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Background:  The real effect of women’s HIV infection on fertility is unknown. The object of this study is to investigate whether infertile HIV-infected women have similar in vitro fertilization (IVF) sucess rate than non-infected women.

Methods:  We performed a case-control study including 50 IVF cycles in HIV-infected women, 50 cycles in HIV-serodiscordant couples (SDS; infected men exclusively) and 100 cycles in non-infected couples (controls), matched by age. We also performed another case-control study including 25 oocyte donation (OD) cycles in HIV infected women (cases) matched by age with 75 cycles in non infected couples and 16 non-matched cycles in HIV discordant couples. IVF cycles were done under standard ovarian hyperstimulation. Standard outcome variables for reproduction and clinical pregnancy rates were used. Variables associated with pregnancy were assessed through multivariate logistic regression analysis.

Results:  Indications for IVF and OD, and the percentage of cancelled cycles among IVF groups were similar. HIV-infected women had a lower number of inseminated oocytes (5 vs 7, p < 0.04), and embryos at day 2 (4 vs 3, p < 0.04) than controls. Pregnancy rates in IVF were 16% (HIV-infected women), 43% (SDS) and 38% (non-HIV-infected). OD cycles were 36% (HIV-infected women), 50% (SDS) and 47% (non-HIV-infected). HIV-infected women under IVF, but not after oocyte donation, had a significantly lower pregnancy rate than controls (SDS and non-infected) (see the table). Independent factors associated with pregnancy in the IVF group were age (adjusted OR per year 0.55, 95% CI 0.31 to 0.97, p < 0.018) and CD4 count (adjusted OR per unit 1.01, 95% CI 1.001 to 1.013, p < 0.018). Known duration of infection and of ART were not associated to pregnancy outcome. In the group of women with an OD, we were unable to find independent factors for pregnancy. On analyzing all HIV-infected women, CD4 count was the only independent factor associated with pregnancy (adjusted OR 1.003 per unit 95% CI 1.000 to 1.005)

SDS: HIV-infected men only, OD: oocyte donation

Conclusions:  HIV-infected infertile women have lower success rate for IVF than non-HIV-infected infertile women, but this difference does not exist with oocyte donation. Lower CD4 cells are associated with the lower success rate for IVF.

Keywords: HIV-1; Fertilization in Vitro; Oocyte Donation