Processing of Sperm Samples in HIV-Positive Patients

  • Rocio Rivera-Egea
  • Thamara Viloria Samochin
  • Marcos Meseguer EscriváEmail author


Human immunodeficiency virus (HIV) is an important public health problem. Approximately 37 million people around the world are infected with HIV type 1 virus. In recent years, prolonged survival of patients receiving highly active antiretroviral therapy has given rise to a number of couples in which only one member is HIV positive (serodiscordant (SDC) couples). This increase has been accompanied by growth of a new demand from SDC couples who wish to have children; therefore, such couples in which the male is infected need to make use of assisted reproduction technology (ART), in combination with semen washing, to decrease the risk of HIV transmission to the partner or to the newborn. Thus, it is essential to test the effectiveness of techniques aimed at reducing HIV and hepatitis C virus (HCV) loads in infected semen, using semen washing and molecular biology tests to eliminate the presence of the virus. This option has been demonstrated to be effective and is widely used in such cases. Semen washing consists of strict selection of the best motile sperm, removing tiny amounts of other cell types and seminal plasma, given that sperm seminal plasma and nonspermatic cells are considered the main reservoir of HIV. Our aim in this chapter is to compile the available information about sperm washing and ART with sperm samples obtained from SDC males with HIV, to describe the current possibilities for these men.


Sperm HIV Assisted reproduction PCR Sperm sample processing HIV and assisted reproduction 


  1. 1.
    Joint United Nations Programme on HIV/AIDS (UNAIDS). Fact sheet: 2014 statistics. Accessed 18 Aug 2015.
  2. 2.
    Joint United Nations Programme on HIV/AIDS (UNAIDS) and World Health Organization (WHO). AIDS epidemic update (December 2009). Accessed 18 Aug 2015.
  3. 3.
    Oliva G, Pons JMV. Lavado de semen en parejas VIH serodiscordantes para su uso en técnicas de reproducción humana asistida. Barcelona: Agència d’Avaluació de Tecnologia i Recerca Mèdiques; 2004.Google Scholar
  4. 4.
    Garrido N, Meseguer M, Bellver J, Remohi J, Simon C, Pellicer A. Report of the results of a 2 year programme of sperm wash and ICSI treatment for human immunodeficiency virus and hepatitis C virus serodiscordant couples. Hum Reprod. 2004;19:2581–6.PubMedCrossRefGoogle Scholar
  5. 5.
    Mencaglia L, Falcone P, Lentini GM, et al. ICSI for treatment of human immunodeficiency virus and hepatitis C virus–serodiscordant couples with infected male partner. Hum Reprod. 2005;20:2242–6.PubMedCrossRefGoogle Scholar
  6. 6.
    Baker HW, Mijch A, Garland S, Crowe S, Dunne M, Edgar D, Clarke G, Foster P, Blood J. Use of assisted reproductive technology to reduce the risk of transmission of HIV in discordant couples wishing to have their own children where the male partner is seropositive with an undetectable viral load. J Med Ethics. 2003;29(6):315–20.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Savasi V, Ferrazzi E, Lanzani C, Oneta M, Parrilla B, Persico T. Safety of sperm washing and ART outcome in 741 HIV-1-serodiscordant couples. Hum Reprod. 2007;22(3):772–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Savasi V, Mandia L, Laoreti A, Cetin I. Reproductive assistance in HIV serodiscordant couples. Hum Reprod Update. 2013;19(2):136–50.PubMedCrossRefGoogle Scholar
  9. 9.
    Meseguer M, Garrido N, Gimeno C, Remohi J, Simon C, Pellicer A. Comparison of polymerase chain reaction–dependent methods for determining the presence of human immunodeficiency virus and hepatitis C virus in washed sperm. Fertil Steril. 2002;78:1199–202.PubMedCrossRefGoogle Scholar
  10. 10.
