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Update on Special Program for Assisted Reproduction
Robert C. Eyre, MD1, Hui-Zhong Yin, MD2, Paul Winig, MD2, Ann Kiessling, PhD2.
1Beth Israel Deaconess Medical Center, Bedford Research Foundation, Boston, Bedford, MA, USA, 2Bedford Research Foundation, Bedford, MA, USA.

BACKGROUND: As antiretroviral treatment for patients infected with HIV became more effective in the late 1980s, it became clear that most patients would not die of AIDS and that young men would need assistance with family planning in order that they not transfer virus to their partner or offspring. Thus, it became critically important to study HIV in semen. Between 1985-1995, our laboratory discovered: 1) Sperm themselves are not HIV-infected; 2) The amount of HIV in semen cannot be predicted by the amount of HIV in blood; 3) HIV exists in semen both as free HIV particles and as HIV-infected cells; and 4) The amount of HIV in semen varies greatly from specimen to specimen on the same patient, therefore there is a need to test each specimen individually for HIV.
METHODS: We developed a testing method whereby each semen specimen is divided into 3 parts: 1/2 of the specimen is washed, cryopreserved and quarantined, 1/4 is fixed and stained for HIV-infected cells, and 1/4 is subjected to a sensitive RT-PCR assay, which can detect 20 copies of viral RNA, and/or 1 infected cell per specimen. In the initial study, 12 men on various regimens of antiretroviral therapy who had either very low or undetectable viral loads in blood for at least 1 year provided semen specimens approximately once per month for 8 months.
RESULTS: The specimens showed variable viral loads and many showed udetectable virus. The results were independent of whether the patient was on antiretroviral therapy. Only specimens found to be negative for virus were used for assisted reproductive techniques (ART). From 2000-2006, 608 semen specimens from 262 men were tested for HIV. 107 (19%) of the specimens were positive for virus and were discarded. 151 couples proceeded to ART. There were 69 pregnancies and 62 babies born (10 sets of twins). From 2007-2011, 826 semen specimens from 368 men were tested for HIV. 147 (18%) tested positive and were discared. 172 couples proceeded to AFT with 87 pregnancies and 96 babies born (4 sets of twins, one set of triplets). As of March 2012, there are 56 collaborating fertility clinics in the US and abroad. 157 babies have been born, with 11 ongoing pregnancies. All mothers and babies have tested negative for HIV.
CONCLUSIONS: SPAR, initially begun as a basic research study, has developed into a widely-recognized program for producing safe conception for HIV-discordant couples.


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