We read with great interest the article by Semprini et al concluding that semen washing with intrauterine insemination (SW-IUI) appears to be a safe and effective method for achieving pregnancy in human immunodeficiency virus (HIV)-discordant couples in which the man is HIV infected.

However, the authors did not discuss some of the problems that render SW-IUI not practicable for most couples in developed countries, and the current debate on different options. SW-IUI is cumbersome and costly, per-cycle live birth rate is 13%, and for a significant number of couples, the wish of parenthood remained unaccomplished due to the technical and financial hurdles associated with the method. Approximately 30% of couples evaluated in Milan, Italy, and St Gallen, Switzerland, did not start the insemination process after initial counseling and another 30% subsequently withdrew after a number of failed cycles. Moreover, almost half of the couples who did not conceive with artificial insemination attempted spontaneous conception through unprotected intercourse, exposing the woman to HIV transmission, and at least 1 infection occurred.

Preexposure prophylaxis for HIV-discordant couples (HIV-infected man, uninfected woman) wishing to conceive their own biological children (preexposure prophylaxis for conception [PrEP-C]) could be an alternative option for the many couples for whom SW-IUI is not feasible or failed, by reducing the risk of HIV transmission associated with attempts of spontaneous conception through unprotected intercourse.

In 2 programs in Switzerland and the United Kingdom, HIV-negative women could conceive safely (pregnancy rate >70% without seroconversion) through unprotected timed intercourse with their partner on suppressive antiretroviral therapy with undetectable HIV-RNA in semen, both with no evidence of sexually transmitted infections, in combination with 2 tenofovir doses as preexposure prophylaxis.

We are starting a study at the Spallanzani Institute in Rome, Italy, offering PrEP-C as an additional strategy within the medical and psychological counseling for planned parenthood in healthy, adult HIV-discordant couples, where the man is virologically suppressed ≥6 months.

For those couples choosing PrEP-C, the woman will monitor the fertility period through ovulation tests (detection of luteinizing hormone) to schedule sexual intercourse covered by PrEP-C, and will have to assume Truvada (emtricitabine 200 mg/tenofovir 300 mg; Gilead Sciences, Inc., Foster City, CA): 2 doses on the day of luteinizing hormone peak, 1 dose after 24 hours, and a final dose after an additional 24 hours during which conception will be attempted. An evaluation of the couple’s fertility will be carried out after 5 unsuccessful attempts, and they will be possibly switched to SW-IUI, which remains the method of choice in case of infertility.