Safe & Effective Method to Help HIV Infected Couples Conceive

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Highlights:

• In HIV infected couples, where the female partner is HIV positive and the male partner is uninfected, timed vaginal insemination (TVI) is a safe and effective method to achieve pregnancy with low risk of HIV transmission to the male
• With advances in treatment, HIV infected persons live normal productive lives and long to have kids and a family and TVI is a safe and inexpensive method to aid conception in low-income countries.
• Although antiretroviral (ART) therapy controls viral load to low levels in infected persons, it does not guarantee that HIV transmission will not occur. Moreover, viral load is not assessed routinely in many cases. Thus timed vaginal insemination is a safer option

Timed vaginal insemination is a safe, inexpensive and effective procedure to help HIV couples, where say only one partner (in this case the woman alone) is HIV positive to conceive and have children. This was published in a recent study by Okeoma Mmeje, M.D., assistant professor of Obstetrics and Gynecology at Michigan Medicine.

"HIV does not change an individual's desire to have children," said the lead author of the study "Our study describes a feasible, safe and effective method for women living with HIV to achieve pregnancy" she added.

‘Timed vaginal insemination is a safe effective method to achieve pregnancy when the female partner is HIV positive and the male partner is HIV negative (i.e they are sero-discordant) with low risk of HIV transmission to the male.’

The findings of the study appear in the journal PLOS ONE.

What is Timed Vaginal Insemination (TVI)?

Timedvaginal insemination refers to the deposition of collected semen by means of a syringe into a woman's vagina during her most fertile period and is done about 24-48 hours before the expected day of ovulation, in order to achieve a pregnancy.

• For timed vaginal insemination, the woman closely monitors her menstrual cycle and during her most fertile period (1-2 days prior to ovulation).
• The male partner's semen is collected either into a water-based lubricated condom (which does not kill sperms) or by ejaculation into a clean cup.
• The semen is then drawn into a needleless syringe or into a bulb pipette.
• While the woman lies on her back with hips elevated the semen is slowly introduced deep into the vagina either by herself or her partner.

Efficacy of Timed Vaginal Insemination in HIV Infected Couples

Participants in the study were enlisted from eight HIV treatment clinics in the Kisumu area of Western Kenya. The women were aged between 18 to 34 years. The participants underwent counseling sessions and teaching aids were used to educate them about the procedure

• The study included 23 couples, in whom the woman was HIV infected and her partner was not.
• The couples were initially monitored for two months when they were tested and treated for sexually transmitted diseases before the timed vaginal insemination was started.
• Timed vaginal insemination was done for up to six menstrual cycles.
• Of the 23 couples, Timed Vaginal Insemination or TVI resulted in six live deliveries without HIV transmission.
• At the end of the study, fertility evaluation was offered to couples who did not conceive.

The findings of the study suggest that timed vaginal insemination is a safe and effective method to help HIV infected couples conceive

Dispelling Myths About Pregnancy in HIV Infected Couples

Pre-conception counseling is particularly important to dispel many wrongly held notions about pregnancy prevalent among HIV couples

It is not possible to have a baby if you use a condom.

• Health personnel discouraged pregnancy in HIV infected couples deeming it unsafe for the baby.
• During pregnancy the immune system becomes even more weak.

Pros & Cons of Timed Vaginal Insemination

• The procedure can be done at home without the need to feel embarrassed about going to a clinic to provide a semen sample.
• The TVI procedure can be easily integrated into HIV control programs and made readily accessible.
• It is safe, inexpensive and effective.
• Timing of the woman's fertile period may not always be accurate; however, the occurrence of thin, clear, cervical mucus that can be stretched (spinnbarkeit) is a reliable indicator of ovulation and correlates best with the timing of ovulation by ultrasound imaging.
• Couples may technically find it difficult to collect the semen correctly and/or deposit the semen into the vagina properly.
• They may feel uncomfortable touching the genitalia while doing the insemination procedure

Timed vaginal insemination is a safe and effective way of achieving pregnancy and can be easily integrated into HIV programs in low-income countries across the world. Once the initial discomfort with the technique and the socio-cultural barriers surrounding the procedure are overcome TVI can become be an affordable and easily accessible reproductive option in these couples.

References:

1. Empowering HIV-infected women in low-resource settings: A pilot study evaluating a patient-centered HIV prevention strategy for reproduction in Kisumu, Kenya - (https:journals.plos.org/plosone/article?id=10.1371/journal.pone.0212656)
2. Achieving Pregnancy Safely: Perspectives on Timed Vaginal Insemination among HIV-Serodiscordant Couples and their Healthcare Providers in Kisumu, Kenya - (https:www.ncbi.nlm.nih.gov/pmc/articles/PMC4221525/)
3. Evaluating Safer Conception Options for HIV-Serodiscordant Couples (HIV-Infected Female/HIV-Uninfected Male): A Closer Look at Vaginal Insemination - (https:www.hindawi.com/journals/idog/2012/587651/)

Source: Medindia

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