Ethics Committee of the American Society for Reproductive Medicine (2021). Human immunodeficiency virus and infertility treatment: an Ethics Committee opinion. Fertility and sterility. https://doi.org/10.1016/j.fertnstert.2021.01.024
Ethics Committee of the American Society for Reproductive Medicine. Human immunodeficiency virus and infertility treatment: an Ethics Committee opinion. Fertility and sterility. 2021. doi:10.1016/j.fertnstert.2021.01.024
Ethics Committee of the American Society for Reproductive Medicine. "Human immunodeficiency virus and infertility treatment: an Ethics Committee opinion." Fertility and sterility, 2021.
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RRM Academy Synopsis
ASRM ethicists back fertility care for HIV couples at equipped clinics
A 2021 ASRM Ethics Committee opinion holds that clinics with the right resources have no ethical basis to turn away couples with HIV. The couple must be willing to use recommended risk-reducing therapies. The opinion reviews published studies and has no data of its own.
Key Findings
The committee states there is "no ethical reason to withhold fertility services" where a clinic has the necessary resources and the couple will follow recommended risk-reducing therapies.
The committee holds that a clinic lacking the needed resources and expertise would act in a way that is "not ethically acceptable" if it proceeded. Such clinics should refer couples elsewhere.
For third-party reproduction, the committee says an intended parent's HIV status should be disclosed to donors or gestational carriers in line with informed consent principles.
The committee cites a 95% reduction in transmission risk associated with pre-exposure prophylaxis in uninfected adults in serodiscordant relationships: incidence <0.5% per year observed against >5% expected.
The committee cites a 2016 meta-analysis of sperm washing that found no HIV transmission among 3,994 women across 11,585 cycles of assisted reproduction.
Interpretation
The document is an ethics committee opinion. The committee states a position and reviews studies done by others. The report contains no data of its own. The text says transmission risk to a child cannot be completely eliminated. Outcome data in serodiscordant couples are limited and conflicting. The committee says the document is not the only approved standard of practice. The opinion covers access, testing and disclosure. For a woman with HIV and an uninfected partner on antiretroviral therapy, the paper says no head-to-head studies compare homologous insemination with timed intercourse.
RRM Context
The opinion concerns access to assisted reproduction. In RRM terms, that bypasses the reproductive system without establishing why conception fails. RRM principles place evaluation of both partners first. When a woman has HIV and her partner does not, the paper lists homologous insemination and timed intercourse, and says timed intercourse may be less safe. A study the paper cites gave couples a safer conception package that included daily fertility and sexual behavior tracking.
Our editorial summary of this paper, not the article's abstract.
Abstract
Human Immunodeficiency Virus is a serious but manageable chronic disease that affects persons of reproductive age, many of whom express a desire for biological parenthood. This document is a revision of the original document of the same name, last published in 2015 (Fertil Steril 2015;104:e1-8).
Ethics Committee of the American Society for Reproductive Medicine, 2016
Ethics and Policy › Reproductive Ethics › Access to Treatment · Clinical Guidelines and Standards › Guidelines by Clinical Area › Fertility and Infertility Guidelines · Assisted Reproduction › Safety and Risks › Procedural Safety
Sigal Klipstein, Ricardo Azziz, Katherine Cameron, Lee Collins, Christos Coutifaris, Judith Daar, Joseph Davis, Ruth Farrell, Elizabeth Ginsburg, William Hurd, Mandy Katz-Jaffe, Jennifer Kawwass, Robert Rebar, Richard Reindollar, Ginny Ryan, Mary Samplaski, Mark Sauer, David Shalowitz, Chevis Shannon, Peter Schlegel, Sean Tipton, Lynn Westphal, Julianne Zweifel, 0000-0003-0284-2845
S Klipstein, R Azziz, Kathy Cameron, Kate Cameron, Katie Cameron, K Cameron, L Collins, C Coutifaris, J Daar, Joe Davis, Joey Davis, J Davis, R Farrell, Liz Ginsburg, Beth Ginsburg, Betsy Ginsburg, E Ginsburg, Bill Hurd, Will Hurd, Billy Hurd, W Hurd, M Katz-Jaffe, Jen Kawwass, Jenny Kawwass, J Kawwass, Bob Rebar, Rob Rebar, Bobby Rebar, R Rebar, Rick Reindollar, Dick Reindollar, Rich Reindollar, R Reindollar, G Ryan, M Samplaski, M Sauer, Dave Shalowitz, D Shalowitz, C Shannon, Pete Schlegel, P Schlegel, S Tipton, L Westphal, J Zweifel
PMID 33832741 33832741 DOI 10.1016/j.fertnstert.2021.01.024 10.1016/j.fertnstert.2021.01.024 Ethics Committee of the American Society for Reproductive Medicine et al. 2021, Ethics Committee of the American Society for Reproductive Medicine 2021
