Effectiveness of semen washing to prevent human immunodeficiency virus (HIV) transmission and assist pregnancy in HIV discordant couples: a systematic review and meta analysis

Semen washing appears to be effective and safe, significantly reducing the risk of human immunodeficiency virus (HIV) transmission in HIV-discordant couples attempting to become pregnant by means of assisted reproduction.

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Authors

Maryam Zafer, M.S., Hacsi Horvath, M.A., Okeoma Mmeje, M.D., Sheryl van der Poel, M.D., Augusto Semprini, M.D., George Rutherford, M.D., Joelle Brown, Ph.D.

Volume 105, Issue 3, Pages 645-655

Abstract

Objective:

To evaluate the effectiveness of semen washing in human immunodeficiency virus (HIV)–discordant couples in which the male partner is infected.

Design:

Systematic review and meta-analysis.

Setting:

All countries.

Patient(s):

Forty single-arm open-label studies among HIV-discordant couples that underwent intrauterine insemination (IUI) or in vitro fertilization (IVF) with or without intracytoplasmic sperm injection (ICSI) using washed semen.

Intervention(s):

Semen washing followed by IUI, IVF, or IVF/ICSI.

Main Outcome Measure(s):

Primary outcome: HIV transmission to HIV-uninfected women; secondary outcomes: HIV transmission to newborns and proportion of couples achieving a clinical pregnancy.

Result(s):

No HIV transmission occurred in 11,585 cycles of assisted reproduction with the use of washed semen among 3,994 women. Among the subset of HIV-infected men without plasma viral suppression at the time of semen washing, no HIV seroconversions occurred among 1,023 women after 2,863 cycles of assisted reproduction with the use of washed semen. Studies that measured HIV transmission to infants reported no cases of vertical transmission. Overall, 56.3% of couples (2,357/4,184) achieved a clinical pregnancy with the use of washed semen.

Conclusion(s):

Semen washing appears to significantly reduce the risk of transmission in HIV-discordant couples desiring children, regardless of viral suppression in the male partner. There are no randomized controlled studies or studies from low-income countries, especially those with a large burden of HIV. Continued development of lower-cost semen washing and assisted reproduction technologies is needed. Integration of semen washing into HIV prevention interventions could help to further reduce the spread of HIV.

Read the full text at: http://www.fertstert.org/article/S0015-0282(15)02112-3/fulltext

Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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