title: Effectiveness of semen washing to prevent human immunodeficiency virus (HIV) transmission and assist pregnancy in HIV-discordant couples: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To evaluate the effectiveness of semen washing in human immunodeficiency virus (HIV)-discordant couples in which the male partner is infected.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Forty single-arm open-label studies among HIV-discordant couples that underwent intrauterine insemination (IUI) or in vitro fertilization (IVF) with or without intracytoplasmic sperm injection (ICSI) using washed semen.
  
  
  METHODS
  Semen washing followed by IUI, IVF, or IVF/ICSI.
  
  
  METHODS
  
  
  
  METHODS
  HIV transmission to HIV-uninfected women; secondary outcomes: HIV transmission to newborns and proportion of couples achieving a clinical pregnancy.
  
  
  RESULTS
  No HIV transmission occurred in 11,585 cycles of assisted reproduction with the use of washed semen among 3,994 women. Among the subset of HIV-infected men without plasma viral suppression at the time of semen washing, no HIV seroconversions occurred among 1,023 women after 2,863 cycles of assisted reproduction with the use of washed semen. Studies that measured HIV transmission to infants reported no cases of vertical transmission. Overall, 56.3% of couples (2,357/4,184) achieved a clinical pregnancy with the use of washed semen.
  
  
  CONCLUSIONS
  Semen washing appears to significantly reduce the risk of transmission in HIV-discordant couples desiring children, regardless of viral suppression in the male partner. There are no randomized controlled studies or studies from low-income countries, especially those with a large burden of HIV. Continued development of lower-cost semen washing and assisted reproduction technologies is needed. Integration of semen washing into HIV prevention interventions could help to further reduce the spread of HIV.
authors.affiliation: Global Health Sciences, University of California, San Francisco, California.
authors.forename: Maryam
authors.initials: M
authors.lastname: Zafer
authors.affiliation: Global Health Sciences, University of California, San Francisco, California.
authors.forename: Hacsi
authors.initials: H
authors.lastname: Horvath
authors.affiliation: Department of Obstetrics and Gynecology, University of Michigan School of Medicine, Ann Arbor, Michigan.
authors.forename: Okeoma
authors.initials: O
authors.lastname: Mmeje
authors.affiliation: Division of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
authors.forename: Sheryl
authors.initials: S
authors.lastname: van der Poel
authors.affiliation: Department of Clinical Sciences "L. Sacco", University of Milan School of Medicine, Milan, Italy.
authors.forename: Augusto E
authors.initials: AE
authors.lastname: Semprini
authors.affiliation: Global Health Sciences, University of California, San Francisco, California.
authors.forename: George
authors.initials: G
authors.lastname: Rutherford
authors.affiliation: Global Health Sciences, University of California, San Francisco, California; Department of Obstetrics and Gynecology, University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Epidemiology and Biostatistics and Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California. Electronic address: joelle.brown@ucsf.edu.
authors.forename: Joelle
authors.initials: J
authors.lastname: Brown
mesh_terms: D000328:Adult; D005260:Female; D005307:Fertilization in Vitro; D006678:HIV / Q000302:isolation & purification*; D015658:HIV Infections / Q000175:diagnosis / Q000517:prevention & control* / Q000635:transmission* / Q000821:virology; D018023:HIV Seronegativity; D006679:HIV Seropositivity; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007315:Insemination, Artificial; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D018873:Pregnancy Rate; D012307:Risk Factors; D020554:Sperm Injections, Intracytoplasmic; D053625:Sperm Retrieval; D013094:Spermatozoa / Q000821:virology*; D016896:Treatment Outcome
keywords: HIV prevention; assisted reproduction; safer conception; semen washing; serodiscordant