Undetectable equals untransmittable (U = U): implications for preconception counseling for human immunodeficiency virus serodiscordant couples

Although limited by society guidelines from the American Society for Reproductive Medicine and the Centers for Disease Control and Prevention in the past, many human immunodeficiency virus serodiscordant American couples who desired future childbearing were referred to reproductive endocrinology and infertility specialists for in vitro fertilization. The access to and cost of assisted reproductive technology created a significant barrier to reproductive care in this patient population. New evidence-based guidelines by the Centers for Disease Control and Prevention, however, endorse condomless intercourse timed to ovulation for human immunodeficiency virus serodiscordant couples with undetectable viral loads on antiretroviral therapy. In parallel, the Prevention Access Campaign's undetectable equals untransmittable initiative advocates increasing awareness of the favorable prognosis of persons living with human immunodeficiency virus to remove the associated stigma of the disease and promote the safety of condomless intercourse in the setting of undetectable viral loads. With these new guidelines, human immunodeficiency virus serodiscordant couples may not require an automatic referral to the reproductive endocrinology and infertility specialist. Rather, providers of preconception care could recommend timed intercourse for these couples after confirmation of an undetectable viral load and discussion with the interdisciplinary team of health care professionals caring for persons living with human immunodeficiency virus.