Management of Infertility in HIV infected couples: A Review
), Osato. F. Giwa-Osagie(2),
(1) Nairawebs Design
(2)
Corresponding Author
Abstract
The HIV epidemic has continued to grow and remains a major challenge to mankind. In the past, ethical considerations about the resulting child and risks of sexual, vertical and nosocomial transmission of HIV prevented practitioners from offering fertility services to people living with HIV. In recent times however, the use of highly active antiretroviral therapy (HAART), has not only improved the life expectancy and quality of life of those infected but also reduced the risk of HIV transmission. The need for fertility services in the HIV-positive population has thus increased and may be employed for management of infertility and protection from transmission or acquisition of HIV infection. As such, preconception counseling, sexual health and fertility screening have become routine in the management of HIV-positive couples. The option of care include adoption, self insemination with husband sperm, embryo donation from couples who have been verified to be HIV negative, insemination with donor sperm, timed unprotected intercourse (TUI) and sperm washing combined with intrauterine insemination (IUI) and assisted reproductive technology (ART) including in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Access to these fertility services by HIV-positive clients should be facilitated as part of efforts to promote their reproductive health and rights.
(Afr J Reprod Health 2012; 16[4]: 13-20).
Résumé
L'épidémie du VIH a continué de croître et reste un défi majeur pour l'humanité. Dans le passé, les considérations éthiques concernant le bien-être de l'enfant et le risque de la transmission sexuelle, verticale et nosocomiale du VIH ont limité la dispensation des services de fertilité pour les personnes vivant avec le VIH. Ces derniers temps, cependant, l'utilisation de la thérapie antirétrovirale hautement active (TARHA), a non seulement amélioré l'espérance de vie et la qualité de vie des personnes atteintes, mais aussi de réduire le risque de la transmission du VIH. La nécessité de services de fertilité dans la population séropositive a donc augmenté et peut être utilisées pour le traitement des facteurs d'infertilité et de la protection de la transmission ou l'acquisition de l'infection du VIH. En tant que tel, le Counselling avant la reproduction, le dépistage de santé sexuelle et de fertilité sont nécessaires pour le traitement des couples séropositifs. L'option des soins comprendrait l'adoption, l’auto-insémination avec le sperme du mari, le don d'embryons de la part des couples qui ont été authentifiés comme étant séronégatifs, l'insémination avec le sperme du donneur, les rapports sexuels chronométrés non protégés et le lavage du sperme combiné avec l’insémination intra-utérine (IIU) et les techniques de reproduction assistée (TRA), y compris la fécondation in vitro (FIV) ou l’injection intra-cytoplasmique de spermatozoïdes (IICS). L'accès à ces services de fertilité par les clients séropositifs devrait être facilité comme faisant partie de la santé de reproduction et des droits (Afr J Reprod Health 2012; 16[4]: 13-20).
Keywords: HIV, AIDS, Infertility, highly active antiretroviral therapy (HAART), sperm washing, assisted reproductive
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