Can we become parents if my partner is HIV+ or has another contagious illness like hepatitis or syphilis?
Spanish Law provides for the protection of the unborn child and therefore strict monitoring is put in place so that no illnesses are transmitted to offspring.
When the male partner has an infectious disease, like HIV, the semen can be “washed” of the virus, frozen and then used in an IVF cycle using microinjection using a spermatozoid free of the virus. When the female partner has the infectious disease, the ability to use assisted reproduction techniques depends on the stage of the infection and the viral load.
Under current Spanish law relating to infectious diseases, Assisted Reproduction Centres are responsible for 3 objectives:
1 .- Avoid vertical transmission to the foetus.
2 .- Prevent transmission between partners.
3 .- Avoid iatrogenic contamination of other patients through the samples in the laboratory.
Therefore, every couple must undergo testing before starting an assisted reproductive technique (ART), having to perform complete serological studies for syphilis, hepatitis B, hepatitis C and human immunodeficiency virus (HIV).
For HIV without medication the risk of vertical transmission is 15-20%.
Hepatitis B has a risk of vertical transmission of 20-90% depending on the stage of viral replication.
For hepatitis C the risk of vertical transmission varies from <1% if viral load is <10 4 copies / ml up to 36% if the load is> 10 6 copies / ml.
In the absence of early diagnosis and treatment of syphilis, only 20% of foetuses will be born healthy.
From here on there are distinct cases we can find and should leave it perfectly clear that each couple and their circumstances are going to be unique and different.
1 .- HIV + Women: The patient must undergo antiretroviral treatment to achieve an undetectable viral load and CD4 cell counts > 200/mm3. In these circumstances and with measures to reduce vertical transmission (caesarean section, intrapartum antiretrovirals and formula feeding) the risk of infection is less than 1%.
2 .- Male HIV +: In this case sperm washing and ICSI will always be applied, regardless of viral load in blood and even though it is undetectable.
Even if both 1 and 2 above are carried out special protocols for preventing occupational risk exposure of health personnel are applied as well as a special laboratory circuit for the treatment of the samples from these patients.
3 .- Woman HBV +: The patient must undergo treatment to reduce viral load prior to pregnancy or fertility treatment. The new born will receive the vaccine against Hepatitis B and gamma globulin. Vaccination is also recommended for the partner.
4 .- Male HBV +: Just vaccination is required of the couple and then follow treatment when the antibody level is adequate.
5 .- HCV + Women: Treatment prior to pregnancy or TRA to decrease viral load.
6 .- Male HCV +: In this case again sperm washing and the use of ICSI is adequate.
7 .- Female or Male with Syphilis: Treatment with penicillin G and wait 3 to 12 months, depending on the stage of the disease, before performing any work.