• HIV
• infertility
• reproductive technology

Sharma et al discuss the fertility needs of HIV affected couples and present a strong case that they should not be denied access to medical interventions to help them conceive while minimising the risks of transmission. Artificial insemination of partner’s semen (AIH) is a simple, cheap, and effective method of avoiding HIV transmission from an HIV infected female to her HIV uninfected partner. Prevention of male to female transmission of HIV while trying to conceive is more complicated. To date, sperm washing has proved to be a safer alternative to timed unprotected intercourse with more than 3000 cycles (of insemination of washed sperm) undertaken without transmission. This represents at least a 3–6-fold reduction in risk compared to the reported transmission rates of 1:500 to 1:1000 per episode of unprotected intercourse between uninfected females and their infected partners.¹ There is also a case for offering this service to HIV infected concordant couples to prevent transmission of new viral strains, particularly strains with drug resistance mutations although transmission rates are uncertain.

What then are the arguments against offering this service? …