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Safe conception for human immunodeficiency virus–discordant couples: the preexposure prophylaxis for conception alternative

2013; Elsevier BV; Volume: 210; Issue: 1 Linguagem: Inglês

10.1016/j.ajog.2013.08.011

1097-6868

Gabriella De Carli, Antonio Palummieri, Giuseppina Liuzzi, Vincenzo Puro,

LGBTQ Health, Identity, and Policy

TO THE EDITORS: We read with great interest the article by Semprini et al 1 concluding that semen washing with intrauterine insemination (SW-IUI) appears to be a safe and effective method for achieving pregnancy in human immunodeficiency virus (HIV)-discordant couples in which the man is HIV infected. However, the authors did not discuss some of the problems that render SW-IUI not practicable for most couples in developed countries, and the current debate on different options. SW-IUI is cumbersome and costly, per-cycle live birth rate is 13%, and for a significant number of couples, the wish of parenthood remained unaccomplished due to the technical and financial hurdles associated with the method. Approximately 30% of couples evaluated in Milan, Italy, and St Gallen, Switzerland, did not start the insemination process after initial counseling and another 30% subsequently withdrew after a number of failed cycles. Moreover, almost half of the couples who did not conceive with artificial insemination attempted spontaneous conception through unprotected intercourse, exposing the woman to HIV transmission, and at least 1 infection occurred. 1,2