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FAQ: Can a mixed HIV status couple conceive a baby without infecting the uninfected person?

for Veterans and the Public

Frequently Asked Questions

Q: Can a couple in which one person is HIV positive conceive a baby without the uninfected partner becoming infected?

Many couples in which one person is HIV positive and the other person isn't want to have children and, fortunately, with some careful planning, it usually is possible to have a safe and successful pregnancy while preventing HIV from passing to the HIV-negative partner (or to the baby). It is very important to discuss your desires and intentions for childbearing with your health care provider before the woman becomes pregnant. Your provider can help with decisions about how to conceive safely (if your provider is not familiar with reproductive issues for HIV-positive persons, ask to see an HIV specialist). That will help to ensure the woman (if she is HIV infected) is on HIV medications (ARVs) that are effective and appropriate for pregnancy. Also, her provider can advise her on other important ways to protect her health before pregnancy.

If you are an HIV-positive woman and your male partner is HIV negative

There are "low-tech" and "high-tech" approaches. A safe and "low-tech" method is to do home insemination using your partner's semen and a needleless syringe, timed with your ovulation. By this method, your partner has no possible exposure to HIV. A more "high-tech" version of this approach is to use either intravaginal or intrauterine insemination. For this, you would need the assistance of a fertility clinic.

Fancier approaches are not really needed in this situation (unless you and your partner have fertility problems), but you could seek advice and assistance at a fertility clinic or an HIV clinic with experience in preventing mother-to-child transmission of HIV. They may offer insemination services (these services are legal in some states for couples with one HIV-positive partner, but not in all states).

Other approaches are riskier as far as HIV transmission is concerned. They reduce the likelihood of infection but are not 100% reliable; transmission sometimes (though rarely) may occur. Neither of the following approaches has been studied thoroughly in the context of trying to conceive a baby, and neither currently is recommended by VA or national guidelines.

  • Unprotected sex during the time the woman is ovulating (this reduces the number of times you have unprotected sex and thus lowers the risk of HIV transmission), possibly with the HIV-negative male partner taking ARVs as prophylaxis to reduce his risk of infection with HIV--either before or after unprotected sex. Ideally, the HIV-positive woman is on anti-HIV drugs and has an undetectable viral load; this greatly reduces the risk of infecting her partner).
  • Unprotected sex during the time the woman is ovulating, with the HIV-negative male partner taking ARVs as prophylaxis to reduce his risk of infection with HIV--either before or after unprotected sex. As above, the HIV-positive woman ideally is on anti-HIV drugs and has an undetectable viral load.

HIV-positive women who become pregnant, regardless of the method, should seek prenatal care, as early in the pregnancy as possible, in a program with experts in preventing HIV transmission during pregnancy or at birth.

If you are an HIV-positive man and your female partner is HIV negative

There are "low-tech" and "high-tech" approaches. Unlike the reverse situation, in which the woman is HIV positive, in this situation, there is no "low-tech" method of conceiving that is 100% safe for the uninfected partner, and many couples prefer "high-tech" approaches.

Low-tech options include:

  • Unprotected sex during the time the woman is ovulating (this increases her chance of getting pregnant while reducing the number of times you have unprotected sex), possibly with the HIV-negative female partner taking ARVs as prophylaxis to reduce her risk of infection with HIV--either before or after unprotected sex. Ideally the HIV-positive man also is on ART with full suppression of his HIV viral load.

Although these approaches reduce the likelihood of infection, they are not 100% reliable, and they have not been studied thoroughly in the context of trying to conceive a baby. We know that taking prophylactic ART (before or after unprotected sex) is not perfect at preventing HIV infection, and although having the HIV-positive partner on ARV therapy is highly effective, transmission sometimes (though rarely) may occur. "Low tech" approaches currently are not recommended by VA or national guidelines.

High-tech options include:

  • Sperm washing, which is intended to isolate individual sperm from the HIV virus in the semen, in combination with in-vitro fertilization or intrauterine insemination. These methods would involve the assistance of a reproductive specialist or fertility clinic. For HIV-discordant couples, these services are legal in some states, but not in all.

(See related question: Can two HIV-positive parents have an HIV-negative child?)