Reproductive assistance to HIV-discordant couples - The German approach

An estimated 35 000 Germans are infected with HIV, and 75% of these are of childbearing age. Couples with one infected partner are faced with the risk of infection of the healthy partner. By using assisted reproduction techni ques (ART) and virus-free sperm it is possible to fulfil the desire for chi ldren while minimising the risk of acquisition of infection. Therefore sinc e 1991 in Germany ART is offered to couples of HIV-positive males and seron egative females. However, established programmes in different centres were temporarily suspended due to serious doubts about the reliability safety of the sperm preparation technique (density gradient centrifugation and swim- up). Since 1997 processed sperm samples are routinely tested for HIV by highly s ensitive detection methods and cryopreserved. Only if the test is negative are the processed spermatozoa used for homologous insemination, in-vitro fe rtilization or intracytoplasmatic sperm injection. This procedure removes m ost medical as well as legal considerations. At present 3 reproductive unit s In Germany offer reproductive assistance to HIV-discordant couples, and a further 9 institutions plan to establish that procedure. From 1991 to 1999 , 54 women were treated by ART. 30 pregnancies occurred and 24 children wer e born. So far no maternal or infant infection was observed after treatment .