People living with HIV can choose if and how to become a parent. Because of treatment options – including PrEP and PEP – and what we know about U=U, people living with HIV who want to become parents have many options.
Science has proven that a person living with HIV who is on medication with an undetectable viral load cannot pass on the virus. Therefore, a sero-discordant heterosexual couple can try to conceive the natural way without passing on the virus.
Undetectable = Untransmittable
HIV factsheet: U = U for health professionals - Canada.ca
Can't Pass It On | CATIE - Canada's source for HIV and hepatitis C information
Prevention Access Campaign – The revolution in living and loving with HIV
Is the person living with HIV fully suppressed?
Are both partners comfortable with this option?
Has the person intending pregnancy had a preconception health workup and started on prenatal vitamins?
Is there any reason to suspect either partner of having a fertility issue?
Read the full story“A few years later, my partner and I started talking about having a baby. We were faced with some negative reactions to our decision - even our friends and family didn’t agree with it. I had to deal with a lot of judgement.”
Condomless sex as a method of conception has only recently been considered a recommended option for individuals with HIV. This option has become a recommended choice because of the science that has informed U=U.
Timed condomless sex refers to timing acts of condomless sex to the period of peak fertility during the menstrual cycle. Timing condomless sex is recommended to increase the likelihood of conceiving. The fertility window can be identified at home by using fertility awareness methods (e.g., calendar method, basal body temperature monitoring, apps for smartphone) or urinary luteinizing hormone testing (ovulation predictor kits). Here is a helpful resource to learn how to identify the peak fertility window.
Home insemination used to be a very popular choice for people living with HIV who wanted to conceive with an HIV-negative person. This was recommended when the person with the uterus was the HIV-positive individual. In the era of U=U, this option is less common but is still relevant. It may be preferred when the HIV-positive individual is not fully suppressed (although it is recommended that they work with a supportive healthcare team to find the right treatment options to achieve suppression before pregnancy), if two people who are not sexual partners would like to conceive without the help of a fertility clinic, or based on choice.
Is the person living with HIV fully suppressed?
Are both parents comfortable with this option?
Has the person intending pregnancy had a preconception health workup and started on prenatal vitamins?
Is there any reason to suspect either partner of having a fertility issue?
Do you have access to the supplies needed for home insemination?
Home insemination involves collecting sperm from a partner or donor in a sterile container or a condom (make sure the condom doesn’t have spermicidal lubricant). The sperm is drawn into a needleless syringe and then inserted into the vagina as close to the cervix as possible. Best results are achieved when insemination is done during peak fertility. This is a preferred method due to cost effectiveness, low resource utilization, and minimization of medicalization of the process of insemination. If home insemination is unsuccessful after 6 to 12 months, you should consider seeking the assistance of a fertility specialist
Like home insemination, the option of sperm washing with insemination in a fertility clinic used to be a common conception method for serodiscordant couples. This was recommended when the person providing sperm was HIV-positive. It is still a relevant option for couples based on preference or in cases where the person providing sperm has a detectable viral load. Sperm washing is a common procedure used in fertility clinics even without the addition of HIV. However, it is still not available to people living with HIV at all fertility clinics in Canada. It also requires private payment.
Are you able to pay the fees?
Have you found a fertility clinic that you feel safe and respected in?
Has the person intending pregnancy had a preconception health workup and started on prenatal vitamins?
If the person living with HIV was suppressed, might you consider a different method of conception?
Sperm washing is a well-established, effective, and safe risk reduction fertility option for serodiscordant couples. In a fertility clinic, semen (which includes sperm and the fluid that the sperm is carried in) is placed in a machine called a centrifuge to separate live sperm (which do not carry HIV) from the fluid. It is then inseminated into the person intending pregnancy at the time of ovulation. This practice is well established in the literature to be an effective method to minimize horizontal transmission.
There are many different fertility treatment options. Most of these are offered to people who have been unable to conceive without medical support. These options include the insemination that is used with sperm washing, as well as procedures such as IVF. All of these options are available to people living with HIV. When a person living with HIV has an undetectable viral load, these procedures are not necessary to prevent transmission of HIV to the other partner/parent. Given the cost and invasive procedures, they are most common when there is an underlying medical fertility issue or when individual circumstances require medical support.
Are you able to pay the fees?
Have you found a fertility clinic that you feel safe and respected in?
Has the person intending pregnancy had a preconception health workup and started on prenatal vitamins?
If the person living with HIV was suppressed, might you consider a different method of conception?
Read the full story“I am still looking for the right support in all of this. I would love to talk to women who have gone through this journey whose lives have followed a similar path as mine.”
Intrauterine insemination (IUI) involves placing prepared sperm directly into the uterus during ovulation.
Invitro Fertilization (IVF) refers to the procedure whereby oocytes (eggs) are taken out of the body and are exposed to sperm.
In many parts of Canada, assisted reproductive technology is not covered by provincial health plans. The costs vary depending on the treatment but can be as much as $15,000 month.
People living with HIV may consider the use of donor sperm or eggs to pursue their reproductive goals. Donor sperm and eggs can be accessed through banks via fertility clinics. The use of donor sperm or eggs is most common when a single person is looking to conceive or when an individual has infertility. There is a cost for donor eggs or sperm. Also, conception attempts using donor eggs or sperm most often happen within fertility clinics.
In surrogacy, eggs are taken from a fertile egg donor. Through IVF, a surrogate becomes pregnant. Following delivery, the infant is given to the intended parents. Intended parents are usually very involved throughout the pregnancy, even attending appointments. There are many different approaches to surrogacy depending on each individual or couple who are using surrogacy.
If you are interested in learning more about surrogacy as a person living with HIV, it is best to get a referral to a fertility clinic. This will help you understand the process and any potential barriers. Clinics can help you understand how Health Canada policies and guidelines create barriers for people living with HIV.
Sperm donation, egg donation, and surrogacy are discussed indepth in a joint policy statement on ethical issues in assisted reproduction prepared by the SOGC and the Canadian Fertilityand Andrology Society
Additional information is available from Assisted Human Reproduction Canada and fertility specialists. Individuals and couples with HIV who require sperm donation, egg donation, or a surrogate are likely to require legal advice and contracts
There are also legal considerations for surrogacy and known sperm donation. Fertility clinics can also help you learn more about these.
Are you able to pay the fees?
Have you found a fertility clinic that you feel safe and respected in?
Have you considered the legal aspects?
Do you understand any policies or guidelines that would create challenges for you as a person living with HIV?
Read the full story“I want to be really honest with others who might be in a similar position as me so they can learn.”
Coming soon!
Yes! Adoption is also an option for people living with HIV and many people living with HIV in Canada are adoptive parents. As an aoptive parent, you would need to go through a screening process that is very intensive before being approved for adoption in Canada. It is important to know that while your HIV status does not exclude you from being eligible to adopt in Canada, instances of HIV stigma have been reported by people living with HIV seeking to adopt (link to adoption paper).
Unfortunately, international adoption continue to be very difficult for people living with HIV. If you are intersted in international adoption, you will need to look into the rules for specific countries to learn more. This includes international adoption of minor family members. This ongoing disrcimination against people living with HIV requires ongoing advoacy.
Are you interested in a domestic or international adoption?
Do you understand the process?
Are you able to pay the fees?
Adoption should be reviewed as an option for parenting with all prospective parents with or affected by HIV. Adoption is a legal and social process. It involves the transferring of rights over a child from birth parents to adoptive parents. In Canada, adoption is regulated provincially, so requirements vary depending upon geographical location. They may also differ depending upon whether the adoption is undertaken privately or through the public system or is international.