Assessing the clinical utility of in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) in human immunodeficiency virus-1 (HIV-1) serodiscordant couples: report of 103 consecutive cycles

Abstract

Objective: To assess the utility and safety of IVF-ICSI in HIV-1 serodiscordant couples interested in having children.Design: A retrospective review of HIV-1 serodiscordant couples undergoing IVF-ICSI at a university-based program.Materials/Methods: Between 7/1997 - 3/2002, couples known to be HIV-1 serodiscordant (male HIV-1 seropositive) were screened for assisted reproduction using IVF-ICSI. 54/76 (71%) was deemed suitable for enrollment. Male partners were aged (mean +/− SD, (range)) 37.80 +/− 5.79 years (22–48 years); females aged 33.85 +/− 4.82 years (24–43 years). Women were prescribed standard ovarian hyperstimulation, and IVF-ICSI was performed on retrieved oocytes. Main outcome measures were IVF performance, clinical and ongoing/delivered pregnancy rates, and seroconversion rate.Results: 103 IVF cycles were initiated in 54 couples (mean number of attempts per couple was 1.93 +/− 1.11 (1–6)). 12.6% of IVF cycles were cancelled prior to retrieval due to poor response. Number of oocytes collected per retrieval was 16.83 +/− 9.79 (2–47), yielding 13.44 +/− 8.29 (0–42) mature oocytes suitable for ICSI, and 9.13 +/− 5.53 (0–24) normal fertilized oocytes. 3.56 +/− 1.15 (1–8) embryos were transferred. 32.2% of couples produced enough embryos to transfer fresh and to cryopreserve (4.90 +/− 3.37 (1–19) embryos cryopreserved). The overall clinical pregnancy rate (PR) was 39.5% per embryo transfer; ongoing/delivered PR was 33.7% per embryo transfer, including 9 twins, 4 triplets, 1 quadruplets (48.3% multiple gestation rate). In successful couples, 58.6% of pregnancies occurred on the first IVF cycle, 82.8% within two IVF cycle attempts, and 93.1% within three IVF cycle attempts. Cumulatively, 50.0% of couples achieved a pregnancy through IVF-ICSI; 53.7% by IVF-ICSI or frozen embryo transfer cycle. There were no seroconversions in treated patients or in delivered babies. Five women (4.9% of initiated cycles) required treatment for ovarian hyperstimulation syndrome (OHSS). Women under age 35 years performed significantly better than older women with respect to cancellation rate, numbers of oocytes retrieved, mature oocytes harvested, normal fertilized oocytes, cryopreservation rate per retrieval, number of embryos cryopreserved per cryopreservation, clinical PR, and ongoing/delivered PR (p <0.05). No woman greater than 39 years (n=10) achieved a pregnancy using her own eggs.Conclusions: HIV-1 serodiscordant couples undergoing IVF-ICSI to avoid disease transmission experience high rates of success, but also encounter complications from assisted reproductive technology similar to traditional patients. Best candidates appear to be women of younger age and without strong risk factors for OHSS. Objective: To assess the utility and safety of IVF-ICSI in HIV-1 serodiscordant couples interested in having children. Design: A retrospective review of HIV-1 serodiscordant couples undergoing IVF-ICSI at a university-based program. Materials/Methods: Between 7/1997 - 3/2002, couples known to be HIV-1 serodiscordant (male HIV-1 seropositive) were screened for assisted reproduction using IVF-ICSI. 54/76 (71%) was deemed suitable for enrollment. Male partners were aged (mean +/− SD, (range)) 37.80 +/− 5.79 years (22–48 years); females aged 33.85 +/− 4.82 years (24–43 years). Women were prescribed standard ovarian hyperstimulation, and IVF-ICSI was performed on retrieved oocytes. Main outcome measures were IVF performance, clinical and ongoing/delivered pregnancy rates, and seroconversion rate. Results: 103 IVF cycles were initiated in 54 couples (mean number of attempts per couple was 1.93 +/− 1.11 (1–6)). 12.6% of IVF cycles were cancelled prior to retrieval due to poor response. Number of oocytes collected per retrieval was 16.83 +/− 9.79 (2–47), yielding 13.44 +/− 8.29 (0–42) mature oocytes suitable for ICSI, and 9.13 +/− 5.53 (0–24) normal fertilized oocytes. 3.56 +/− 1.15 (1–8) embryos were transferred. 32.2% of couples produced enough embryos to transfer fresh and to cryopreserve (4.90 +/− 3.37 (1–19) embryos cryopreserved). The overall clinical pregnancy rate (PR) was 39.5% per embryo transfer; ongoing/delivered PR was 33.7% per embryo transfer, including 9 twins, 4 triplets, 1 quadruplets (48.3% multiple gestation rate). In successful couples, 58.6% of pregnancies occurred on the first IVF cycle, 82.8% within two IVF cycle attempts, and 93.1% within three IVF cycle attempts. Cumulatively, 50.0% of couples achieved a pregnancy through IVF-ICSI; 53.7% by IVF-ICSI or frozen embryo transfer cycle. There were no seroconversions in treated patients or in delivered babies. Five women (4.9% of initiated cycles) required treatment for ovarian hyperstimulation syndrome (OHSS). Women under age 35 years performed significantly better than older women with respect to cancellation rate, numbers of oocytes retrieved, mature oocytes harvested, normal fertilized oocytes, cryopreservation rate per retrieval, number of embryos cryopreserved per cryopreservation, clinical PR, and ongoing/delivered PR (p <0.05). No woman greater than 39 years (n=10) achieved a pregnancy using her own eggs. Conclusions: HIV-1 serodiscordant couples undergoing IVF-ICSI to avoid disease transmission experience high rates of success, but also encounter complications from assisted reproductive technology similar to traditional patients. Best candidates appear to be women of younger age and without strong risk factors for OHSS.