A decade of sperm washing: clinical correlates of successful insemination outcome.
BACKGROUND
Since 1999, we have treated HIV-positive men with sperm washing as part of a risk-reduction programme.


METHODS
Retrospective analysis of the sperm-washing database from the treatment of 245 couples with 439 cycles of intrauterine insemination assessed the effects of patient factors (age, maternal FSH, rank of attempt), markers of HIV-disease [time since diagnosis, CD4 count, viral load (VL), use of highly active antiretroviral therapy (HAART)], cycle factors (natural versus stimulated, number of follicles, fresh versus frozen sperm) and sperm parameters on clinical (CPR) and ongoing pregnancy rate (OPR).


RESULTS
Overall 111-245 (45.4%) couples achieved a clinical pregnancy (CPR: 13.5% and OPR: 9.6% per insemination) with no seroconversions. The mean duration since HIV diagnosis was 5.8 years, 73% of men were on antiretroviral therapy, there was an undetectable VL in 64% and the median CD4 was 409 cells/mm(3). A significantly decreased OPR and a non-significantly increased miscarriage rate (MR) was observed after the female age of 40. Similarly, there was a significant increased OPR and decreased MR for women with a mean cycle maternal FSH of <6.4 IU/l. There was no effect of VL, CD4 count, use of HAART or time since diagnosis on the outcome. Nor was there a difference in the OPR according to paternal age, rank of attempt, cycle regime or number of follicles. Semen volume, sperm concentration, total count and progressive motility and post-wash concentration, progressive motility and total motile count inseminated were significantly higher in successful cycles. The use of frozen sperm had a significant negative impact on outcome.


CONCLUSIONS
This study of the potential safe and successful reproductive options available to HIV-positive men demonstrates that maternal age and semen quality, rather than HIV factors, remain the most important determinants of cycle success.
Chelsea and Westminster Assisted Conception Unit, 369 Fulham Rd, London SW10 9NH, UK. jnicopoullos@aol.com
James D M
JD
Nicopoullos
Paula
P
Almeida
Maria
M
Vourliotis
Rebecca
R
Goulding
Carole
C
Gilling-Smith
D000328:Adult; D000367:Age Factors; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000821:virology; D006801:Humans; D007317:Insemination, Artificial, Homologous / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D012189:Retrospective Studies; D018570:Risk Assessment; D012661:Semen / Q000821:virology; D013094:Spermatozoa / Q000821:virology*; D016896:Treatment Outcome; D019562:Viral Load