Test tube babies offer hope to HIV-discordant couples

MUMBAI: After six years of marriage, Reema and Nagesh wanted a child. Only, their wish isn't as simple as it sounds. Nagesh is HIV-positive and didn't want Reema to get infected ever.

The couple, who only want to be identified as residents of a big southern city, began visiting doctors and, of course, countless websites. They soon found an answer - assisted reproductive techniques (ART) better known as infertility treatment. "I found out after an intensive Google search that we could have a healthy baby using an ART procedure called ICSI," reveals Nagesh.

After some infertility experts refused to take up their case, they flew down to Mumbai to meet Anjali and Aniruddha Malpani who had agreed on email to help them.

"Many people don't know that it is possible and extremely safe for HIV-discordant couples (one person is HIV positive but the other is not) to have HIV-negative babies using ART," says Anjali Malpani, who has helped four discordant couples conceive in the last one year.

Her husband, Aniruddha, points out that ART for HIV discordant couples is an established medical protocol. "Two medical journals, Lancet and New England Journal of Medicine , carried exhaustive studies highlighting this over five years back establishing a treatment protocol for HIV-discordant couples," says Aniruddha.

Rahul and Sapna are another HIV-discordant couple who approached the Malpanis for medical assistance. The 26-year-old husband and 24-year-old wife are now proud parents of a baby girl.

"A baby is one of the natural urges in human beings," says Rahul, who got infected while trying to help an accident victim. "I and my wife always loved babies and so we also wanted one for ourselves. More importantly, we wanted the child to be a part of both of us," he says in an email interview.

In medical terms, the HIV-affected man's sperms are put through a "wash" for the IVF treatment. The density gradient sperm wash, which is conducted in a centrifuge machine, continues for almost 60 minutes and separates the sperms and other cells and waste in the semen. The live sperms are once again tested for HIV before being transferred to the woman in a procedure called the intra-uterine transfer.

"However, to be extra cautious, we use a technique called ICSI or an intracytoplasmic sperm injection to ensure that both the child and mother won't be exposed to HIV," says Aniruddha. ICSI involves injecting the sperm into the inner part (or cytoplasm) of the woman's egg in a laboratory, explains Anjali.

According to Lilavati Hospital's infertility expert Nandita Palshetkar, "Given the improved treatment and medications for HIV as well as IVF technologies, healthy pregnancy and babies can be a reality for HIV-discordant couples."

While the US bans transfers of any tissues or organs from HIV-positive persons and puts a question mark on such pregnancies, it is carried out in Europe. In fact, a peer-reviewed medical journal, AIDS 2007, recently advocated the wider use of IVF techniques for HIV-discordant couples.

The article, submitted by scientists from the University of Toulouse, France, states, "It is neither ethically nor legally justifiable to exclude individuals from infertility services on the basis of male HIV-infection. For many countries in the world, the first priority of the policy against HIV is to improve education, to allow access to HIV screening, to encourage condom use and to offer antiretroviral therapy where appropriate. In countries where these approaches are now in place we recommended that assisted reproductive programmes, such as IUI with sperm washing, should be integrated into a global public health initiative against HIV."

Rahul and Sapna, who began enjoying the joys of parenthood a few months back, couldn't agree more.

Source: timesofindia.indiatimes.com