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.
Nicopoullos
James D M
JD
Chelsea and Westminster Assisted Conception Unit, 369 Fulham Rd, London SW10 9NH, UK. jnicopoullos@aol.com
Almeida
Paula
P
Vourliotis
Maria
M
Goulding
Rebecca
R
Gilling-Smith
Carole
C
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