P17.30 A feasibility study assessing fertility in hiv-serodiscordant couples attempting pregnancy in kisumu, kenya

Abstract

Background HIV-serodiscordant couples desiring children face the difficult choice between risking transmission through condomless intercourse to become pregnant and the social stigmatisation of being childless. In sub-Saharan Africa, 14.3 million women are HIV-infected and many exercise their reproductive right to achieve pregnancy; however, though often overlooked, fertility problems due to tubal damage, menstrual cycle irregularities, and diminished ovarian reserve may affect these women. Methods A study of female positive/male negative (♀+/♂-) HIVserodiscordant couples using timed vaginal insemination (TVI) as a safer method of conception was conducted in Kenya. A fertility evaluation was offered to couples unable to achieve pregnancy after six cycles of TVI. Men completed a semen analysis and women a hystero-salpingo-contrast-sonography (HyCoSy) to investigate the uterus, ovaries, and fallopian tubes. Results Fifteen of 23 ♀+/♂- HIV-serodiscordant couples were eligible for fertility evaluations; 14 consented; and seven completed male and female fertility assessments. The mean age of the men and women who completed fertility evaluations was 33.7 (std. dev. = 4.58), and 30 (std. dev. = 5.41) years, respectively. Fertility evaluations determined that three women had bilateral fallopian tube occlusion with one male partner having decreased sperm motility; and four women had unilateral/bilateral fallopian tube patency. Seven couples declined or were unable to complete a full couple evaluation. Of the 14 women evaluated, six (46%) had an HIV RNA viral load (≥400 copies/ mL); six (46%) had an undetectable HIV RNA viral load; and two declined serum assessment. Conclusion Amongst HIV-serodiscordant couples attempting to achieve pregnancy, underlying male and/or female factor infertility and inadequate viral suppression may be present. As safer conception interventions are integrated into HIV care programs, a fertility evaluation should be offered, if feasible and available, to HIV-affected individuals/couples planning a pregnancy, to optimise their conception efforts, decrease HIV transmission, and assess their potential to conceive without assistance.