There are several different options for reducing the chances of passing on HIV while trying to get pregnant. If you are a man living with HIV who is either single or in a same-sex relationship, the options below for having a child will help you understand what might be the best for you and prepare you for discussions with your health care provider. (For other options, you can return to the main "Getting Pregnant and HIV" page.)
The US Department of Health and Human Services (DHHS) recommends semen analysis for men living with HIV before trying to get pregnant. Men living with HIV may have fertility problems more often than HIV-negative men. Making sure his sperm is fertile before you start trying to get pregnant can help you and your partner choose the best method for getting pregnant.
Analyzing semen for fertility (ability to achieve pregnancy) is a simple procedure that requires a urine specimen. However, it can sometimes be difficult to find a facility willing to analyze the semen of a man living with HIV (see below for help finding facilities and providers). In the US, this analysis is usually not covered by insurance and costs $100 to $250.
One of the best things that you can do in this situation is take HIV drugs regularly and maintain a suppressed viral load, even when you have no symptoms and a relatively healthy immune system. This will increase the likelihood that you will have healthy, virus-free semen if you choose to have your sperm washed and use a surrogate.
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 transmitting HIV. See "Understanding the Science" for more information. Any of the types of assisted reproduction listed below can be used with washed sperm to get a surrogate woman pregnant. Although it is biologically possible to have an HIV+ man's washed sperm fertilize a donor's egg and be implanted in a surrogate, you may encounter several legal or regulatory challenges to this option. Even if it is legal in your state, you may find fertility clinics or surrogacy centers unwilling to provide this service to men living with HIV.
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 patients living with HIV, 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 a 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 a woman's uterus. This method is used when a man's sperm do not swim well or are not normally shaped.
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 people living with HIV adopting children. In addition, adoption may be more difficult as a single man or as a man in a same-sex relationship given different states' and/or international adoption rules. Some states and countries do not allow single or same-sex parents to adopt. Even in those that allow it, there are often prejudices against single or same-sex parents and in favor of heterosexual married couples.
Finding a Provider and Building a Support Network
When choosing to have a child as a person living with HIV, it is important to be an advocate for yourself and your future child. Finding the right health care provider who is supportive of your plans to get pregnant is a big first step! 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 living with HIV and being pregnant.
When The Well Project's Founder, Dawn Averitt, asked providers about getting pregnant over 14 years ago, she faced some very negative reactions before she found a wonderful provider who supported her desire to have children. While her original experience in getting pregnant and having two healthy HIV-negative daughters is discussed in the three articles listed below, Dawn recently posted a blog about Getting Pregnant while Living with HIV in 2015. Here's part of what she said:
My own children are now 11 and nearly 13, and in most urban settings, no one raises an eyebrow when they say "my mom has HIV." I wish I could say this was universal, but it isn't. Many health care providers are not familiar enough with the information about HIV to know that HIV-positive women can choose to become pregnant, and that, with access to good prenatal care and HIV treatment, their risk of transmitting HIV to their infants is less than two percent. This is why it is so important to find a health care provider who is knowledgeable about HIV and pregnancy – they are definitely out there! Dawn Averitt, Getting Pregnant while Living with HIV in 2015
For more about Dawn's experience in trying to get pregnant, please explore the links below:
- HIV and Pregnancy: Tough Choices and the Right to Choose (Journal of the Associate of Nurses in AIDS Care, Vol. 13, No. 3, May/June 2002, 11-12 courtesy of the Sophia Forum)
- Breaking the Taboos: Pregnancy Planning and Fertility Issues for PLWHAs in the US (transcript from presentation at AIDS 2010 in Vienna, Austria, courtesy of TheBody.com)
- Baby Love (POZ magazine, December 2002)
The Well Project has started a list of friendly family planning providers in the US who are informed about pregnancy planning for people living with HIV. 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. Pregnant women living with HIV, their exposed infants, and HIV-affected couples seeking safer conception options can also contact Shannon Weber (Shannon.Weber@ucsf.edu) at HIVE for referrals to local providers.
Given the existing stigma against people living with HIV 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 info sheet 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.