intercourse, higher
HIV viral load and biological factors in the man and the woman
that are still largely not understood and which cannot be
detected at home. Doctors cannot publicly advocate for these
procedures—another good reason why you need a compassionate
physician to guide you in private.
Resources
American Society for Reproductive
Medicine. Visit www.asrm.org.
Bay Area Perinatal AIDS Center
(BAPAC), at the University of California, San Francisco's
(UCSF) Positive Health Program in San Francisco General Hospital.
Offers pre-conception counseling and infertility work-up to
seroconcordant and discordant couples (both partners positive
or one partner is positive). Also conducts prenatal care to
HIV-positive women. Call (415) 206-8919. Visit http://php.ucsf.edu/bapac.
Center for Women’s Reproductive
Care, at Columbia University in New York City. Conducts IVF
for serodiscordant couples. Call (646) 756-8282.
Beford Research Foundation (formerly Duncan Holly Biomedical).
Operates the Special Program of Assisted Reproduction (SPAR),
started in 1994 as a support group for couples living with
incurable sexually transmitted virus diseases such as HIV.
Developed a mail-in product for shipping sperm-washed samples
to fertility clinics around the country, as well as an HIV
testing kit for sperm that can be mailed to you at home. Complete
details and in-depth articles available on its website, including
the story of Baby Ryan, the first baby conceived through SPAR.
Call (617) 623-5670 or (617) 623-7447, or visit www.duncanholly.org.
Reproductive Lab Service,
233 East Erie St. Suite 309, Chicago, IL 60611. Call toll-free:
(877) REPROLAB (737-7652). Visit www.reprolab.org.
SMART (Sisterhood Mobilized
for AIDS/HIV Research & Treatment), New York City, provides
treatment and prevention education and support for women impacted
by HIV/AIDS. Call (917) 593-8797, write smartuniv@aol.com
or visit www.smartuniversity.org.
“Sperm Washing:
Reducing the Risk of Father to Mother Transmission.”
Comprehensive article, although written in 2001. Visit www.hivinsite.ucsf.edu.
Women Organized in Response
to Life-threatening Diseases (WORLD), 414 13th Street, 2nd
floor, Oakland, CA 94612. Call (510) 986-0340. Visit www.womenhiv.org.
Unfortunately, not all copies of their excellent newsletter
and articles are available on-line. However, an abbreviated
version of their article “Reducing the Risks of Conception:
Getting Pregnant When One or Both Partners is HIV positive,”
is available at www.PositiveWords.com.
The article is very easy to understand and extremely detailed.
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