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According to 2017 data from the USA, approximately 1.1 million people are infected with HIV, of whom 23% (258,000) are females [1]. Nearly 20% (7,401) of newly diagnosed HIV in the USA and nearly half of people living with HIV worldwide are females [2]. The majority of the female HIV burden is borne by reproductive‐aged women (15–44 years old).

Prior to the widespread availability of effective HIV therapy (specifically, highly active antiretroviral therapy: HAART), the impact of HIV disease on maternal health, as well as the alarming rates of vertical transmission (7–71% [3]), generally rendered childbearing an unreasonable and unsafe consideration in HIV‐seropositive women. The risk of horizontal transmission to serodiscordant partners was simply addressed by advocating universal condom use in these couples.

The introduction of HAART has transformed both patients’ and providers’ perspective on HIV disease. Maternal morbidity and mortality now resemble rates seen in many other chronic diseases and if appropriate steps are taken (medical treatment for mother and newborn, cesarean delivery and avoidance of breastfeeding), vertical transmission can be reduced to 2% or less [4]. The CDC developed a framework to guide organizations to reduce the risk of vertical transmission [5], and studies show that the vertical transmission rate can be less than 1% if HAART is started in the first trimester [7]. According to 2019 UN AIDS global statistics, 82% of pregnant women had access to antiretroviral medications, compared with 47% in 2010 [2]. These developments have created the need for recommending various safe approaches to childbearing in HIV‐serodiscordant couples.

While genital HIV shedding generally correlates with plasma HIV RNA concentration, a significant proportion of women will harbor HIV in the genital tract even at low levels of plasma HIV RNA [7]. Therefore, even in HIV‐seropositive women on HAART and/or with undetectable plasma viral load, the risk of horizontal transmission during unprotected intercourse is difficult to quantify, and natural efforts at conception via unprotected intercourse are not endorsed. Much progress was made in the application of sperm washing techniques and assisted reproductive technology (ART) for HIV‐seropositive males seeking fertility care in the 1990s. Yet, lingering concerns regarding possible vertical transmission and/or ART laboratory specimen, equipment and personnel contamination and cross‐contamination delayed significant attention to the needs of HIV‐seropositive females seeking care until the 2000s [8].