In “Safe conception for HIV-discordant couples: Insemination with processed semen from the HIV-infected partner,” Semprini et al document the safety of semen washing with intrauterine insemination (SW-IUI) from the largest cohort to-date. These data have the potential to significantly alter the landscape of reproductive health care for such couples in the US.

There are an estimated 140,000 heterosexual, HIV-serodifferent couples in the US, approximately 50% of whom desire future fertility. Between 2006 and 2011, the National Perinatal HIV Hotline and Clinicians Network (“The Perinatal HIV Hotline,” 1-888-HIV-8765) experienced a significant increase in the number and proportion of calls from providers and HIV-serodifferent couples with questions related to safer conception. Over 80% of these calls related to HIV+ male/HIV− female (H+M/H-F) couples, 63% inquired about referrals to fertility clinics offering assisted reproduction, and 34% sought alternatives, including preexposure prophylaxis (PrEP), when assisted reproduction was unaffordable or unavailable.

In 1990, the CDC reported a case of HIV transmission from an HIV+ male to his HIV− partner who underwent SW-IUI. In this case, suboptimal sperm washing techniques were used, including the omission of density gradient procedures. Based on this sole case, the CDC recommended “against insemination with semen from HIV-infected men.” Although the July 2012 DHHS perinatal antiretroviral therapy guidelines include both SW-IUI and SW-in vitro fertilization as options for H+M/H-F couples seeking conception, the CDC has not reversed its recommendation against SW-IUI for these couples. Moreover, although SW-IUI has been the standard of care in Canada, Europe, and Australia for H+M/H-F couples, the overwhelming majority of fertility clinics in the US providing assisted reproduction to these couples only offer IVF. The Perinatal HIV Hotline maintains a referral list of US clinics offering assisted reproduction for serodifferent couples. As of March 2013, there are 17 known clinics willing to perform IVF and only 7 willing to offer SW-IUI. With the geographic and financial barriers associated with IVF and the dearth of clinics offering SW-IUI, most H+M/H-F couples in the US are unable to access any assisted reproduction.

Given these reassuring follow-up data from Semprini et al robust cohort of H+M/H-F couples using SW-IUI, we encourage the CDC to formally reverse its recommendation against the use of SW-IUI for H+M/H-F couples. In doing so, fertility clinics in the US could more readily embrace SW-IUI as part of a comprehensive reproductive care strategy for these serodifferent couples who desire conception.