Providing fertility care to men seropositive for human immunodeficiency virus: reviewing 10 years of experience and 420 consecutive cycles of in vitro fertilization and intracytoplasmic sperm injection

Objective: To review 10 years of experience providing fertility care to men seropositive for human immunodeficiency virus (HIV) using sperm washing and in vitro fertilization with intracytoplasmic sperm injection (IVF-ICSI). Design: Retrospective study. Setting: University-based practice. Patient(s): HIV-seropositive men with HIV-seronegative partners. Intervention(s): IVF-ICSI, HIV testing of females and infants. Main Outcome Measure(s): IVF performance, pregnancy rates, obstetrical outcomes, infection rates. Result(s): We initiated 420 cycles (355 fresh and 65 frozen cycles) in 181 couples. Due to poor ovarian response, 16% of stimulations were canceled. The number of oocytes collected per retrieval was 15.0 ± 0.5, providing 12.1 ± 0.5 mature oocytes suitable for ICSI, yielding 9.0 ± 0.3 embryos per couple. The overall clinical pregnancy rate/embryo transfer was 45%; ongoing/delivered pregnancy rate/embryo transfer was 37%. The most frequent obstetric complication was multiple gestation (41%), with 5% experiencing high order multiple birth. An attendant high rate of preterm delivery was noted, as 43% of infants were born premature. No maternal or neonatal HIV infections or deaths occurred. Conclusion(s): We have found IVF-ICSI to be an expeditious and safe means for HIV-serodiscordant couples to achieve pregnancy with minimal risk of viral infection. Risks and liabilities of IVF-ICSI relate to multiple gestations and will occur in a significant number of participants.