NICE guideline on fertility treatment proposes alternatives to sperm washing
Polly Clayden, HIV i-Base
National Institute for Health and Clinical Excellence (NICE) are updating their fertility recommendations (last guidance was 2004).
The 2012 draft includes a section on viral transmission with the review question: “What is the effectiveness and safety of sperm washing to reduce the risk of viral transmission?” It specifically addresses transmission risk of HIV when HIV positive male partners are on treatment and when HIV negative women use pre-exposure prophylaxis.
On review of the evidence the guideline concluded that recommendations should be in concordance with ‘Swiss Criteria’ ie if a person meets the following criteria then they are not sexually infectious:
- The person adheres to antiretroviral therapy, the effects of which must be evaluated regularly by the treating physician, and
- The viral load has been suppressed (<50 copies/mL) for at least six months, and
- There are no other sexually transmitted infections.
Where these criteria were not met couples would still be advised to have sperm washing. The guidance acknowledges that there might be some couples who would still be anxious about transmission with unprotected intercourse and request sperm washing, despite the HIV positive man being adherent on ART with a viral load of less than 50 copies/mL. In these circumstances the recommendation is that the request should be considered. Couples should be made aware that fertility rates would be lower with sperm washing and IUI compared with unprotected intercourse at the time of ovulation.
In situations where ART was being used and viral loads were undetectable the guidance highlights that sperm washing only reduced viral loads rather than eliminating it, so there would be little or no added benefit from this option.
National Collaborating Centre for Women’s and Children’s Health, Commissioned by the National Institute for Health and Clinical Excellence Draft for stakeholder consultation. Fertility: assessment for people with fertility problems (update, May 2012).