HIV Positive Intended Parent Information
From Dr. Dan Bowers to surrogates and intended parents,
Thank you for your interest in the Growing Generations’ HART program, which assists intended parents with HIV to create their families through surrogacy. The goal of this program is to take every step possible to ensure the health and safety of the surrogate and the intended parent’s child by utilizing the very latest advances in assisted reproduction techniques, laboratory testing and preventative medications.
Before I outline the medical aspects of our program, I wanted to provide a brief introduction. My name is Dr. Dan Bowers, and I have been a physician with a specialty in HIV for over 20 years. I am also a father through assisted reproduction, so the issues of our program are both professionally and personally very dear to me.
The purpose of the information below is threefold:
- To provide the latest safety data on the risk of HIV transmission from an HIV-positive man to an HIV-negative woman using assisted fertilization techniques.
- To list the processes involved to provide this safety.
- To highlight the steps that the intended parent and your IVF clinic will take to not only meet, but exceed, current safety standards. Additionally, relevant data on the risk of HIV transmission through unprotected intercourse when a partner has an undetectable viral load is reviewed.
What is the history of using sperm from an HIV-positive man in assisted reproduction?
The technique of washing the semen from an HIV-positive man for the purpose of artificially inseminating an HIV-negative woman began in 1992, at a time when we did not have fully suppressive HIV regimens or the ability to measure HIV in the blood. Since then, there have been many advances in sperm washing and assisted reproduction techniques beyond basic intrauterine insemination such as in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).
In 1996, the ability to measure the amount of HIV in the blood – the viral load – was developed. At the same time, the first three-drug regimens became available, which could suppress HIV to undetectable levels. This enabled for the selection of sperm donors with the lowest risk of having HIV in their semen.
Has there ever been a transmission of HIV in assisted reproduction?
In 2016, a comprehensive international review of all published reports of double washed sperm used for assisted reproduction found no cases of HIV transmission in over 11,000 cycles of either intrauterine insemination or IVF/ICSI.
Additionally, studies of HIV transmission through unprotected intercourse in serodiscordant couples (one HIV positive and one HIV negative) when the positive partner has an undetectable viral found no cases of HIV of HIV transmission between the couple after over 77,000 acts of unprotected intercourse.
What steps are taken to ensure safety for the surrogate?
To ensure that the sperm donor is non-infectious, the following three criteria must be met:
- The intended parent is fully adherent to his HIV regimen
- The viral load has been fully suppressed for at least six months
- There are no active sexually transmitted infections
To meet these criteria the following steps will be required:
- The intended parent must provide records from his HIV physician to document at least six months of an undetectable viral load (<48), which has not been changed during that time period. This must include one viral load within two weeks of sperm donation. These records will be reviewed by me.
- The intended parent must undergo complete infectious disease screening, and it will be repeated if more than seven days have elapsed before semen donation.
- The intended parent must provide 2 to 3 semen samples that are washed in a two-step process, a small portion of which will be sent to an HIV specialty lab to test for any residual virus. Although most men with undetectable viral loads in their blood also have undetectable HIV viral loads in their semen, sometimes a very low amount of HIV is found. If any HIV is detected, the specimen will be discarded, even though studies have shown that this low level of HIV is not infectious.
- As an additional precaution, the surrogate will be prescribed a medication to further reduce the chances of any viral transmission. This is called pre-exposure prophylaxis. Very recent studies show that giving the antiretroviral medication Truvada (tenofovir plus emtricitabine) to an HIV-negative partner prior to exposure reduces the risk of transmission through unprotected intercourse with an HIV-positive partner by about 70% to 90%. An FDA advisory panel has recommended the approval of Truvada for HIV serodiscordant couples, which is what, in essence, a surrogate and an intended parent are. This medication is safe to give during the first trimester of pregnancy and will start just prior to an embryo transfer through one month after an embryo transfer. Truvada is one of the more frequently prescribed HIV medications during the last 10 years and is extremely well-tolerated.
HIV is now a long-term manageable disease with current medications able to completely control the virus for a full lifetime. National studies now calculate the life expectancy of those with and without HIV to be nearly identical.
I look forward to personally speaking with you to learn more about helping create a family for HIV-positive individuals and couples. Please be in touch with your Growing Generations admission specialist to schedule a phone appointment.
Dr. Dan Bowers
About Dr. Dan Bowers
Dr. Dan Bowers, the Medical Director for the HIV Assisted Reproduction Program, will be speaking with you to review this information and answer any questions.
Daniel H. Bowers, M.D. is a board-certified family physician and nationally recognized HIV doctor. Born in a small town in Iowa, Dr. Bowers got his undergraduate degree from Stanford University and his medical degree from the University of Iowa College of Medicine. After completing his family practice residency at the University of Minnesota Medical School in 1980, Dr. Bowers joined a small family practice clinic in the Como Park area of Saint Paul, where he delivered babies, set fractures, performed minor surgery, ran a nursing home and cared for families that were five generations deep. He also continued to teach in the Family Practice Department of the University of Minnesota Medical School. As an openly gay physician, Dr. Bowers was one of the first doctors to see gay men with swollen glands and recurrent infections at the beginning of the HIV/AIDS epidemic. As one of the pioneers in this field, Dr. Bowers was an early spokesperson against AIDS discrimination and a vocal advocate for public education and awareness programs. In 1989, Dr. Bowers moved to Los Angeles to join Pacific Oaks Medical Group, the largest private practice in the country specializing in HIV, whose founders reported the original five cases of AIDS to the CDC in 1981. For the next 19 years, Dr. Bowers participated in the evolution of the treatment of HIV/AIDS – from the care of those struggling with AIDS and the arrival of triple-drug combination therapy to the present state-of-the-art treatment of HIV as a long-term manageable disease. As a senior partner at Pacific Oaks, Dr. Bowers became a thought leader in the field of HIV/AIDS and has lectured, consulted and written extensively on the subject. At the same time, he also maintained a large and diversified practice in general adult medicine, with special interests in travel medicine, male aging and sexually transmitted diseases.
In 2008, Dr. Bowers moved to New York City and is now practicing in Manhattan. On a personal basis, Dr. Bowers has served on numerous not-for-profit boards, both local and national, and has been a frequent community lecturer for a variety of AIDS service organizations. He is a professionally trained choral singer. He and his spouse have one son.