Dr. John Jain:
Hello, I’m Dr. John Jain from Santa Monica Fertility, and today I’m going to talk about fertility treatment for men with HIV, who wish to become fathers. Since the discovery of HIV 40 years ago, there’ve been many innovations. And today men with HIV who are adherent to their antiretroviral therapies can expect a normal lifespan, and contemplate having children, and even seeing those children reach adulthood. So, I’d like to go through the steps for in vitro fertilization, necessary for men with HIV who wish to become biological fathers. So, for gay couples, either man or both men can become biological fathers and they’ll have to decide how they wish to participate.
The first step is to obtain a semen analysis. This is a test of the sperm. The semen analysis is performed by looking under the microscope, counting the sperm, assessing their motility as well as their shape.
The next step is to perform a panel of infectious disease tests. These are mandated by the FDA. Since the sperm will ultimately be used to create an embryo, which will then be transferred to a surrogate, providers of the sperm are called directed donors, and must undergo these tests within seven days of giving the sperm for in vitro fertilization.
The next step is to choose an egg donor. Santa Monica Fertility has many desirable donors. Once a donor is chosen, she undergoes hormonal injections to recruit multiple eggs. She’s then taken to the operating room where under anesthesia a needle is placed through the vagina and directly into the ovary and the egg follicle, allowing us to aspirate or suction the egg from the ovary.
The next step is very important for men with HIV, and that is called sperm washing. Semen is placed into a test tube and centrifuged at high speed, allowing us to separate the seminal fluid from the sperm. And this is important because sperm actually do not have receptors for HIV. HIV can’t infect sperm, but it can infect white blood cells and other constituents of the seminal fluid. So we wash sperm and then we go one step further. We use preliminary chain reaction, also known as PCR to assure that no residual viral particles exist.
We then take the sperm to perform fertilization using a procedure called intracytoplasmic sperm injection, also known as ICSI. ICSI is performed under a microscope by selecting one sperm with a needle, and then injecting an egg directly with the sperm in order to fertilize it. We can then test the embryo using a procedure called pre-implantation genetic screening to determine if the embryo is chromosomally normal and if it’s a boy or a girl. In this procedure, a laser is used to make a small hole in the eggshell. Cells are then retrieved and tested for chromosomes. Again, to see if the embryo is normal and to determine the sex.
After pre-implantation genetic screening, we freeze the embryo for future use. Once frozen an embryo can last forever.
The next step is to select a surrogate. This is the woman that will be carrying your baby. At Santa Monica Fertility, we have many surrogates. We’ll select some profiles that we feel are a good match, and then arrange an in-person or a video meeting so that you can assure yourself that the surrogate is compatible with your needs. After signing a legal agreement, she’ll undergo an embryo transfer, and then our team will help follow the surrogate throughout pregnancy and birth.
Santa Monica Fertility is one of a limited number of clinics in the United States that offers sperm washing for men with HIV. In addition, we have our own in-house egg donor and surrogate agencies. In this manner, we’re able to offer a comprehensive approach to family building. We look forward to helping you. Thank you for listening.