    Semprini AE, Levi-Setti P, Bozzo M, et al. Insemination of HIV-negative women with processed semen of HIV-positive partners. Lancet. 1992;340:1317–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Lasheeb AS, King J, Ball JK, Curran R, Barratt CL, Afnan M, Pillay D. Semen characteristics in HIV-1 positive men and the effect of semen washing. Genitourin Med. 1997;73(4):303–5.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Marina S, Marina F, Alcolea R, et al. Human immunodeficiency virus type 1–serodiscordant couples can bear healthy children after undergoing intrauterine insemination. Fertil Steril. 1998;70:35–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Chrystie IL, Mullen JE, Braude PR, Rowel P, William E, Elkington N, de Ruiter A, Rice K, Kennedy J. Assited conception in HIV discordant couples: evaluation of semen processing techniques in reducing HIV viral load. J Reprod Immunol. 1998;41(1-2):301–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Hanabusa H, Kuji N, Kato S, Tagami H, Kaneko S, Tanaka H, Yoshimura Y. An evaluation of semen processing methods for eliminating HIV-1. AIDS. 2000;14(11):1611–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Sauer MV, Chang PL. Establishing a clinical program for human immunodeficiency virus 1-seropositive men to father seronegative children by means of in vitro fertilization with intracytoplasmic sperm injection. Am J Obstet Gynecol. 2002;186(4):627–33.PubMedCrossRefGoogle Scholar
  16. 16.
    Politch JA, Xu C, Tucker L, Anderson DJ. Separation of human immunodeficiency virus type 1 from motile sperm by the double tube gradient method versus other methods. Fertil Steril. 2004;81(2):440–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Garrido N, Meseguer M, Remohi J, Simon C, Pellicer A. Semen characteristics in human immunodeficiency virus (HIV)– and hepatitis C (HCV)–seropositive males: predictors of the success of viral removal after sperm washing. Hum Reprod. 2005;20:1028–34.PubMedCrossRefGoogle Scholar
  18. 18.
    Bujan L, Sergerie M, Kiffer N, Moinard N, Seguela N, Mercadier B, Rhone P, Pasquier C, Daudin M. Good efficiency of intrauterine insemination programme for serodiscordant couples with HIV-1 infected male partner: A retrospective comparative study. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2007;135:76–82.CrossRefGoogle Scholar
  19. 19.
    Kato S, Hanabusa H, Kaneko A, Takakuwa K, Suzuki M, Kuji N, Jinno M, Tanaka R, Kojima K, Iwashita M, Yoshimura Y, Tanaka K. Complete removal of HIV-1 RNA and proviral DNA from semen by the swim-up method: assisted reproduction technique using spermatozoa free from HIV-1. AIDS. 2006;20(7):967–73.PubMedCrossRefGoogle Scholar
  20. 20.
    Molina I, Carmen Del Gonzalvo M, Clavero A, Angel Lopez-Ruiz M, Mozas J, Pasquau J, Sampedro A, Martinez L, Castilla JA. Assisted reproductive technology and obstetric outcome in couples when the male partner has a chronic viral disease. Int J Fertil Steril. 2014;7(4):291–300.PubMedGoogle Scholar
  21. 21.
    Zamora MJ, Obradors A, Woodward B, Vernaeve V, Vassena R. Semen residual viral load and reproductive outcomes in HIV-infected men undergoing ICSI after extended semen preparation. Reprod Biomed Online. 2016;32:584–90.PubMedCrossRefGoogle Scholar
  22. 22.
    WHO. World Health Organization. 2010.Google Scholar
  23. 23.
    Rivera R, Galbis MC, Puchalt NG. Reproductive assistance in HIV-serodiscordant couples when the man is positive. In: Borini A, Savasi M, editors. Assisted reproductive technologies and infectious diseases. Cham: Springer; 2016. p. 65–89. Scholar
  24. 24.
    Dulioust E, Tachet A, De Almeida M, Finkielsztejn L, Rivalland S, Salmon D, Sicard D, Rouzioux C, Jouannet P. Detection of HIV-1 in seminal plasma and seminal cells of HIV-1 seropositive men. J Reprod Immunol. 1998;41(1–2):27–40.PubMedCrossRefGoogle Scholar
  25. 25.
    Garrido N, Remohi J, Pellicer A, Meseguer M. The effectiveness of modified sperm washes in severely oligoasthenozoospermic men infected with human immunodeficiency and hepatitis C viruses. Fertil Steril. 2006;86:1544–6.PubMedCrossRefGoogle Scholar
  26. 26.
