Infertility among human immunodeficiency virus-positive women: incidence and treatment dilemmas

The increasing demand for fertility advice among human immunodeficiencyvirus (HIV)-positive women under our care led us to review theincidence of infertility and the ethical problems associatedwith its management. All HIV-positive women who attended theHIV outpatients clinic from October 1990 to the end of January1996 were studied. The main outcome measures were: the numberof women undergoing infertility investigations before and afterHIV diagnosis, their demographic and social details, and theoutcome of these investigations. Most of the 183 women studiedwere in their reproductive years (mean age 32.7 ± 6.7years). Nine women had undergone infertility investigations,and/or treatment before HIV diagnosis, three of whom were diagnosedwith HIV during routine testing prior to IVF treatment Six declinedfurther infertility treatment after discovering their HIV status.Eight women have undergone infertility investigations afterHIV diagnosis but none have achieved pregnancy to date. Managementdecisions may have been hampered by ethical uncertainties inseveral cases. In conclusion therefore, as requests for infertilitytreatment from HIV-infected women occur and may become morecommon as the prevalence of HIV infection in women continuesto rise, the ethical issues associated with the management ofthis problem demand urgent attention so that clear guidelinesare available to aid treatment decisions.