World AIDS Day, celebrated on the 1st of December every year since 1988, is an international day dedicated to raising awareness of the AIDS pandemic caused by the spread of HIV infection. HIV/AIDS is now the leading cause of death worldwide, especially in sub-Saharan Africa. The pandemic has spread since the early 1980s and today around 35 million people are infected worldwide. In our article we will investigate the connection between HIV and infertility.
HIV and AIDS are not the same thing. HIV is the virus that attacks cells that help the body fight infection, making a person more vulnerable to other infections and diseases. If HIV is left untreated, it can lead to AIDS disease. No effective HIV cure exists so once you have HIV, you have it for life. However, by taking HIV medicine people can live long and healthy lives and prevent transmitting HIV to their sexual partners. So, AIDS is the late stage of HIV infection that occurs when the body’s immune system is badly damaged because of the virus.
In the U.S most people with HIV do not develop AIDS because taking HIV medicine every day as prescribed stops the progression of the disease.
Fertility Desires and Intentions of HIV-Positive Men and Women, a study published in 2001 in Family Planning Perspectives, concluded that 29% of HIV-positive women and 28% of HIV-positive heterosexual or bisexual men who received medical care in the U.S. wished to have children in the future. Yet while many women and men with HIV desire children, fertility and conception issues may complicate this wish. Indeed, of those wanting children among the total sample of 1,421 subjects aged 20-44 mentioned above, 31% of women and 41% of men did not expect to have any.
Researchers mainly hypothesize that the virus not only plays a direct role in reduced fertility among HIV-positive people but also has an indirect impact on HIV-positive women and men. But little data are 100% scientifically approved on the direct role of the virus in infertility. HIV infection may influence women to voluntarily terminate a pregnancy out of fear of dying or transmitting HIV to the child. Other theories include a direct relationship between HIV and the fetal thymus gland, as well as an increased risk of infection due to the weakened immune system of the mother. It may also directly influence the ability of HIV-positive men to produce healthy sperm. Also, women with HIV may experience infertility due to coinfection with another sexually transmitted disease.
Some HIV complications, such as the increased risk of cervical abnormalities, early menopause, pelvic inflammatory disease, and severe wasting may also contribute to infertility in women.
Couples, where one or both partners have HIV, should consult a doctor to minimize the risk of the virus’s transmission and treat the fertility problems which will arise while trying to conceive. It is not impossible to have a baby if you or your partner are HIV positive. Many couples have children with near-zero risk of passing the infection to their offspring. However, women who are HIV positive might experience subfertility and, in some cases, poorer outcomes with assisted reproductive technology (ART). Evidence suggests this is because HIV infection can interfere with the reproductive system, both directly and indirectly. For these reasons, HIV-positive couples might need extra help when trying to have a baby. Where a male partner is a carrier of HIV, their semen sample must be washed before being used in any fertility treatment to get rid of potential virus particles. When a female partner is a carrier of HIV, there is a risk of vertical transmission. This is when the HIV infection is transmitted by the mother to her baby during pregnancy, delivery, or when breastfeeding. Although the risk of vertical transmission is relatively low, preventative measures must be taken to minimize this risk as much as possible. Similarly, it is important to consider that women who are HIV positive show an increased risk of preterm birth, preeclampsia (high blood pressure during pregnancy), intrauterine growth restriction, and stillbirth. All the above make it essential to monitor and control the infection so as to minimize the risk of transmission for you, your partner, and your baby.
Multiple factors are associated with HIV infection that can potentially affect fertility. These factors vary from social, psychological, and biological.
Biological factors: Advanced age, systemic illnesses, stress, weight loss, sexually transmitted infections, anovulation, and amenorrhea are some of the biological factors that can cause infertility.
Psychological factors: The first and most important factor here is the guilt and shame someone feels when is HIV infected and that feelings lead to fear of reproducing. Also, the awareness of challenges in pregnancy, birth, and parenting when being HIV infected can lead to second thoughts while deciding to conceive.
Social factors: Most important factors here are financial ones and limited reproductive care access and availability of treatments, especially to eastern countries. Also, although in 2021, there still is HIV stigmatization that causes extra shame to the infected couples.
To sum up, even if scientific data are not 100% approved that HIV leads to infertility, factors such as biological and social ones lead infected couples to second guess their decision to conceive. If not naturally conceived, there are other roads to parenthood, including adoption and sperm donation from a known or unknown donor. While HIV continues to be a barrier for couples seeking to become parents likewise, many have been successful. For those seeking unconventional methods of parenting, such as surrogacy, little information is available specific to HIV-positive couples. However, similar rules would likely apply regarding the implantation of potentially infected tissue into an HIV-negative woman.
As more HIV-positive couples consider parenthood, fertility services will slowly become more available to suit their needs. And it is also likely that ongoing advocacy and education will be required to ensure affordable, timely, and stigma-free access for all couples seeking to become parents. In fact, with the recent government act that has been voted in Greece, couples with HIV are now eligible to fertility treatments! Radical and very important change in the fertility landscape.
Until all the above happen, MEDIPASS is always here to help you untangle the daunting journey of fertility. How? By listening to your concerns and needs and helping you have an ideal and more personalized fertility journey. Where will this happen? In magical Greece, which is one of the best fertility destinations in the world.
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