title: The effect of human immunodeficiency virus on sperm parameters and the outcome of intrauterine insemination following sperm washing.
abstract: BACKGROUND
  This is the first study to assess the outcome of sperm washing and intrauterine insemination (IUI) cycles in human immunodeficiency virus-positive (HIV(+)) men to determine any predictors of success, as well as evaluating the effect of HIV on sperm parameters.
  
  
  METHODS
  Semen characteristics were evaluated in 106 HIV(+) men and a control group of 234 HIV(-) men, and the effect of markers of HIV disease assessed. Age, stimulation regime, sperm parameters, markers of HIV disease and the use of anti-retrovirals were assessed as predictors of the outcome of sperm washing/IUI cycles in the HIV(+) men.
  
  
  RESULTS
  Ejaculate volume, sperm concentration, total count, progressive motility and normal morphology were all significantly higher in the control group compared to the HIV(+) men (P<0.05). A significant positive correlation was observed between CD4 count and sperm concentration, total count, motility, progressive motility type 'a'+'b' and post-preparation concentration and a significant negative correlation with normal sperm morphology of both raw and post-preparation samples. No correlation was observed between viral load (VL), years since diagnosis, use of anti-retrovirals or duration of use and any sperm parameter. The only factors that significantly improved IUI outcome were a VL <1000 copies/ml and the use of anti-retrovirals.
  
  
  CONCLUSIONS
  These data demonstrate that sperm parameters are significantly impaired by the presence of HIV infection and in particular correlate with CD4 count. Undetectable VL and the use of anti-retrovirals improve the outcome of IUI/sperm washing in HIV(+) men.
authors.affiliation: Assisted Conception Unit, Chelsea & Westminster Hospital, London SW10 9NH, UK. james.nicopoullos@chelwest.nhs.uk
authors.forename: James D M
authors.initials: JD
authors.lastname: Nicopoullos
authors.forename: Paula A
authors.initials: PA
authors.lastname: Almeida
authors.forename: Jonathan W A
authors.initials: JW
authors.lastname: Ramsay
authors.forename: Carole
authors.initials: C
authors.lastname: Gilling-Smith
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology*; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007317:Insemination, Artificial, Homologous; D008297:Male; D008875:Middle Aged; D013076:Sperm Count; D013081:Sperm Motility; D013094:Spermatozoa / Q000648:ultrastructure; D007507:Therapeutic Irrigation; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents