Ten years of assisted reproduction in HIV-discordant couples in Germany

About 75% of the 40,000 HIV-positive people in Germany are of childbearing age and many with stable disease wish to have children. In HIV-discordant couples this entails assessing the risk of infection for the seronegative partner and the risk of HIV transmission to the fetus-neonate. If only the male partner is HIV-positive, techniques to produce virus-free sperm can minimize the female partner's risk of infection. Such programs have been available in Germany since 1991. Some programs closed because of concerns regarding the safety of sperm processing, density gradient centrifugaion, and swim-up techniques. Routine testing of all sperm samples with highly sensitive molecular techniques was introduced in 1997 and is now available at 12 centers. We now look back on 235 treatment cycles in 93 couples over the past 10 years with 46 pregnancies and 37 deliveries and no maternal or perinatal infection. The situation for HIV-positive women and seroconcordant couples is less favorable. Counseling, a fertility work-up, and reproductive assistance for self-insemination are considered appropriate. But because of legal, medical and ethical considerations, assisted reproduction techniques for HIV-positive women are on offer with only one pilot project in Germany. All HIV-positive individuals in Germany are at a disadvantage regarding reimbursement by third-party payers for the costs of assisted reproduction.