In 1995, AIDS was the leading cause of death among Americans of parenting age, ages 25 to 44. Gay men, in particular, were dying in droves. Once infected with HIV, that was the lens through which gay men saw their lives. Desperate to stay alive, building a family was the furthest thing from their thoughts.
Fast forward two decades from the peak of the HIV/AIDS epidemic and and it is truly remarkable how dramatically the world has changed for gay men, including those infected with HIV. With antiviral therapies, HIV infected gay men are now living long, normal lives with a manageable chronic disease. In many parts of the globe, same-sex couples have been granted the right to marry and with increasing frequency they are creating families of their own.
Gay men who desire a genetic link to their children have found themselves thrust into the world of fertility clinics and “gay surrogacy”. With the help of in vitro fertilization and the combination of a gestational carrier (often referred to as a surrogate) and an egg donor, they can now overcome the barriers presented by their lack of a female partner.
A genetic link to a baby is also within the reach of HIV positive gay men. A study published in 2014 retrospectively reviewed almost 10,000 cycles of intrauterine insemination and in vitro fertilization (combined) involving the sperm of men infected with HIV. These cycles did not involve a single reported transmission of HIV to the women who carried the babies or to the babies.
A number of American fertility clinics are particularly interested in helping gay men build their families and some have also taken a particular interest in helping HIV positive gay men. Most of these clinics collaborate with the Special Program of Assisted Reproduction (SPAR) Program at the Bedford Research Foundation in Boston, a not-for-profit public charity run by Ann Keissling, a Ph.D who is a renowned expert in semen transmission of HIV, and, until 2012, was a professor at Harvard Medical School. The SPAR program takes into consideration that more than 10% of semen specimens in men on antivirals with an undetectable viral load in their blood test positive for HIV. With this in mind, they ask men going through their program to produce two specimens and test half of each specimen for the virus. Only sperm extracted from specimens that did not reveal the presence of the HIV virus are then washed, frozen and shipped to a fertility clinic. There, donated eggs are fertilized with the sperm. One or two embryos are then transferred into a gestational carrier.
To date, there has been no transmission of HIV to women and babies with SPAR approved sperm. At May 2014, the SPAR Program had 193 babies born. It will only be once SPAR has been involved in the birth of 400 babies that statisticians will be able to calculate a risk factor with a 95% confidence interval. However, given that the SPAR program involves an extra layer of protection over the thousands of cycles in which only sperm washing was performed without transmission of HIV (SPAR only washes sperm extracted from specimens that it first confirms are not HIV infected), without a single case of transmission of HIV to the woman or baby, it is believed to be unlikely that SPAR approved sperm will cause transmission.
