The technique of processing sperm from HIV-positive men prior to the insemination of their HIV-negative partners was first published by Semprini et al. in 1992. The first inseminations with sperm, washed free of HIV, were carried out in Italy and Germany as early as 1989 and 1991, respectively. Up to mid 2003, more than 1,800 couples had been treated in about 4,500 cycles, applying various techniques of assisted reproduction. More than 500 children have been born with no single seroconversion reported in the centers closely following the protocol of washing and testing the sperm prior to assisted reproductive techniques.
Native ejaculate mainly consists of three fractions: spermatozoa, seminal plasma and nuclear concomitant cells. HIV progenome and virus has so far been detected in the seminal plasma, the concomitant cells, and occasionally in immobile spermatozoa. Several studies have indicated that viable, motile spermatozoa are not likely to be a target for HIV infection (Weigel 1999, Pena 2003, Gilling-Smith 2003).
Motile spermatozoa can be isolated by standardized preparation techniques. After separation of the spermatozoa from plasma fractions and NSC (non-spermatozoa cells), the spermatozoa are washed twice with culture medium and resuspended in fresh culture medium. Incubation for 20 - 60 minutes allows motile sperm to "swim-up" to the supernatant. To be more certain that it is not contaminated with viral particles, an aliquot of the sample should be tested for HIV nucleic acid using highly sensitive detection methods (Weigel 2001; Gilling-Smith 2003). Depending on the method, the lowest limit of detection is 10 cp/ml. Since HIV could, theoretically, remain undetected, sperm washing is currently regarded as a very effective risk reduction, but not a risk-free method.
Most of the European centers that offer assisted reproduction to HIV-discordant couples, are part of the CREATHE-network, which aims to optimize treatment and safety of the methods as well as to compile an extensive database. There are high hopes that soon sufficient clinical cases can be reported to demonstrate the safety and reliability of sperm washing.
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