    Garrido N, Gil-Salom M, Martinez-Jabaloyas JM, Meseguer M. First report of the absence of viral load in testicular sperm samples obtained from men with hepatitis C and HIV after washing and their subsequent use. Fertil Steril. 2009;92:1012–5.PubMedCrossRefGoogle Scholar
  27. 27.
    Meseguer M, Aplin JD, Caballero-Campo P, et al. Human endometrial mucin MUC1 is up-regulated by progesterone and down-regulated in vitro by the human blastocyst. Biol Reprod. 2001;64:590–601.PubMedCrossRefGoogle Scholar
  28. 28.
    Zazzi M, Romano L, Catucci M, et al. Low human immunodeficiency virus type 1 (HIV-1) DNA burden as a major cause for failure to detect HIV-1 DNA in clinical specimens by PCR. J Clin Microbiol. 1995;33:205–8.PubMedPubMedCentralGoogle Scholar
  29. 29.
    Pasquier C, Anderson D, Andreutti-Zaugg C, et al. Multicenter quality control of the detection of HIV-1 genome in semen before medically assisted procreation. J Med Virol. 2006;78:877–82.PubMedCrossRefGoogle Scholar
  30. 30.
    Bujan L, Hollander L, Coudert M, et al. Safety and efficacy of sperm washing in HIV-1-serodiscordant couples where the male is infected: results from the European CREAThE network. AIDS. 2007;21:1909–14.PubMedCrossRefGoogle Scholar
  31. 31.
    Englert Y, Van Vooren JP, Place I, Liesnard C, Laruelle C, Delbaere A. ART in HIV-infected couples: has the time come for a change of attitude? Hum Reprod. 2001;16(7):1309–15.PubMedCrossRefGoogle Scholar
  32. 32.
    Marina S, Marina F, Alcolea R, Nadal J, Exposito R, Huguet J. Pregnancy following intracytoplasmic sperm injection from an HIV-1-seropositive man. Hum Reprod. 1998;13(11):3247–9.PubMedCrossRefGoogle Scholar
  33. 33.
    Loutradis D, Drakakis P, Kallianidis K, Patsoula E, Bletsa R, Michalas S. Birth of two infants who were seronegative for human immunodeficiency virus type 1 (HIV-1) after intracytoplasmic injection of sperm from HIV-1-seropositive men. Fertil Steril. 2001;75(1):210–2.PubMedCrossRefGoogle Scholar
  34. 34.
    van Leeuwen E, Repping S, Prins JM, Reiss P, van der Veen F. Assisted reproductive technologies to establish pregnancies in couples with an HIV-1-infected man. Neth J Med. 2009;67(8):322–7.PubMedGoogle Scholar
  35. 35.
    Ruibal M, Larcher JS. Riesgo de transmisión del HIV en parejas serodiscordantes en tratamiento de fertilidad. Reproducción. 2009;24:115–27.Google Scholar
  36. 36.
    Eke AC, Oragwu C. Sperm washing to prevent HIV transmission from HIV-infected men but allowing conception in sero-discordant couples. Cochrane Database Syst Rev. 2011;(1):CD008498.Google Scholar
  37. 37.
    Gilling-Smith C. HIV prevention. Assisted reproduction in HIV-discordant couples. AIDS Read. 2000;10:581–7.PubMedGoogle Scholar
  38. 38.
    Ohl J, Partisani M, Wittemer C, et al. Assisted reproduction techniques for HIV serodiscordant couples: 18 months of experience. Hum Reprod. 2003;18:1244–9.PubMedCrossRefGoogle Scholar
  39. 39.
    Sharma S, Gilling-Smith C, Semprini AE, Barton SE, Smith JR. View 1: assisted conception in couples with HIV infection. Sex Transm Infect. 2003;79:185–8.PubMedPubMedCentralCrossRefGoogle Scholar
  40. 40.
    Bujan L, Pasquier C, Labeyrie E, Lanusse-Crousse P, Morucci M, Daudin M. Insemination with isolated and virologically tested spermatozoa is a safe way for human immunodeficiency type 1 virus–serodiscordant couples with an infected male partner to have a child. Fertil Steril. 2004;82:857–62.PubMedCrossRefGoogle Scholar
  41. 41.
