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Timed vaginal insemination effective for HIV-affected couples trying to conceive
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Timed vaginal insemination is an “acceptable, feasible, and effective” method for attempting pregnancy among HIV-infected women in low-resource settings, according to findings from a prospective pilot study published in PLoS One.
“Female-positive/male-negative HIV-serodiscordant couples express a desire for children and may engage in condomless sex to become pregnant. Current guidelines recommend antiretroviral treatment in HIV-serodiscordant couples, yet HIV RNA viral suppression may not be routinely assessed or guaranteed, and pre-exposure prophylaxis (PrEP) may not be readily available,” Okaoma Mmeje, MD, assistant professor of obstetrics and gynecology at the University of Michigan School of Public Health, and colleagues wrote. “Therefore, options for becoming pregnant while limiting HIV transmission should be offered and accessible to HIV-affected couples desiring children.”
In a prospective pilot study conducted in Kisumu, Kenya, Mmeje and colleagues evaluated timed vaginal insemination during the fertile period of the menstrual cycle as a safer method for serodiscordant couples to become pregnant. According to the study, women participating were aged between 18 and 34 years with regular menses. Couples were observed for 2 months before timed vaginal insemination, which was performed for up to six menstrual cycles.
In total, 23 couples underwent timed vaginal insemination, of which eight (34.8%) became pregnant. According to the study, of these eight, there were six live births, all without a case of HIV transmission.
According to Mmeje and colleagues, fertility evaluation of seven couples who did not achieve pregnancy revealed that four women had no demonstrable tubal patency bilaterally, five women had unilateral/bilateral tubal patency, seven women had an HIV RNA viral load of 400 copies/mL or higher and one male partner had decreased sperm motility.
Overall, they found timed vaginal insemination to be “a feasible and effective method for attempting pregnancy” in female-positive/male-negative serodiscordant couples.
“There is an apparent research gap in the implementation and provision of safe reproductive options for HIV-serodiscordant couples desiring children,” they wrote. “Our findings suggest that implementation studies are warranted to inform widespread integration of [timed vaginal insemination] into HIV care and treatment programs in low-resource settings.
“HIV-serodiscordant couples planning to have children should be supported in shared decision-making with a range of reproductive options that may include treatment as prevention, timed condomless intercourse, [timed vaginal insemination], PrEP, and assisted reproductive technology services.” – by Caitlyn Stulpin
Disclosures: The authors report no relevant financial disclosures.
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