I. Fertility program for male HIV carriers
For families where only the male is infected with HIV, sperm washing technology + assisted reproduction is the core solution.
Principle of sperm washing technology
Gradient centrifugation: Through Percoll density gradient centrifugation, virus particles in seminal plasma (present in semen but not sperms) are separated from healthy sperms, with a virus clearance rate of >99%.
Microscopic screening: Normal morphology and viable spermatozoa were screened under a 1000x microscope for intracytoplasmic sperm injection (ICSI).
Verification of viral detection: The washed sperm should be tested by ultrasensitive PCR to ensure that the HIV viral load (VL) is <20 copies/ml. Implementation conditions Men must have been receiving antiretroviral therapy (ART) for at least 6 months with sustained viral load suppression (VL <50 copies/ml). CD4+ T-cell count >200/mm³ and no comorbidity with other sexually transmitted diseases (e.g. syphilis, hepatitis B).
Success rate and cost
Clinical pregnancy rate: 65%-75%, not significantly different from the general population.
II. Fertility management for female HIV carriers
Female infected patients need to reduce the risk of vertical transmission through the whole mother-to-child blockade, and the success rate can reach 98%.
Preconception preparation
Antiretroviral therapy: Initiate ART 3 months prior to conception, prioritize integrase inhibitor regimen (e.g., raltegravir) and ensure VL <50 copies/ml. Ovarian function assessment: test AMH (>1.1 ng/ml) and sinus follicle count (AFC >5) to guarantee the efficacy of ovulation promotion.
Intervention during pregnancy
Medication adjustment: replace efavirenz (teratogenic risk) with raltegravir, continuous monitoring of liver and kidney function.
Delivery options:
VL <1000 copies/ml can be delivered spontaneously, strictly shorten the second stage of labor (<4 hours). VL >1000 copies/ml requires cesarean section to reduce the risk of birth canal exposure.
Postnatal management
Neonatal blockade: Zidovudine (AZT) within 6 hours of birth for 4-6 weeks, complete HIV nucleic acid testing at 6 months of age.
Feeding: breastfeeding is prohibited, formula is used, and mixed feeding is eliminated.
III. Special response for both parties infected with HIV
Cross-infection prevention and control
Even if both partners are infected, condoms should be used to prevent the virus from mutating and spreading drug resistance.
Priority should be given to ensure that both partners have VL <50 copies/ml and CD4 >350/mm³ before initiating childbearing program.
Embryo genetic risk control
Embryos are screened for chromosomes using 3-generation IVF (PGT) to rule out HIV-related mutations (e.g. CCR5Δ32).
iv. legal support and ethical norms
Reproductive rights protection
Article 41 of China’s AIDS Prevention and Control Regulations explicitly prohibits medical institutions from refusing to provide assisted reproduction services to HIV-infected patients.
Privacy protection: Infection status is limited to the knowledge of the medical team, and the laboratory implements biosafety level 3 protection.
International Medical Options
Thailand: LIVINA, JETANIN and other fertility centers provide the full process of sperm washing + three-generation IVF services, with a success rate of 75%.
USA: California Center for Reproductive Medicine (CCRM) can synchronize embryo gene editing (e.g., CRISPR-Cas9) to completely block the vertical transmission of HIV.
V. Implementation Path and Resource Docking
Domestic formal channels
Designated institutions: Peking Union Medical College Hospital, Shanghai Ruijin Hospital, etc. are qualified for HIV sperm washing.
Approval process: ART treatment records, viral load report and ethics committee review are required.
Psychological and social support
Patient community: China Red Ribbon Foundation provides legal counseling and medical resources.
International assistance: Global Fund (GF) provides 50%-80% cost subsidy for low-income families.
Risk warning and quality control
Technical Risks
There is still a 0.1% risk of viral residue after sperm washing, which needs to be combined with embryo freezing and secondary testing.
The risk of mother-to-child transmission is as high as 30% for natural conception without formal sperm washing.
Screening Criteria for Medical Institutions
Confirm that the laboratory has ISO15189 certification and virus inactivation equipment (e.g. ultracentrifuge).
Priority is given to organizations with an annual caseload of >100 cases, such as Superior ART Hospital in Thailand.
The core of scientific fertility is early planning and standardized treatment. With antiretroviral therapy to keep viral load at undetectable levels (U=U principle), combined with assisted reproduction techniques, it is entirely possible for HIV-infected patients to have healthy offspring. More than 2.4 million HIV-positive families around the world have succeeded in having children through this pathway, which is not only a medical breakthrough, but also a reflection of social inclusion.