    Barnes A, Riche D, Mena L, Sison T, Barry L, Reddy R, Shwayder J, Parry JP. Efficacy and safety of intrauterine insemination and assisted reproductive technology in populations serodiscordant for human immunodeficiency virus: a systematic review and meta-analysis. Fertil Steril 2014;102424–434.Google Scholar
  42. 42.
    Zafer M, Horvath H, Mmeje O, van der Poel S, Semprini AE, Rutherford G, Brown J. Effectiveness of semen washing to prevent human immunodeficiency virus (HIV) transmission and assist pregnancy in HIV-discordant couples: a systematic review and meta-analysis. Fertil Steril. 2016;105(3):645–55.PubMedCrossRefGoogle Scholar
  43. 43.
    Dondero F, Rossi T, D’Offizi G, Mazzilli F, Rosso R, Sarandrea N, Pinter E, Aiuti F. Semen analysis in HIV seropositive men and in subjects at high risk for HIV infection. Hum Reprod. 1996;11(4):765–8.PubMedCrossRefGoogle Scholar
  44. 44.
    Dulioust E, Du AL, Costagliola D, Guibert J, Kunstmann JM, Heard I, Juillard JC, Salmon D, Leruez-Ville M, Mandelbrot L, Rouzioux C, Sicard D, Zorn JR, Jouannet P, De Almeida M. Semen alterations in HIV-1 infected men. Hum Reprod. 2002;17(8):2112–8.PubMedCrossRefGoogle Scholar
  45. 45.
    Lopez-Ruz MA, Navas P, López-Zúñiga MA, Gonzalvo MA, Sampedro A, Pasquau J, Hidalgo-Tenorio C, Javier R, Castilla JA. Effect of monotherapy with darunavir/ritonavir on viral load in seminal fluid, and quality parameters of semen in HIV-1-positive patients. PLoS One. 2016;11(7):e0159305. Scholar
  46. 46.
    Garrido N, Remohi J, Martinez-Conejero JA, Garcia-Herrero S, Pellicer A, Meseguer M. Contribution of sperm molecular features to embryo quality and assisted reproduction success. Reprod Biomed Online. 2008;17(6):855–65.PubMedCrossRefGoogle Scholar
  47. 47.
    Rivera R, Meseguer M, Garrido N. Increasing the success of assisted reproduction by defining sperm fertility markers and selecting sperm with the best molecular profile. Expert Rev Obstet Gynecol. 2012;7(4):346–62.CrossRefGoogle Scholar
  48. 48.
    Melo MA, Meseguer M, Bellver J, Remohi J, Pellicer A, Garrido N. Human immunodeficiency type-1 virus (HIV-1) infection in serodiscordant couples (SDCs) does not have an impact on embryo quality or intracytoplasmic sperm injection (ICSI) outcome. Fertil Steril. 2008;89:141–50.PubMedCrossRefGoogle Scholar
  49. 49.
    Nicopoullos JD, Frodsham LC, Ramsay JW, Almeida PA, Rozis G, Gilling-Smith C. Synchronous sperm retrieval and sperm washing in an intracytoplasmic sperm injection cycle in an azoospermic man who was positive for human immunodeficiency virus. Fertil Steril. 2004;81:670–4.PubMedCrossRefGoogle Scholar
  50. 50.
    Bujan L, Daudin M, Moinard N, Plante P, Parinaud J, Pasquier C. Azoospermic HIV-1 infected patients wishing to have children: proposed strategy to reduce HIV-1 transmission risk during sperm retrieval and intracytoplasmic sperm injection: case report. Hum Reprod. 2007;22:2377–81.PubMedCrossRefGoogle Scholar
  51. 51.
    Meseguer M, Garrido N, Remohi J, et al. Testicular sperm extraction (TESE) and ICSI in patients with permanent azoospermia after chemotherapy. Hum Reprod. 2003;18:1281–5.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Rocio Rivera-Egea
    • 1
  • Thamara Viloria Samochin
    • 2
  • Marcos Meseguer Escrivá
    • 3
    Email author
  1. 1.Andrology Laboratory and Sperm Bank, IVIRMA ValenciaValenciaSpain
  2. 2.IVF Laboratory, Instituto Universitario IVI ValenciaValenciaSpain
  3. 3.IVF LaboratoryIVI ValenciaValenciaSpain

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