1 / 34

HIV & Subfertility

HIV & Subfertility. Leila C G Frodsham Clinical Research Fellow Assisted Conception Unit Chelsea and Westminster. Talk to UK-CAB (UK-Community Advisory Board) 25 October, 2002 HIV I-Base: http://www.I-base.org.uk. Our Team. Leila CG Frodsham Research Fellow Bronwen Tamberlin

zoe-diaz
Download Presentation

HIV & Subfertility

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. HIV & Subfertility Leila C G Frodsham Clinical Research Fellow Assisted Conception Unit Chelsea and Westminster Talk to UK-CAB (UK-Community Advisory Board)25 October, 2002HIV I-Base:http://www.I-base.org.uk

  2. Our Team • Leila CG Frodsham Research Fellow • Bronwen Tamberlin Sperm washing Coordinator • Carole Gilling-Smith Consultant Gynaecologist+Director Assisted Conception Unit Chelsea and Westminster Hospital

  3. Who we treat • HIV positive males with negative partners • HIV positive females with negative partners • Couples where both partners are positive

  4. What treatments do we offer? • IUI (intrauterine insemination) • IVF (in vitro fertilization) • ICSI (intracytoplasmic sperm injection) • Donor Insemination

  5. IUI • In couples with normal/unexplained infertility • Ovulation predicted via ultrasound tracking • Sperm washed • Sperm injected into partners womb

  6. 18mm Natural cycle IUI/SWP Day 8 Day 11 Day 13

  7. InVitroFertilization • In subfertile couples Tubal disease/low sperm count • Superovulation by injection • Follicles tracked by scan • Eggs collected

  8. InVitroFertilization • Sperm washed • Sperm and eggs mixed in the lab • Embryos replaced in womb

  9. Intracytoplasmic sperm injection • Very low sperm count • As IVF • Single washed sperm injected into egg

  10. Referral to the programmes • We are happy to consider anyone

  11. Referral to the programmes • Consider ‘welfare of the child’ • Detailed HIV history Recent viral load and CD4 Drugs and resistance • Sexual health screen • Smear/colposcopy • Intended obstetric care

  12. Referral to the programmes • No storage of positive gametes/embryos • Gamete donation on named basis • Couples only will be considered

  13. Pre conceptual counselling & HIV • Stability of relationship • Disease progression / health of infected parent • High risk behaviour (drug abuse, unprotected sex) • Social support • Understand & agree to comply with risk reduction treatment

  14. Welfare of the Child in HIV +ve • In male partner: • Transmission of HIV in sperm • In female partner: • Vertical transmission risk (< 1%) • Use of antiretrovirals • Mode of delivery • Avoidance of breastfeeding • Effect of antiretrovirals on fetus/child • In both: • Disease progression / health of infected parent • High risk behaviour (drug abuse, unprotected sex)

  15. Sperm washing programme • Since April 1999 • 59 Couples treated • 11 babies born

  16. Sperm washing-How safe? seminal fluid NSC sperm NSC ? sperm NSC NSC NSC

  17. Validation of sperm washing • sperm samples from 11 HIV +ve men tested for: • HIV RNA viral load • HIV proviral DNA (latent virus) • expression ofCD4 receptor & HIV co-receptors CCR5 • spermatozoa had no: • HIV RNA • HIV proviral DNA • CD4 or CCR5 expression L Kim et al,AIDS 1999, 13: 645-51

  18. sperm washing • semen centrifuged in density gradient • NASBA check for HIV-1 RNA (25 HIV-1 copies/106 sperm) • 6% risk of positive NASBA • cancelled cycle

  19. 4 seroconversions • 2 during pregnancy • 2 postpartum Mandlebrot et al, Lancet 1997; 349:850-851 Risks of unprotected intercourse • unprotected timed intercourse • 1 in 500 risk of infecting partner • series of 92 HIV +ve men /HIV -ve women • carefully timed but unprotected intercourse

  20. 1st appointment (GUM) sexual health screen Counselling 2 sessions 2nd appointment (ACU) fertility screen 3rd appointment (ACU) treatment planned IVF or ICSI IUI Fertility provision for HIV +ve males Initial referral info pack sent out

  21. Pregnancy rates • IUI 36 patients=91 cycles: 20% pregnancy • IVF 13 patients=19 cycles: 33.3% pregnancy • ICSI 10 patients=16 cycles: 12.5% pregnancy

  22. Pregnancy monitoring • Pregnancy test • Serial scans from 5+4 weeks • 3 monthly HIV tests during antenatal + post natal periods

  23. Female positive programme • Since April 2002 • 3 women treated • 4 pregnancies-1 ongoing

  24. HIV-1 +ve women:welfare of the child • risk of vertical transmission • cannot ‘wash eggs’ • reduced to < 1% with good obstetric care • effect of antiretrovirals in utero • health / life expectancy of parent • persistent drug abuse in parent • future for child if born HIV positive

  25. HIV+ve women and vertical transmission • equal or greater risks to offspring in: • older women • trisomy 21 and other chromosome abnormalities • women with cardiac disease or cystic fibrosis • diabetics • multiple pregnancy • severe oligoasthenospermia & ICSI HIV and infertility: time to treat. Gilling-Smith C, Smith JR, Semprini A. BMJ 2001, 322: 567-8

  26. Mother to child HIV transmission HAART + Caesarean Section + No Breastfeeding = <2% Vertical transmission

  27. Mother to child HIV transmission Chelsea &Westminster (since1995) 50 births in HIV +ve womennone of the babies +ve St Mary’s Paddington (since 1996)78 births in HIV +ve womentwo positive babies (in both cases mother did not comply and take medication & delivered elsewhere)

  28. Antenatal Care • Must be optimal • Joint care from GU Physician & HIV Specialist Obstetrician • C+W if insufficient locally

  29. 1st appointment (GUM) sexual health screen 2nd appointment (ACU) fertility screen IUI • Obstetric • monitoring • HAART • LSCS • no breast feeding 3rd appointment (ACU) treatment planned pregnant IVF or ICSI Fertility provision for HIV positive females Preconceptual counselling Sperm washing

  30. Female positives • IUI-3 cycles 1 pregnancy; early miscarriage • IVF-5 cycles 3 pregnancies-1 ongoing pregnancy • ICSI-0 cycles

  31. Females:when to refer • Provided • Negative partner • regular cycle • no history PID/STD or abdominal surgery • No other known fertility factors >35 years: 6 months self-insemination <35 years: 6-12 months self-insemination

  32. Couples where both are positive • Sperm washing required • Extra counselling • 3 couples ready for/undergoing treatment

  33. CREAThE • Centres for Reproductive Assistance Techniques in HIV in Europe • 7 centres in 6 countries to pool data to assess: • safety of risk reduction options • efficacy in relation to fertility factors in this population • epidemiology • behavioural and psychosocial aspects • draw up guidelines for counselling and treatment

  34. Who to contact • Bronwen Tamberlin /Dr Leila Frodsham Happy to take any enquiries Thankyou

More Related