HIV and fertility: Can you become a mother?

When discussing HIV and fertility, it is very important to clarify concepts that are often misunderstood. Let’s take a closer look.

HIV, or Human Immunodeficiency Virus, is a microorganism that attacks the immune system, weakening it and making individuals vulnerable to infections—some of which can be life-threatening.

AIDS, or Acquired Immunodeficiency Syndrome, is the advanced stage of HIV infection characterized by low immune defenses and the appearance of opportunistic infections.

Both HIV and AIDS have become significant public health and social issues over the past 25 years. Fortunately, the development of effective antiviral drugs and treatment protocols since the mid-1990s has greatly reduced the disease’s incidence and mortality.

With these clarifications, let’s explore how HIV and fertility in women are affected.

What happens if I have HIV and want to become a mother?

It’s important to note that the prevalence of HIV infection among women has increased significantly, and since 1994, heterosexual transmission has been the main way the disease spreads, surpassing parenteral transmission (such as sharing needles).

Before antiviral treatments were available, mother-to-child transmission during pregnancy was the leading cause of pediatric HIV/AIDS. Because of this, pregnancy was often discouraged due to the high risk of the baby becoming infected. Recently, however, evidence shows that antiretroviral treatment drastically reduces the chance of transmission to the baby, marking a major shift.

Reproductive centers like ours help women and couples affected by HIV. Being a mother with HIV is possible, but the approach depends on whether both partners are HIV-positive or if the couple is serodiscordant.

What can fertility clinics do for couples with HIV?

As mentioned, the assisted reproduction treatments depend on each couple’s situation.

For example, if the male partner is HIV-positive, semen samples can be processed and washed in the lab to reduce the virus’s presence and significantly lower transmission risk.

The semen is divided into two parts: one for testing via PCR to confirm the sample is virus-free, and if negative, the other part is frozen for use during artificial insemination or IVF.

It’s important to understand that no technique guarantees 100% virus elimination. If needed, donor sperm is an alternative. The couple must accept the minimal risk involved with using the processed semen.

If the female partner is HIV-positive, a medical report confirming pregnancy suitability and a recent viral load test are required. Assisted reproduction is only performed when the viral load is undetectable or very low, with a specified lymphocyte count.

Throughout pregnancy and birth, the woman must undergo medical tests and monitoring, and the newborn will also receive necessary medical follow-up and treatments, all aimed at minimizing the risk of mother-to-child transmission.

Advances and risks in HIV and fertility

Thanks to highly active antiretroviral therapy, elective cesarean sections in selected cases, artificial feeding, intrapartum prophylaxis, and treatment of the newborn, mother-to-child transmission rates in developed countries like Spain have dropped to 0.5-2%.

Pregnancy does not worsen the clinical, immunological, or virological progression of HIV. However, HIV infection and antiretroviral treatment during pregnancy can increase risks of obstetric complications such as miscarriage, premature membrane rupture, intrauterine growth retardation, fetal death, preeclampsia, gestational diabetes, and prematurity.

Monitoring pregnancy with HIV

Pregnancies in HIV-positive women require stricter monitoring than usual. Stabilizing the disease with antiretroviral therapy and preventing maternal-fetal transmission are key goals.

Such pregnancies are usually managed in high-risk units within hospitals, by multidisciplinary teams including gynecologists, internists, and neonatologists.

Pregnant women undergo frequent blood tests and ultrasounds every four weeks to prevent obstetric complications and to monitor viral load and lymphocytes.

Delivery and HIV

Birth is the time when most mother-to-child HIV transmissions occur. The main goals during delivery are to minimize transmission risk and reduce morbidity in both mother and newborn.

The most important factor is that the mother arrives at delivery with the lowest possible viral load. In most cases, an elective cesarean section is recommended to further reduce the chance of transmission.