HIV & Subfertility HIV & Subfertility Leila C G Frodsham Clinical Research Fellow Assisted Conception Unit Chelsea and Westminster Talk to UK-CAB (UK-Community Advisory Talk to UK-CAB (UK-Community Advisory Board) Board) 25 October, 2002 25 October, 2002 HIV I-Base: HIV I-Base: http://www.I-base.org.uk http://www.I-base.org.uk
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HIV & Subfertility Leila C G Frodsham Clinical Research Fellow Assisted Conception Unit Chelsea and Westminster Talk to UK-CAB (UK-Community Advisory Board)
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HIV & SubfertilityHIV & Subfertility
Leila C G FrodshamClinical Research Fellow
Assisted Conception Unit
Chelsea and Westminster
Talk to UK-CAB (UK-Community Advisory Board)Talk to UK-CAB (UK-Community Advisory Board)25 October, 200225 October, 2002
HIV I-Base:HIV I-Base:http://www.I-base.org.ukhttp://www.I-base.org.uk
risk of vertical transmission– cannot ‘wash eggs’ – reduced to < 1% with good obstetric care
effect of antiretrovirals in uterohealth / life expectancy of parentpersistent drug abuse in parentfuture for child if born HIV positive
HIV-1 +ve women:welfare of the HIV-1 +ve women:welfare of the childchild
Talk to UK-CAB 25.10.02
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+ve women and vertical HIV+ve women and vertical transmissiontransmission
HIV and infertility: time to treat. Gilling-Smith C, Smith JR, Semprini A. BMJ 2001, 322: 567-8
Talk to UK-CAB 25.10.02
Mother to child HIV Mother to child HIV transmissiontransmission
HAART+
Caesarean Section
+
No Breastfeeding
=
<2% Vertical transmission
Talk to UK-CAB 25.10.02
Mother to child HIV Mother to child HIV transmissiontransmission
Chelsea &Westminster (since 1995)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)
Talk to UK-CAB 25.10.02
Antenatal CareAntenatal Care
Must be optimal
Joint care from GU Physician
& HIV Specialist Obstetrician
C+W if insufficient locally
Talk to UK-CAB 25.10.02
Fertility provision for HIV positive Fertility provision for HIV positive femalesfemales
1st appointment (GUM)sexual health screen
3rd appointment (ACU)treatment planned
2nd appointment (ACU)fertility screen
Preconceptual counselling
Obstetric monitoring
•HAART•LSCS
•no breast feeding
pregnant
IUI
IVF or ICSI
Sperm washing
Talk to UK-CAB 25.10.02
Female positivesFemale positives
IUI-3 cycles
1 pregnancy; early miscarriage
IVF-5 cycles
3 pregnancies-1 ongoing pregnancy
ICSI-0 cycles
Talk to UK-CAB 25.10.02
Females:when to referFemales: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
Talk to UK-CAB 25.10.02
Couples where both are Couples where both are positivepositive
Sperm washing required
Extra counselling
3 couples ready for/undergoing treatment
Talk to UK-CAB 25.10.02
CREAThECREAThE
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