Question

Can we stop using condoms in order to have a baby?

24 May 2009. Related: All topics, Pregnancy.

I want to have a baby but…

My husband and myself are a discordant couple, he is positive and I’m negative. We were planning on having a baby and we had secured funding for sperm washing through our NHS trust. However, because it is a long process my husband is now saying it is too much for him. Basically, he says other doctors have attitude towards him and he does not like all these different doctors knowing his status other than his HIV doctor.

He is on meds and his viral load is constantly undetectable, so my question is could we try timed conception? But knowing my husband, he might refuse, because he told me he does not want to ever pass the virus to me. We are consistant condom users. We discovered he was positive before we got married. Please help me with more info around this area. Is it possible for me to take nevirapine on my fertile days then have unprotected sex to try and conceive? Please help.

Answer

Answer: Simon Collins

It is great that your NHS trust can provide you with the financial back up for sperm washing. I am afraid, many people in the UK are not as lucky as you. Some of them need to pay out of pocket and as a result never succeed to have a baby and this is a shame.

When it comes to the problems that your husband has re: attitude of doctors, perhaps you may decide to discuss meeting other, more friendly doctors. I can reassure you they are out there.

If you decide, however, not to take the sperm washing option, then you may try the limited conception attempts approach, but you need to know that that means is more controversial.

To make this safer an HIV-positive man must use HIV treatment to reduce his viral load to undetectable both in blood and semen for at least 6 months. Conception can either be naturally (having gentle sex) or with self insemination. Most doctors can provide guidance on how to plan and identify which days would be appropriate.

Viral load in semen can be tested using a similar viral load tests that are used for blood, and the your husbands clinic could advise on this. Currently, the Chelsea and Westminster Hospital is the main clinic providing viral load tests on sperm.

Approximately 10% of people with undetectable levels in blood, can have detectable levels in semen, so this could offer additional safety.

Self-insemination would reduce the risk of trauma during sex where a small tear could increase the risk of HIV transmission. Again, your clinic can provide you with the information and what you would need for this.

Finally, using medicines as a pre-exposure prophylaxis may make sense (not nevirapine, but perhaps tenofovir plus FTC), but there are little data to quantify how this would minimise risk further, given that viral load will be at such low levels.

Hope this helps.