With medical advances over the past 2 decades, more and more people living with HIV are choosing to have children. If you or your partner are living with HIV and are planning a pregnancy, all the typical pre-conception recommendations apply – eat well, take folic acid, try to achieve a healthy weight, abstain from alcohol and other substances, and so on. It is very important to see a health care provider prior to conceiving to discuss medications and other special considerations. If one member of a heterosexual couple is HIV-positive and the other is not, it is important to try not to transmit HIV to the uninfected partner while trying to achieve a pregnancy. It is possible to prevent transmission. Your health care provider can offer you strategies to prevent transmission to your partner, and to your baby. You should also be aware of the possibility that you will face discrimination for your choice from people who are less informed about the risks of transmission. Counsellors are available to help you cope with any mental health or social difficulties.
Together, antiretroviral therapy, Caesarean delivery, and not breastfeeding have reduced the chances of transmitting HIV to the baby to less than 1%. In the absence of such preventive measures, transmission rates can be as high as 42%. There are legal implications if you do not permit your baby to receive antiretroviral therapy, or if you do not disclose a positive HIV status.
It is important to continue antiretroviral therapy in the pre-conception period to reduce viral load. This helps prevent transmission to your partner and/or the baby. If you are not on antiretroviral therapy, it is recommended that you start treatment in the months before you start trying to conceive. Once you are pregnant, your health care provider (an HIV specialist and/or pharmacist) will adjust your therapy to the safest regimen for the fetus. Tell your HIV specialist about your intent to become pregnant so that any necessary changes in medications can be part of your planning.
If you are attempting to become pregnant and your partner is HIV positive, you are at risk of contracting HIV. Your partner should be on combination antiretroviral therapy for at least 3-6 months, and have below-detectable levels of virus for at least 2 months in a row, before attempting to conceive. If your partner is not taking antiretroviral therapy, your risk of transmission is 0.1% to 0.3% per act of intercourse. One option to reduce this risk is to have a ‘sperm washing’ procedure conducted at a fertility clinic, followed by artificial insemination.
There are many fertility techniques that can reduce the risk of HIV transmission to the uninfected partner. These include:
Your health care provider and/or fertility specialist can give you all the information you need to make an informed choice on which method is best in your specific situation.
There are new, very effective treatments now available that cure hepatitis C. There have not been many studies on how these treatments affect a growing baby so it is best to finish treatment before attempting to conceive. There is also an older drug called ribavirin that should not be used in either women or men for at least 6 months prior to conception.