Efficacy and safety of intrauterine insemination and assisted reproductive technology in populations serodiscordant for human immunodeficiency virus: A systematic review and meta-analysis

Arti Barnes, Daniel Riche, Leandro Mena, Thérèse Sison, Lauren Barry, Raveena Reddy, James Shwayder, John Preston Parry

Research output: Contribution to journalArticle

26 Scopus citations

Abstract

Objective To assess procreative outcomes for HIV-positive men and women with seronegative partners. Design Systematic review and meta-analysis. Setting Not applicable. Patient(s) Twenty-four studies with extractable data for HIV-serodiscordant couples undergoing intrauterine insemination (IUI) or in vitro fertilization (IVF). Intervention(s) None. Main Outcome Measure(s) Primary outcomes: HIV transmission to a seronegative partner and per cycle fecundability; secondary outcomes: analysis of multiple gestation rates, miscarriage rates, and cancellation rates. Result(s) 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. Conclusion(s) 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.

Original languageEnglish (US)
Pages (from-to)424-434
Number of pages11
JournalFertility and sterility
Volume102
Issue number2
DOIs
StatePublished - Aug 2014

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Keywords

  • HIV
  • IUI
  • IVF
  • insemination
  • serodiscordant

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology

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