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Background:  The French law allows assisted reproductive techniques for HIV-infected patients. Assisted Reproductive Techniques are proposed to avoid contamination of the female partner and the offspring and for the treatment of an associated infertility. We report here our 4-year experience of pluridisciplinary care of infected men.

Methods:  We followed the care of 123 HIV-positive men were referred to our center. Seventy-nine files are already complete. Twenty-nine patients were co-infected with Hepatitis C virus (HCV). For 10 couples, both partners were infected. The median age of the male patients was 36 (25 to 58); the median age of their female partners was 32 (19 to 44) and their follicle-stimulating hormone (FSH) basal level was 6.5 in utero (IU)/l (0.1 to 18.7). We treated 70 men with antiretroviral therapy and 9 patients did not need any treatment. Their infection was well-controlled with a median CD4 count of 542/mm³ (197 to 1 577). Plasmatic viral load was indetectable for 63.3% of the patients and was 902 copies/mL (70 to 649 430) for the others. Assisted reproductive techniques were proposed to avoid viral contamination and for the treatment of an eventual associated infertility.

Spermatozoa preparation used a 2-step discontinuous gradient and the swim-up technique. Only samples negative for HIV-1 RNA/DNA and for HCV RNA in the final fraction of seminal cells could be used.

Results:  We prepared 100 semen samples and tested for HIV, and were able to validate 89 of them. We also tested 26 samples for HCV, and were able to validate and all of them. An assisted reproductive technique procedure has already been performed for 68 couples:  intrauterine insemination (IIU) for 10, intracytoplasmic sperm injection (ICSI) for 140, and frozen-thawed embryo transfer for 30. Assisted reproductive techniques resulted in 46 pregnancies:  1 for IIU, 43 for ICSI, and 2 for frozen embryo transfers. Out of these pregnancies, 28 deliveries resulted in the birth of 36 babies. 11 miscarriages and 1 extra uterine pregnancy occurred. 6 pregnancies are ongoing. A pregnancy was obtained for 67.6% of the couples and 41.2% of the couples are already parents. All the women and the babies born are healthy with a negative viral load screening.

Conclusions:  Our results show that assisted reproductive techniques are feasible, safe and very efficient for HIV seropositive men, and that assisted reproductive techniques, especially ICSI, can be proposed to seropositive couples to avoid contamination of the female partner and the offspring and to treat a possible associated infertility.

Keywords: ART; HIV; men