Getting Pregnant and HIV: HIV+ man and HIV-negative woman (serodiscordant)

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There are several different options for reducing the chances of passing on HIV while trying to get pregnant. If you are an HIV+ man and an HIV-negative woman seeking information on getting pregnant, the options below will help you understand what might be the best for you, and to prepare for discussions with your health care provider. (For other options, you can return to the main "Getting Pregnant and HIV" page.)

Sperm Washing

Sperm washing refers to a process in which sperm is separated from seminal fluid (semen = sperm + seminal fluid). Since HIV exists in seminal fluid but not in sperm, 'washing' the sperm clean of the seminal fluid lowers the risk of infection. See "Understanding the Science" for more information. Any of the types of assisted reproduction listed below can be used with washed sperm to get the HIV- woman pregnant.

Assisted Reproduction

This means that a sperm fertilizes an egg with the help of a medical technique or therapy. Assisted reproduction (sometimes called "assisted reproductive technology" or ART) is useful when the future parent(s) require help to prevent HIV transmission between partners, are using donor sperm, or are having difficulty getting pregnant at home because of fertility issues. Unfortunately, few facilities offer assisted reproduction to HIV+ patients, and few health insurance plans cover it. There are several types of assisted reproduction that can be used with washed sperm:

  • Intra-uterine insemination (IUI): Washed sperm is drawn up into a narrow tube, which is then inserted through the cervix into the uterus (womb). The sperm is deposited in the uterus, where fertilization of the egg can occur.
  • In-vitro fertilization (IVF): The woman takes fertility drugs to help her prepare eggs (also called ripening her eggs). When eggs are ready (or ripe), they are removed from the ovary and put in a dish with sperm. Once there is a fertilized egg (embryo), it is put back in the woman's uterus.
  • Intra-cytoplasmic sperm injection (ICSI): This is a specific type of IVF in which a sperm is injected directly into an egg using a very thin needle. When a fertilized egg occurs, it is returned to the woman's uterus. This method is used when a man's sperm do not swim well or are not normally shaped.

Donor Sperm

Donor sperm comes from a sperm bank or from someone you know who does not have HIV. Sperm donors to sperm banks are most often anonymous, and they are tested for fertility and diseases to make sure the sperm is safe and able to result in pregnancy. This involves no risk of HIV transmission to your partner.

Donor sperm is often used in an assisted reproductive technique called intra-vaginal insemination (IVI). In this procedure, sperm are placed deep inside the vagina by a health care provider. This is very similar to home insemination, only done in a clinic. Donor sperm can also be used in any of the other assisted reproductive techniques listed above.

Home Insemination

This involves using donor sperm from someone you know who does not have HIV. Depending on the state in which you live, you may be able to use donor sperm from a sperm bank for home insemination. If using donor sperm from a sperm bank for home insemination is possible in your state, ask your sperm bank for instructions on how to use the sperm at home.

If using sperm from someone you know who does not have HIV, have the man ejaculate (cum) into a clean cup or condom. If using a condom, be sure to use a condom without spermicide. Then, using a syringe (without a needle) or baster, you suck up the semen and insert the syringe or baster deep inside the vagina. Once the syringe or baster is deep inside the vagina, you squeeze out and deposit the semen. It is often recommended that the woman lie down for 20 minutes after inserting the semen to improve fertility. You can get non-needle syringes at most any pharmacy as they are commonly used to give medicines to babies. Your HIV provider may also have some to give you.

It is more effective to use home insemination when a woman is fertile, or when she is ovulating. Ovulation occurs when an egg is released from the woman's ovary and usually happens about two weeks before a woman starts her menstrual period. Insemination during the "fertile window" – usually one to two days before ovulation and one day after ovulation – has a greater chance of success. For more information on understanding and tracking your fertility, visit:

Unprotected Sex

It is important to remember that no matter how low the HIV+ partner's viral load – even if it is undetectable – there is always some risk of passing HIV to the uninfected partner with any type of unprotected sex. If you choose this method, the risk of passing on HIV is lower if you only have unprotected sex when the woman is ovulating (when she is most likely to get pregnant).

The risk of passing HIV to an uninfected partner may also be reduced when the HIV+ member of the couple takes HIV drugs (continuous combination antiretroviral treatment), even when he or she has no symptoms and a relatively healthy immune system. Recent studies of serodiscordant heterosexual ("straight") couples showed that HIV drugs were very effective in preventing HIV transmission to the uninfected stable partner of someone with HIV.

Another way to reduce the risk of passing HIV to an uninfected partner is to have the HIV-negative partner take Truvada (tenofovir/emtricitabine) as Pre-Exposure Prophylaxis, or PrEP. PrEP means taking medicine before being exposed to something to prevent yourself from becoming infected. In July 2012, the US Food and Drug Administration (FDA) approved the daily use of Truvada as PrEP for sexually active adults at risk for HIV infection. The US Department of Health and Human Services (DHHS) now recommends that serodiscordant couples consider using PrEP as an additional tool to help reduce sexual transmission of HIV while trying to conceive.

If you intend to have unprotected sex, it is important to tell your sexual partner that you are HIV+. Exposing someone to HIV without telling them you are HIV+ can result in serious legal action being taken against you.

Adoption

Offering a permanent family to a parentless child may be an option if having biologic offspring is not a good choice for you. Adoptions can be done within the US or internationally. Some agencies and/or countries may have prejudices against HIV+ people adopting children.

Finding a Provider and Building a Support Network

Regardless of your HIV status, choosing to have a child can be a very difficult and very exciting decision. While having a supportive relationship with a knowledgeable health care provider is a good idea for any potential parent, for people living with HIV it is even more important. A friendly health care provider can talk with you about many issues around pregnancy and having children: which conception option is right for you, appropriate HIV treatments for you and/or your partner, whether to disclose your HIV status to others (including other providers, your child's pediatrician, additional friends and family), and how to handle the stigma and fear around being HIV+ and pregnant.

Unfortunately, it can be difficult to find a friendly health care provider who is knowledgeable about HIV and pregnancy. Some health care providers simply are not aware of the wealth of information about pregnancy planning for their HIV+ patients. Perhaps even more challenging, though, are the judgmental attitudes still held by many health care providers. When The Well Project's Founder, Dawn Averitt, asked providers about getting pregnant, she faced some very negative reactions before she found a wonderful provider who supported her desire to have children. For more about Dawn's experience in trying to get pregnant, and subsequently having two healthy HIV-negative daughters, please read the links below:

The Well Project has started a list of friendly family planning providers who are informed about pregnancy planning for HIV+ people. Even though the providers listed might not be in your area or town, it might be worth a call or email to answer any questions you might have or for possible referrals. HIV-positive pregnant women, their exposed infants, and HIV-affected couples seeking safer conception options can also contact Shannon Weber (sweber@nccc.ucsf.edu) for referrals to local providers.

Given the existing stigma against HIV+ people having children, you may encounter judgmental responses from others. Therefore, it is important that you build a strong support network of loving family, friends, and providers. Your support network can help you make good decisions and get through the negative, sometimes disheartening moments. If you do not have a good number of friends and family who support you, you may consider starting your own support group; for more information, see our article on Starting a Support Group.

Ultimately, you get to choose when and whether to have children. You deserve to be treated with respect and given access to the information necessary to make an informed decision and plan for your future.

Additional Resources

Select the links below for additional material related to getting pregnant and HIV.

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