title: Fertility needs and funding in couples with blood-borne viral infection.
abstract: BACKGROUND
  Couples infected with HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) are increasingly seeking assisted conception. These couples avoid unprotected intercourse and use condoms at all times in order to minimize the risk of infecting their partner. As this practice inhibits pregnancy, assisted procreation is generally required for safe conception. For many couples, access to such services is restricted on ethical, geographical and financial grounds.
  
  
  OBJECTIVE
  The aim of the study was to assess the fertility needs, geographical origin and state funding of patients with blood-borne viral infection.
  
  
  METHODS
  A retrospective review of the medical records of couples referred for fertility treatment between January 1999 and December 2006, where one or both partners were infected with HIV, HBV and/or HCV, was carried out.
  
  
  RESULTS
  Of the 205 couples included in the study, 44% lived in London, 51% came from elsewhere in the United Kingdom and 5% travelled from outside the United Kingdom to seek treatment. Genitourinary medicine clinics were the main source of referral. 85.8% of couples had HIV infection, 15.1% were infected with HBV and 13.6% had HCV infection. Fertility screening identified a high incidence of male factor infertility (33.3%) in HIV-infected men and tubal disease (40.8%) in HIV-infected women. Only 23.6% of HIV-infected couples, 20% of HBV-infected couples and 12.5% of HCV-infected couples obtained state funding for assisted conception.
  
  
  CONCLUSIONS
  Fertility screening identified a high incidence of male and tubal factor subfertility among couples living with HIV, HBV and HCV. Limited access to specialist clinics equipped to cater for these couples and restricted funding may impact negatively on couples obtaining risk-reducing assisted reproduction treatment. This may have long-term public health implications as individuals attempt to conceive through unprotected intercourse.
authors.affiliation: Assisted Conception Unit, Chelsea and Westminster Hospital, London, UK. ekalu@doctors.org.uk
authors.forename: E
authors.initials: E
authors.lastname: Kalu
authors.forename: R
authors.initials: R
authors.lastname: Wood
authors.forename: M
authors.initials: M
authors.lastname: Vourliotis
authors.forename: C
authors.initials: C
authors.lastname: Gilling-Smith
mesh_terms: D017280:Condoms / Q000706:statistics & numerical data; D003219:Confidentiality; D018562:Disease Transmission, Infectious / Q000517:prevention & control; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006525:Hepatitis, Viral, Human / Q000150:complications; D006801:Humans; D007246:Infertility / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D027724:Reproductive Techniques, Assisted / Q000191:economics*; D012189:Retrospective Studies; D006113:United Kingdom