Background:  The optimization of ART has led to great improvements in both the quality of life and life expectancy in countries where HAART is widely available. Assisted reproduction techniques can minimize the risk of infection and treat possible sterility associated with serodiscordant couples. Our aim was to evaluate the results of our assisted reproduction program.

Methods:  Our center for sperm wash and assisted reproduction was attended by 55 serodiscordant couples with HIV⁺ males and HIV/hepatitis C virus (HCV)-seropositive males. At enrollment, a full report of disease course and current ART was obtained for all HIV-seropositive men, and selected couples were accepted for intracytoplasmic sperm injection (ICSI) only if the male partner had a plasma viral load of HIV <50 copies/mL and HCV RNA <3600 copies/mL detected by polymerase chain reaction (PCR). Sperm wash was performed with a combination of swim-up and density centrifugation. At the end of the procedure an aliquot containing at least 2 million spermatozoa underwent virological studies (mRNA amplification method). The other part of the swim-up fraction was frozen in liquid nitrogen and used only in case of negative response. After this treatment the couples were advised to undergo ICSI. Pregnant women and newborns were tested by HIV DNA PCR at birth and 3 months later. In nonpregnant patients, HIV ELISA antibody screens were performed 3 months following endometrial thickening.

Results:  We cancelled 4 cycles because of poor ovarian response and risk of hyperstimulation. A total number of 49 ICSI cycles with frozen negative semen samples were carried out and 15 pregnancies were obtained. The pregnancy rate of ICSI was 30.6% per endometrial thickening. The ongoing and delivered pregnancy rate was 25.6%. No seroconversion was detected in the patient’s partner during the follow-up period and no infection was evidenced in the newborns.

Conclusions:  Assisted reproduction techniques and particularly ICSI provide HIV-seropositive men with a safe and highly effective means of fathering children. Serodiscordant couples who undergo in vitro fertilization and ICSI to avoid sexual transmission of disease express a good rate of success. Both partners always have to be informed that even if specimens are processed, and extensive testing methods are used, a possible infection of the partner or child cannot be completely ruled out. However, after more of 10 years of assisted procreation, there has been no known case of horizontal transmission after adequate sperm preparation.