Background:  Since 2001, French law allows the use of assisted reproductive treatment in couples in which a member is HIV infected. Most published results concern fertile patients. Being infected does not preclude being fertile. This study presents results of a comprehensive assisted reproductive treatment program dealing with chronic HIV-1-infected, infertile patients and the outcome of assisted reproductive treatment (i.e. take-home baby rate) according to HIV carrier and gender cause of infertility .

Methods:  This retrospective study, 2002 to 2006, used the following major Inclusion criteria were: CD4 lymphocyte count >200/mm³ and a stable HIV viral load <4 months prior to assisted reproductive treatment, and undetectable plasma viral load within 2 weeks for the negative partner. After a viral screening of selected sperm (after washing if the male is HIV⁺) and a cryo-preservation of virus-free straws, in vitro fertilization or intra-cytoplasmic sperm injection was performed according to the etiology of infertility. Couples without fertility problems treated with intrauterine insemination (70% in our program) and couples with both partners infected are not included in this study.

Results:  Of 75 couples, 45 HIV⁺ women (group A) had HIV^– partners, and 30 HIV^– women (group B) had HIV⁺ partners. Among group A, 26 woman were unfertile and 19 had an infertile partner. Among group B, 5 women were infertile. Of 30 HIV⁺ men and of 45 HIV⁺ women, 27 and 39, respectively, were treated with HAART, 79% with a plasma viral load below the level of quantification at time of enrolment. The median female CD4 level was 518/mL (179 to 1339). We achieved a 13.1% clinical pregnancy rate per attempt, with a 17.3% take-home baby rate per couple. We compared assisted reproductive treatment outcome between group A and B. Median age of 34.5 years (35 to 44), rank of attempt, assisted reproductive treatment, CD4 count, and viral load were not different. Take-home baby rate per treated couple was 13.3% in group A vs 23.3% in group B. Within group A we identified 2 sub-groups, either a female (n = 26) or a male (n = 19) etiology of infertility, with 7.7 vs 21% take-home baby rate, respectively. Among fertile women (n = 44), results were 21% and 20% of take-home baby rate, respectively, in HIV⁺ and HIV^– women. None of these comparisons was significant using Fischer’s exact test.

Conclusions:  We found no difference in terms of assisted reproduction results between HIV⁺ and HIV^– .women in the absence of female etiology of infertility (21% vs 20%). The lowest rate of success (7.7%) was found in couples in whom the women have both fertility impairment and HIV infection.