POZ Community Forums
Main Forums => Living With HIV => Topic started by: spoiled on June 11, 2006, 10:02:14 am
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Hello everyone,
My husband and I just found out in February that he is HIV+. I'm negative. He started taking the meds within a couple of weeks of finding out and his viral load is now undetectable. My issue is that we are ready to have a family and cannot afford $7,000 to go to a fertility clinic that will wash his sperm and do invetro fertilization, etc. We have always had protected sex. Has anyone heard of a couple tracking ovulation and then just have one episode of unprotected sex in order to conceive? I wonder what the statistical odds of me contracting the virus are from one encounter if his viral load is undetectable ???. I'm not looking for concrete answers, just opinions, thoughts, ideas and/or advice.
Thank you so much.
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Hi Spoiled, welcome to the forum.
It sounds like you've already done your homework concerning the options open to you on the conception front. While I've never heard of what you describe happening, it doesn't mean that it hasn't been tried.
I think the bottom line here is just how much you are willing to risk in order to have your husband's child. Granted, the risk of him infecting you is lower with an undetectable viral load, but it is not without risk all the same.
If I were in your shoes, I think I might be willing to try that, but only if my cervix was in tip-top condition as this is the area most vulnerable to hiv infection. That is a mighty big might, I'd like to add. While I might consider doing this myself, I couldn't in good conscience recommend it to anyone else because the risk of infection is definitely there. I think I would be more inclined to look into finding a sperm donor who was hiv negative. This doesn't have to be expensive as conception has been achieved through people using a friend's sperm and a turkey baster. (I kid you not)
Another option is adoption, which I'm sure you're aware. There are many kids out there who need a loving home - including hiv positive children. Just something for you and your husband to consider.
Good luck - keep us posted.
Oh, and please read through the Welcome note at the top of this forum. There's information in there about what's available on the rest of this website.
Ann
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This may be a shot in the dark, but you may want to double check your health insurance coverage and employment benefits (even contacting HR if you're not sure). I just recently found out that our health plans cover all-types of infertility treatments, (up to a $25,000 lifetime maximum).
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hello, welcome...
i-base (UK hiv info resource, and a good one at that) has a guide with some useful info...
http://www.i-base.org.uk/guides/pregnancy/index.html (http://www.i-base.org.uk/guides/pregnancy/index.html)
here are some of the key bits:
"It is usually unwise for sero-different couples to have unsafe sex. Even when politely called a “conception attempt”, there is always a risk to the HIV-negative partner of contracting HIV.
For an HIV-negative woman, for example, the chance of becoming HIV-positive from having unprotected sex will depend on many things, including the viral load in the semen of her male partner. (It is important to remember that an undetectable viral load result from a blood test does not mean that viral load is undetectable in seminal fluid.)
...having sex with an uncircumcised HIV-positive man is of greater risk to an HIV-negative woman than sex with a circumcised man.
Infections of the genital tract also increase the risk of sexual transmission of HIV. Regardless of the method of conception, both members of a sero-different couple should check for such infections. This should include screening and treatment for other sexually transmitted infections.
The man should have a semen analysis. This can rule out any infection and also to ensure that his sperm count is fit and healthy.
All these risk factors aside, HIV is actually quite a difficult virus to transmit. Statistically it is much harder to transmit HIV than to get pregnant. Therefore, limited conception attempts made during ovulation (a woman’s fertile period) may carry a low risk if the positive partner has undetectable levels of viral load. But there is still a risk involved for both male and female negative partners from any single unprotected exposure. After all, people can conceive from one attempt and also become HIV-positive from one exposure.
In one study of HIV-negative women and HIV-positive men, 4% of women became HIV-positive. Most would consider this an unacceptable risk."
im guessing you're in the states, not uk? ask your husbands dr if there is a hospital near you witha n assisted conception unit...over here, there's a bit of funding for "risk reduction treatments"...
ultimately, i guess you (and husband) need to weigh up how much you want a baby vs risk to your health...
good luck
kate
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Hi there spoiled
First of all welcome to the forum.
I have to agree with Ann and Kate, unprotected sex is a risk albeit a low risk, but the fact that your husband has an undetectable HIV viral load is a good start, but I'm not a 100% sure if this would also mean that the virus in the seminal fluid would have the same undetectable level...I really don't know much about this...but I have heard that the levels can differ..please correct me if I'm wrong.
My suggestion would be to talk to a Doctor who may have some information on this, I know sperm can be tested for many things so maybe it can be tested for viral loads.
I know that tracking can be done.(I've done this on many patients in the past)..so if you can determine the levels in the sperm then maybe..(.just maybe..because I don't know for sure) this would lower the chance even more of you becoming infected.
I wish I could tell you 100% that it will be ok to go ahead but I can't..please keep in touch and let us know how things go.
thinking of you.
Hugs
Jan
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.
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Have You considered the possible health risks to the child?
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From what I gather, health risks to the child are minimal if the mother is HIV negative.
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Hi Spoiled:
Another POSSIBLE option to consider -- on top of the information provider by Ann, Annie, and others -- is pre-exposure prophylaxis (PrEP) for you. This would involve you taking an anti-HIV drug to help prevent infection if your husband's HIV did manage to get into your system.
