Fertility, conception and HIV

Is it possible to have a baby if you are HIV positive? Generally speaking, the answer is yes. Thanks to medical advancements, many people with HIV lead happy, healthy lives and can go on to become parents if that’s something they want! But does HIV impact your fertility? And is it safe to conceive naturally or is it necessary to go through assisted fertility treatments? We’ve got everything you need to know right here.  

Does HIV impact fertility?

There is some evidence to suggest that HIV can impact the fertility of both men and women. For women, the virus can make it harder for the body to produce estrogen and progesterone – both important hormones for reproduction. This can not only impact fertility but can also lead to early menopause. 

For men, studies have shown that sperm parameters including motility, concentration and morphology are all significantly impaired in people with HIV. Fertility issues for both men and women seem to correlate to having a low CD4 count, which means the more advanced and aggressive your HIV is, the more likely you are to struggle to conceive.  

What is a CD4 count? 

CD4 cells are white blood cells that have an important role in supporting our immune system. A CD4 count is the number of these cells in a cubic meter of blood. 

For someone that does not have HIV their CD4 count will be anywhere between 500 and 1500. If you have HIV but are managing it with medication your CD4 cells should be over 500 – which means you can lead a happy, healthy life! However, if you have HIV and your CD4 count is below 300, you might be at risk of developing serious illnesses and below 200 a doctor will likely diagnose that your HIV has developed into AIDS. 

Conceiving naturally with HIV

Whilst fertility issues are not uncommon in people with HIV, if you are in a heterosexual couple, conceiving naturally is not impossible! Luckily, condoms are no longer the only way you can protect yourself from HIV or avoid passing it on to a partner. 

If you are in a serodiscordant relationship – when one partner is HIV positive and one is HIV negative – it’s likely you are already taking medication to keep both of you safe. These medications will also help to protect you if you try to conceive naturally. 

If you are HIV-negative, taking PrEP – a daily pill – can reduce the risk of catching HIV by 99%, if taken as prescribed. For people living with HIV, Antiretroviral therapy can reduce your viral load down so low that you are undetectable – which means your risk of passing on the virus is effectively zero. 

After starting Antiretroviral therapy, your viral load will likely be undetectable within 6 months. It’s then recommended to be careful for another 6 months – and still, take your medication as prescribed –  whilst your body shows that it can maintain an undetectable viral load. After 12 months, if you are still recording an undetectable viral load and still taking your medication, there is almost no risk of you passing HIV on to a sexual partner. It’s recommended that if you want to try for a baby naturally, you ensure that you have been undetectable for at least 12 months.  

HIV and Assisted Fertility Treatment

There are many reasons you might decide to go down the route of assisted fertility treatment and these treatments are still accessible if you are living with HIV – if you are in a heterosexual couple (but more on that later). 

If you are a HIV-positive guy, there are ways to ensure that you don’t pass the virus on to your partner, surrogate or baby during assisted fertility treatment. Firstly, it’s recommended that you always undergo Antiretroviral therapy to reduce your viral load before embarking on treatment – in fact, it is a prerequisite for many fertility clinics. 

Whether you are undergoing IVF, ICSI or IUI, it’s also necessary to go through sperm washing. This is a process that separates sperm cells from semen and allows doctors to identify and remove the virus from your sperm. Studies have proven sperm washing to be incredibly effective at reducing the risk of transmission to almost zero – so it’s a very safe option. You can also use washed sperm for ICI (at-home insemination). 

Assisted Fertility Treatments, IVF and Same-Sex Couples 

Whilst assisted fertility treatments are currently available for heterosexual couples where one partner or both are HIV-positive, the same is sadly not the case for same-sex couples. In the UK being a sperm or egg donor is not allowed if you are HIV positive – and for same-sex couples, this causes a problem. 

If you are two men looking to conceive you will need to supply sperm for a surrogate. In this situation, the person supplying the sperm is technically classed as a ‘donor’ which means if you have HIV you will not be able to go through the process. If you are both female and you wanted to use the eggs of one partner but have them implanted into another to carry the pregnancy, this is also classed as being an egg donor (even if the person you are ‘donating’ the eggs to is your partner)- and herein lies the problem. 

Of course, if only one of you is HIV positive it is possible to go through assisted fertility treatment using only the sperm or eggs of the HIV-negative partner. However, this does limit the options for couples where both are HIV positive – and also means that partners who are HIV positive have no way of being biologically linked to their child. 

Considering the medical advancements that can reduce the risk of passing HIV on to practically zero, this legislation feels outdated and unfair and is negatively impacting the lives of countless people who have HIV and want to become parents. The National Aids Trust is currently running a petition to have this law overturned. 

HIV and Pregnancy 

It is possible to pass HIV on to a baby during pregnancy, labour and through breastfeeding. However, once again, if you are taking medications that mean your viral load is undetectable, the chance of this happening is very low. Some doctors may recommend a cesarean to reduce the risk even further and some people decide to bottle-feed their baby once it arrives to further reduce the chance of transmission. If you are pregnant and HIV positive your medical team will be able to advise you on the best course of action to ensure you and your baby are kept safe and healthy.