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P17.30 A feasibility study assessing fertility in hiv-serodiscordant couples attempting pregnancy in kisumu, kenya
  1. O Mmeje1,
  2. A Murage2,
  3. B Njoroge3,
  4. S van der Poel4,
  5. CR Cohen5,6
  1. 1University of Michigan, Department of Obstetrics and Gynecology
  2. 2Aga Khan University, Nairobi, Kenya
  3. 3Kenya Medical Research Institute (KEMRI), Centre for Microbiology Research
  4. 4Department of Reproductive Health and Research Including the HRP Special Research Programme, World Health Organization, Geneva, Switzerland
  5. 5Family AIDS Care and Education Services (FACES)
  6. 6University of California, San Francisco, Department of Obstetrics, Gynecology & Reproductive Sciences

Abstract

Background HIV-serodiscordant couples desiring children face the difficult choice between risking transmission through condomless intercourse to become pregnant and the social stigmatisation of being childless. In sub-Saharan Africa, 14.3 million women are HIV-infected and many exercise their reproductive right to achieve pregnancy; however, though often overlooked, fertility problems due to tubal damage, menstrual cycle irregularities, and diminished ovarian reserve may affect these women.

Methods A study of female positive/male negative (♀+/♂-) HIV-serodiscordant couples using timed vaginal insemination (TVI) as a safer method of conception was conducted in Kenya. A fertility evaluation was offered to couples unable to achieve pregnancy after six cycles of TVI. Men completed a semen analysis and women a hystero-salpingo-contrast-sonography (HyCoSy) to investigate the uterus, ovaries, and fallopian tubes.

Results Fifteen of 23 ♀+/♂- HIV-serodiscordant couples were eligible for fertility evaluations; 14 consented; and seven completed male and female fertility assessments. The mean age of the men and women who completed fertility evaluations was 33.7 (std. dev. = 4.58), and 30 (std. dev. = 5.41) years, respectively. Fertility evaluations determined that three women had bilateral fallopian tube occlusion with one male partner having decreased sperm motility; and four women had unilateral/bilateral fallopian tube patency. Seven couples declined or were unable to complete a full couple evaluation. Of the 14 women evaluated, six (46%) had an HIV RNA viral load (≥400 copies/mL); six (46%) had an undetectable HIV RNA viral load; and two declined serum assessment.

Conclusion Amongst HIV-serodiscordant couples attempting to achieve pregnancy, underlying male and/or female factor infertility and inadequate viral suppression may be present. As safer conception interventions are integrated into HIV care programs, a fertility evaluation should be offered, if feasible and available, to HIV-affected individuals/couples planning a pregnancy, to optimise their conception efforts, decrease HIV transmission, and assess their potential to conceive without assistance.

Disclosure of interest statement This research was supported in part by a grant from the National Institutes of Health (NIH), University of California San Francisco-Gladstone Institute of Virology and Immunology Centre for AIDS Research (P30 AI027763) and the United Nations jointly sponsored HRP Special Research Programme. O. Mmeje was partly supported by NIH/T32–5T32AI065388–03.

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