I had the awesome opportunity of having a Q&A session with Dr Matabese of the Cape Fertility Clinic who has a state of the art HIV lab to help couples who are HIV positive realising their goal of having babies of their own. I have learnt a lot about this issue and I can only thank Dr Matebese for her information. I’m sure many HIV patients will be helped with this information.
GET PREGNANT Q&A with Dr Nomathamsanqa (Tamtam) Matebese, Specialist in Reproductive Medicine at the Cape Fertility Clinic
TOPIC – Assisted conception for HIV positive patients
1. I often get emails from HIV positive couples who are scared to call just any fertility clinic for help, for fear of being rejected or judged. Do you know which clinics are able to help?
We are definitely able to help at the Cape Fertility Clinic, as we have a dedicated lab for the treatment of fertility in HIV positive patients.
2. What would you tell an HIV positive couple to reassure them?
Modern technology allows HIV positive patients to realise their dream of having HIV negative children. While the thought of receiving treatment may seem very daunting, by seeking consultation with a reputable fertility clinic, that specialises in treating HIV positive patients, couples can rest assured that their treatment is in the hands of an expert doctor.
3. Are all fertility clinics required to help?
According to international guidelines, a clinic must have a dedicated HIV lab in order to offer assisted reproduction to couples who are HIV positive. This means that a separate set of equipment is used for patients with infectious diseases like HIV/AIDS. The equipment is very expensive and this might be a deciding factor for some clinics, as to whether or not they offer such treatments.
HIV positive patients who are not able to receive treatment from some clinics should not think that they’re being rejected because of their status. The reality is that many clinics to not have the equipment needed to help them, and this would probably apply to most of the public hospitals.
4. Is it possible for a HIV positive couple to conceive and give birth to a HIV negative baby?
Absolutely! If the mother is on antiretroviral drugs during the pregnancy then the risk of transmission to the baby is very low.
5. Is there a guarantee that the baby will be HIV negative?
Unfortunately there are no guarantees. However, if the mother is on ARV’s and her viral load is non-detectable, she has a 98% chance of delivering a HIV negative baby.
6. What procedure is used when the male partner is HIV positive?
It’s important to know that it’s not the sperm that carries the virus, but rather the semen in which the sperm survives. A procedure of sperm washing is therefore done to remove the HIV virus from the sperm. The sample then undergoes viral testing to determine whether or not the virus has been successfully removed. If the sample is negative, the sperm is then inseminated directly into the woman’s uterus.
Another option is for the couple to use donor sperm. With this option, the risk of the female partner getting HIV is eliminated completely.
A third option is IVF/ICSI. With ICIS (an intracytoplasmic sperm injection), the sperm is washed and then injected directly into the egg. This reduces the chance of transmission to the partner.
7. What procedure is used when the female partner is HIV positive?
We can inseminate the HIV negative sperm directly into the woman’s uterus so that there is no risk of unprotected intercourse for the male partner. The couple can also consider the option of surrogacy.
8. What procedure is used when both partners are HIV postive?
The couple can choose to have artificial insemination or IVF depending on other clinical criteria such as the age of the female partner and whether or not her he fallopian tubes are blocked.
Blocked fallopian tubes are quite common in patients who are HIV positive as they are prone to pelvic infection. If the fallopian tubes are blocked, then artificial insemination will not work. IVF and preferably ICSI (mentioned above) will reduce the risk of transmission.
9. How would a HIV positive mother give birth, without infecting the baby?
There is enough medical evidence to show that if a HIV positive mother is on antiretroviral treatment with a non-detectable viral load, she has a 98% chance of delivering a HIV negative baby. Under these circumstances there is no longer enough medical evidence to show that an elective caesarean section is necessary. Certain precautions are however necessary. The mother’s membrane, for example, must not be ruptured until she’s close to delivering the baby. In other words, the mothers’ waters must not be artificially broken. If her waters break spontaneously and it is estimated that she will NOT deliver the baby within 4 hours, then she will require a caesarean section. During natural childbirth, cutting of the perenium should be avoided. The use of forceps and vacuum should also be avoided. All procedures that put the baby at risk of coming into contact with the mother’s blood should be avoided.
10. What happened after the birth? Are there any ARV’s the baby has to take?
Yes, the baby is given antiretroviral medication in a syrup form for the first 6 weeks. In most cases exclusive bottle feeding is advised.
11. Are there special precautions to make sure the baby remains HIV negative?
Exclusive bottle feeding is the best. However, if no safe clean water is available or the couple cannot afford the formula then exclusive breastfeeding for six weeks has been shown to reduce the chances of the baby getting HIV from breast milk.
12. Will baby have to go for regular blood tests?
The baby will have an HIV-PCR test at six weeks and if test comes back negative, then it confirms that the baby is HIV negative.
13. Many people would wonder if both parents are HIV positive and they give birth to a HIV negative baby and by some unfortunate circumstances they both die an early death and the baby is left orphaned. What would you say to those people?
If someone is HIV positive, takes their ARV medication properly, has a healthy immune system on blood tests and has a good HIV physician looking after them, they can expect to live a long normal healthy life. It is really the same as living with any other long term well controlled illness e.g. Diabetes or asthma. There is no reason why they should not consider having children as well.
14. Can ARV therapy affect fertility?
There is no definite scientific evidence for this. There are a few papers however, which show that some antiretroviral drugs have a negative effect on the sperm.
15. Are ARV’s safe to use during pregnancy?
Most ARV’s are safe in pregnancy. Only Efavirenz is contra-indicated in pregnancy due to the increased chance of getting abnormalities in the baby if on this drug during pregnancy.
16. Would mommy be able to breastfeed?
Exclusive bottle feeding is the best.