Effectiveness of semen washing to prevent human immunodeficiency virus (HIV) transmission and assist pregnancy in HIV-discordant couples: a systematic review and meta-analysis.
Level 4 - case-series / case-control
Systematic review of 40 single-arm open-label observational studies without control groups.
PubMed 26688556 · doi:10.1016/j.fertnstert.2015.11.028
What was done
Systematic review and meta-analysis of 40 single-arm open-label studies evaluating semen washing followed by intrauterine insemination, in vitro fertilization (IVF), or IVF with intracytoplasmic sperm injection in HIV-discordant couples (male partner HIV-infected). Primary outcome was HIV transmission to uninfected female partners; secondary outcomes were vertical transmission to newborns and proportion achieving clinical pregnancy.
What was found
Across 11,585 cycles among 3,994 women using washed semen, no HIV transmissions occurred (0 seroconversions). In the subset of men without plasma viral suppression at the time of semen washing, no seroconversions occurred across 2,863 cycles among 1,023 women. Studies measuring newborn transmission reported zero cases of vertical transmission. Overall, 56.3% of couples (2,357/4,184) achieved a clinical pregnancy.
Why it matters
This synthesis demonstrates that semen washing prevents male-to-female and vertical HIV transmission during assisted reproduction, including among couples where the male partner lacks plasma viral suppression.
Limits
All 40 included studies were non-randomized, single-arm open-label observational studies. There were no randomized controlled trials and no studies from low-income countries where HIV burden is highest.
Cited by
- supports Sperm washing procedures reduce the risk of HIV transmission from an HIV-positive father to an embryo to near zero.