title: Efficacy and safety of intrauterine insemination and assisted reproductive technology in populations serodiscordant for human immunodeficiency virus: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To assess procreative outcomes for HIV-positive men and women with seronegative partners.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Twenty-four studies with extractable data for HIV-serodiscordant couples undergoing intrauterine insemination (IUI) or in vitro fertilization (IVF).
  
  
  METHODS
  None.
  
  
  METHODS
  
  
  
  METHODS
  HIV transmission to a seronegative partner and per cycle fecundability; secondary outcomes: analysis of multiple gestation rates, miscarriage rates, and cancellation rates.
  
  
  RESULTS
  For serodiscordant couples, HIV-positive men or women undergoing IUI and IVF treatment had a 17%, 30%, 14%, and 16% per cycle fecundability, respectively. Multiple gestation rates were 10%, 33%, 14%, and 29%, respectively. Miscarriage rates were 19%, 25%, 13%, and 20%, respectively. No HIV transmission was observed in 8,212 IUI and 1,254 IVF cycles, resulting in 95% confidence that the true rate is 4.5 transmissions per 10,000 IUI cycles or less.
  
  
  CONCLUSIONS
  In serodiscordant couples, IUI and IVF seem effective and safe based on the literature. Evidence-based practice and social justice suggest that our field should increase access to care for HIV-serodiscordant couples.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Texas, Southwestern, Dallas, Texas.
authors.forename: Arti
authors.initials: A
authors.lastname: Barnes
authors.affiliation: Department of Pharmacy Practice, University of Mississippi Medical Center, Jackson, Mississippi.
authors.forename: Daniel
authors.initials: D
authors.lastname: Riche
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Texas, Southwestern, Dallas, Texas.
authors.forename: Leandro
authors.initials: L
authors.lastname: Mena
authors.affiliation: University of Mississippi Medical School, Jackson, Mississippi.
authors.forename: Thérèse
authors.initials: T
authors.lastname: Sison
authors.affiliation: Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi.
authors.forename: Lauren
authors.initials: L
authors.lastname: Barry
authors.affiliation: Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi.
authors.forename: Raveena
authors.initials: R
authors.lastname: Reddy
authors.affiliation: Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi.
authors.forename: James
authors.initials: J
authors.lastname: Shwayder
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Mississippi Medical Center, University of Mississippi, Jackson, Mississippi. Electronic address: fertility@umc.edu.
authors.forename: John Preston
authors.initials: JP
authors.lastname: Parry
mesh_terms: D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D005298:Fertility; D015658:HIV Infections / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000635:transmission*; D020276:HIV Long-Term Survivors; D018023:HIV Seronegativity; D006679:HIV Seropositivity; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D007317:Insemination, Artificial, Homologous / Q000009:adverse effects; D008297:Male; D061214:Patient Safety; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology; D027724:Reproductive Techniques, Assisted / Q000009:adverse effects; D018570:Risk Assessment; D012307:Risk Factors; D018454:Spouses; D016896:Treatment Outcome
keywords: HIV; IUI; IVF; insemination; serodiscordant