What we know about PrEP comes from monkey studies. Check out this article to learn a bit more:
http://www.aidsmeds.com/news/am20060403.html (http://www.aidsmeds.com/news/am20060403.html)
The major drawbacks, of course, is that we don't quite now how well PrEP works in people, nor do we know how best to prescribe it to people. In your case, it might be best to start a drug like Viread (or Truvada) several days before sexual intercourse and then continue it several days afterward. I wish I could be more specific, but like I said... there really aren't any specific prescribing guidelines to draw from.
Viread (or Viread and Emtriva in Truvada) are believed to be safe in pregnancy and aren't believed to affect a babies development, even in its "zygote" period (the first few days/weeks of pregnancy. But again, what we don't know about the use of PrEP -- including its safety and effectiveness for serodiscordant couples hoping to become pregnant -- is a lot.
Be sure to talk to your doctor -- including an OB/GYN -- about the possibility of PrEP and the other pieces of advice you've received here. Do keep in mind that not all primary care docs and OB/GYNs are supportive of the initiatives to help serodiscordant couples have kids, so be sure to get multiple opinions if necessary.
Good luck...
Tim Horn
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I copied this excerpt from this rather lengthy but very informative article which addresses some of your questions:
Reproduction Decision Making for Couples Affected by HIV (http://www.iasusa.org/pub/topics/2004/issue2/61.pdf)
Physicians can still provide useful guidance to couples with little or no access to these expensive procedures. Oyesiku and Turner describe timed ovulatory intercourse as a “relatively safe and cost-effective” reproductive option, provided that the male partner’s HIV viral load is below detectable levels and the CD4+ cell count is above 400/μL. Gilling-Smith also described timed intercourse using ovulation detection methods, citing a 4% transmission rate in 92 serodiscordant couples, with seroconversions restricted only to partners who reported inconsistent condom use outside the “fertile period.” Both partners should be screened for factors known to reduce fertility prior to timed intercourse to prevent unnecessary exposure to the seronegative partner. Men can provide single semen specimens that can be analyzed for count, motility, progression, and morphology in both ejaculate and swim-up. Women should receive pelvic ultrasonographic scans during the early follicular phases of their cycles, as well as endocrine profiles of follicle-stimulating, luteinizing, and thyroid functioning hormones. Physicians can then more accurately advise patients with regard to engaging in unprotected intercourse during the “fertility period.”
The fertility period is defined as the specific days relative to ovulation during which a woman is most likely to conceive, which consists of 6 days: the day of ovulation and 5 days prior. There are 5 recognized methods used to identify the fertility window: basal body temperature, calendar calculation, serial ovarian ultrasound, hormones in urine, and vaginal discharge. Calendar calculation and basal body temperature are considered the most unreliable methods of ovulation detection. Calendar calculation depends on statistical averages, which are variable and may unduly expose HIV-uninfected
women to HIV, and basal body temperature typically does not rise until after ovulation, creating difficulty in identifying the actual day of ovulation. Serial ovarian ultrasound is highly accurate but expensive and not readily available. Urine luteinizing hormone (LH) kits detect a rise in LH, which occurs between 16 and 48 hours before ovulation, making them moderately effective in determining ovulation. Monitoring changes in cervical and vaginal discharge is considered the most effective method of determining ovulation. Type E (estrogenic) mucus occurs 5 days to 6 days prior to ovulation, during the fertility window. The clear, stretchy, slippery discharge facilitates the transport and survival of sperm in the cervix, and is known to be the best indication of ovulation.
I echo what Tim said about difficulties you might encounter in finding a doctor who would be willing to help you through this process of conceiving "naturally" for obvious reasons. Hope this helps and good luck.
Gerry
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I want to thank all of you for your insightful responses. My husband seems to be on board with the "ovulation-one time unprotected sex" idea until it actually gets to the time to do it (I'm ovulating right now), then he gets scared and doesnt want to anymore. I dont want to adopt and I'd rather not spend close to $10k to get pregnant if the odds of getting infected are about the same, so it's looking like I may have to resign to the fact that I wont be a mother. It's really sad that having HIV is not enough, now you cant even have a biological family! Sorry if I seem a little bitter, it just seems that if I'm going to be penalized by not being able to have a child with my husband than I might as well have the disease myself! Atleast then I could have a child with him! Thanks for letting me vent :'(
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You very understandably sound discouraged and upset. Those feelings may pass.
If this baby is what you and your husband really want I urge you to look for a doctor who is willing to work with you.
Also, and this may not be acceptable to you, but what about sperm from a donor? I know of a couple who recently had a baby for the second time through that method. Of course it's not the preferred choice, but it might be something to consider. And I can tell you they are thrilled with their two children.
Wanting a baby is such a big thing that I would not want to see two give up on that dream.
Cheers,
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Update to everyone that remembers me. Well I actually went thru with the plan I told you all about. My husbands viral load went undetected, I purchased a bunch of ovulation test sticks and once they lit up we had unprotected sex one time and it worked. I got pregnant. Two months later I went to have an HIV test and it was negative! Then another 2 weeks later I miscarried. Well this was back last year so it's been a while and we are going to try again, doing the same steps. His viral load is undetected again and we are going to do one more lab run to make sure and if it's still good then we are going to pull out the ovulation kit again.
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This doesn't have to be expensive as conception has been achieved through people using a friend's sperm and a turkey baster. (I kid you not)
This is so true. My daughter's best friend (Jasmine) and her wife had a "donor" ejaculate into a cup and used a turkey baster to inseminate Jasmine, who by the way, is now four months pregnant. Just another thought..... Hope you find what you're looking for!
Peace-
Betty