Different types of couples
A discordant couple could be made up of a man and a woman, a woman and a woman, or a man and another man. If the couple is made up of a man and a woman, natural conception is possible if precautions are taken. For gay and lesbian couples, fertility treatment is necessary.
Let’s talk transmission
When HIV+ takes antiretroviral treatment (ART) correctly and consistently, the risk of transmitting the virus to a sexual partner is markedly decreased. This means a male-female discordant couple can have unprotected intercourse to get pregnant after sustained viral suppression is achieved. The partner can also take pre-exposure prophylaxis (PrEP) without HIV to reduce the risk of sexual acquisition of the virus when trying to conceive.
IUI to get pregnant
Intrauterine insemination (IUI) is often the first assisted reproductive technology (ART) that a discordant couple will consider using to get pregnant. With IUI, the sperm is cleaned and concentrated and placed directly into the uterus near the time of ovulation. This option is excellent for discordant lesbian couples who plan to get pregnant using donor sperm. IUI can also be considered when the male partner is HIV+ and semen washing is desired. With semen washing, sperm are removed from the surrounding seminal fluid, which contains high concentrations of the virus. The washed sperm are then used during IUI, decreasing the risk of HIV transmission.
Using IVF to avoid risk
In vitro fertilization (IVF) is another possibility when considering fertility treatment to get pregnant. With IVF, fertility medication is used to stimulate the ovaries to produce multiple eggs at once. The eggs are then extracted and combined with sperm in the lab to create embryos. The embryo can then be placed directly into the uterus of the woman who plans to carry the pregnancy. For discordant couples, the main benefit of IVF is that sustained viral load only has to be achieved for a short period of time when the sperm sample is collected and egg retrieval is performed. Rather than multiple chances for transmission with ongoing natural attempts at conception, IVF allows discordant couples to achieve high success rates with an attempt.
2 men, 1 baby
Discordant couples made up of 2 men require both an egg donor and a gestational surrogate to have a baby. Fertility clinics can help coordinate this type of arrangement. If using sperm from the HIV+ partner, semen washing can lower the risk of transmission significantly. To eliminate the risk completely, the HIV- partner or an anonymous donor could also provide the sperm.
Pregnancy is possible
Pregnancy is definitely possible if the discordant couple is using IUI, IVF, a donor, or a surrogate. Fertility treatment is a safe way to minimize the risk of HIV transmission. Discordant couples who want to get pregnant should speak with a healthcare provider to understand all available options.