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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 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 best for you and prepare you for discussions with your health care provider. (For other options and more general information, 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 your sperm is fertile before you start trying to get pregnant can help you choose the best method for getting pregnant.
Analyzing semen for fertility (ability to achieve pregnancy) is a simple procedure that requires a semen sample. 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.
One of the best things that you can do in this situation is to take HIV drugs regularly and maintain a suppressed (undetectable) 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.
This means that a sperm fertilizes an egg with the help of a medical technique or therapy. Assisted reproduction (sometimes called "assisted reproductive technology") 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 people 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): 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.
An egg from a surrogate (woman who enters an agreement with other people to carry a baby for them) or an egg donor is fertilized using IVF or ICSI, then transferred to the surrogate's womb. The surrogate then carries and gives birth to your child.
Although it is biologically possible to have the washed sperm of a man living with HIV 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.
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. Unfortunately, while many people living with HIV have welcomed children into their homes through adoption, unfair biases do exist in this field. 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 countries’ adoption rules. Some countries do not allow single or same-sex parents to adopt. Even in those that allow it – and even though it is now technically legal for LGBT parents to adopt across the United States – there are often prejudices against single or same-sex parents and in favor of heterosexual married couples.
Finding a Supportive Provider
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, including which conception option is right for you. They may also be able to speak with you about whether to disclose your HIV status to others (including other providers, your child's pediatrician, additional friends and family), and how to handle any stigma or fear you may experience around living with HIV and having children. Please see the main "Getting Pregnant and HIV" page for even more information about building a support network.
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.