According to the World Health Organization, nearly half of all couples living with HIV around the world areserodiscordant, meaning that one partner has HIV and the other doesn’t.In the United States, it is estimated that there over 140,000 different-sex couples are serodiscordant.
This article takes an in-depth look at the tools and strategies serodiscordant couples can use to safely conceive irrespective of which partner has HIV.
Wavebreakmedia / iStock / Getty Images
Preconception Strategies
If a couple with HIV is planning to conceive, preparation is needed. During the preconception stage, the strategy would ideally aim to do two things:
HIV PrEP
There are benefits and risks to each of these options.
Pre-market studies have found that people who used Apretude were between 69% and 90% less likely to get HIV compared to Truvada. With that said, there is little data currently available to assess the drug’s safety in pregnancy.
By contrast, a 2020 studysuggested that oral versions of PrEP are generally safe for use in people with pregnancy as well as their babies.
Speak with your healthcare provider before starting any form of PrEP to fully understand the benefits and risks of treatment. This includes understanding the need for routinetestingto ensure that HIV transmission has not occurred.
Treatment as Prevention (TasP)
The eight-year study involving 777 HIV serodiscordant couples reported that not one infection occurred in couples for whom the HIV-positive partner had an undetectable viral load.
The strategy, referred to as treatment as prevention (TasP), traditionally requires the partner with HIV to take their medications every day as prescribed to remain fully undetectable.
However, in 2021, a new antiretroviral therapy calledCabenuva(cabotegravir and rilpivirine) was approved that can suppress the virus to undetectable levels with just two shots given once monthly.
If Both Partners Have HIVIf both partners have HIV, it is important that both have an undetectable viral load to avoidreinfection. Reinfection can lead to transmitted resistance in which a drug-resistant variant is passed to a partner. If this happens, certain HIV drugs may not work as well.
If Both Partners Have HIV
If both partners have HIV, it is important that both have an undetectable viral load to avoidreinfection. Reinfection can lead to transmitted resistance in which a drug-resistant variant is passed to a partner. If this happens, certain HIV drugs may not work as well.
HIV Statistics You Should Know
Safer Conception
If the female partner has HIV, maintaining an undetectable viral load during the pregnancy reduces the risk of transmission from mother to child to between 0.1% and 0.3%.Some studies suggest that having an undetectable viral load beforeconceiving may reduce the risk to zero.
If PrEP cannot be used for any reason, the couple can still conceive if the partner with HIV is virally suppressed.
Once this is achieved, intercourse can be scheduled using ovulation detection methods (like theClearblue EasyorFirst Responseurine tests). This ensures that you only have condomless sex when conception is possible. Outside this fertile window,condoms should be used.
Once a pregnancy is confirmed, the partner with HIV would continue antiretroviral therapy. The partner without HIV can decide whether to continue PrEP or not.
From that point forward, the focus would be placed on ensuring a safe pregnancy.
Alternative Strategies
If for any reason a couple decides not to conceive naturally, they can work with a fertility specialist to explore assisted fertility options. The options vary based on which partner has HIV.
If the female partner has HIV, the options include:
If the male partner has HIV (or both partners have HIV),sperm washingmay be explored. This involves separatingspermfrom HIV-infected seminal fluids for use in either IUI or IVF.
The one limiting factor of IUI and IVF is cost. With IUI, the price without insurance can range from $300 to $1,000 per attempt.With IVF, the fee for one cycle (including medications, lab tests, embryo storage, and procedures) is around $15,000, according to Planned Parenthood.
Summary
If you or your partner have HIV and want to have children, it is possible to conceive safely. The partner with HIV would need to be on antiretroviral therapy to suppress the virus to undetectable levels. The partner without HIV should consider using pre-exposure prophylaxis (PrEP) to lower the risk of getting HIV.
When these strategies are used together, the risk of HIV transmission can be eliminated.
Other strategies can prevent HIV transmission (including sperm washing, intrauterine insemination, and in vitro fertilization) but these tend to be more complicated and expensive without necessarily being “better” than PrEP and antiretroviral therapy.
A Word From Verywell
If you have HIV and want to get pregnant, it’s always a good idea to connect your HIV specialist with yourobstetrician-gynecologist (OB-GYN)and/or fertility specialist.
Among the concerns, there are certain antiretrovirals, like Sustiva (efavirenz) that are contraindicated for use in people with pregnancy and should be changed before trying to conceive.
Similarly, HIV can sometimes cause fertility problems in either partner that may need to be addressed before assisted fertility is pursued.
15 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
World Health Organization.Living with HIV when one partner is positive and the other is negative.
Mmeje O, Cohen CR, Cohan D.Evaluating safer conception options for HIV-serodiscordant couples (HIV-infected female/HIV-uninfected male): A closer look at vaginal insemination.Infect Dis Obstet Gynecol.2012;2012:587651. doi:10.1155/2012/587651
Centers for Disease Control and Prevention.How effective is PrEP?
U.S. Food and Drug Administration.FDA approves first injectable treatment for HIV pre-exposure prevention.
Davey DLJ, Pintye J, Baeten JM, et al.Emerging evidence from a systematic review of safety of pre-exposure prophylaxis for pregnant and postpartum women: where are we now and where are we heading?J Int AIDS Soc.2020 Jan;23(1):e25426. doi:10.1002/jia2.25426
Rodger A, Cambiano V, Bruun T, et al.Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study.Lancet.2019;393(10189):2428-2438. doi:10.1016/S0140-6736(19)30418-0
U.S. Food and Drug Administration.FDA approves first extended-release, injectable drug regimen for adults living with HIV.
Panichsillapakit T, Smith DM, Wertheim JO, Richman DD, Little SJ, Mehta SR.Prevalence of transmitted HIV drug resistance among recently infected persons in San Diego, CA 1996-2013.J Acquir Immune Defic Syndr. 2016;71(2):228-36. doi:10.1097/QAI.0000000000000831
Peters H, Francis K, Sconza R, et al.UK mother-to-child HIV transmission rates continue to decline: 2012–2014.Clin Infect Dis.2017;64:527-8. doi:10.1093/cid/ciw791
Mandelbrot L, Tubiana R, Le Chenadec J, et al.No perinatal HIV-1 transmission from women with effective antiretroviral therapy starting before conception.Clin Infect Dis.2015;61(11):1715-25. doi:10.1093/cid/civ578
Zafer M, Horvath H, Mmeje O, et al.Effectiveness of semen washing to prevent HIV transmission and assist pregnancy in HIV-discordant couples: A systematic review and meta-analysis.Fertil Steril.2016;105(3):645-55.e2. doi:10.1016/j.fertnstert.2015.11.028
Planned Parenthood.What is intrauterine insemination (IUI)?
Planned Parenthood.What is in-vitro fertilization (IVF)?
DHHS Panel on Antiretroviral Guidelines for Adults and Adolescents.Recommendations for the use of antiretroviral drugs in pregnant women with HIV infection and interventions to reduce perinatal HIV transmission in the United States.
DHHS Panel on Treatment of Pregnant Women with HIV Infection and Prevention of Perinatal Transmission.Recommendations for the use of antiretroviral drugs in pregnant women with HIV infection and interventions to reduce perinatal HIV transmission in the United States.
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
