Читать книгу Assisted Reproduction Techniques - Группа авторов - Страница 34

Mark V. Sauer and Shelley Dolitsky

Department of Obstetrics, Gynecology and Reproductive Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA

Case History 1: An HIV‐serodiscordant couple wished to have a child. The man had a history of intravenous drug use as a teenager and contracted HIV from an infected needle. He claims to have discontinued all illicit drug use 15 years ago and is compliant with his highly active antiretroviral therapy (HAART). His viral load was undetectable, and his CD4 count was 800 cells/mm3 at a recent visit to his primary care physician. The couple’s infertility evaluation was entirely unremarkable. Intrauterine insemination (IUI) of washed/swim up prepared sperm was performed on his partner during her natural spontaneous ovulatory cycles using a previously frozen semen specimen. Prior to the sample being frozen and used for treatment, an aliquot of semen was tested for the presence of detectable HIV RNA using a nucleic acid sequence‐based amplification (NASBA) method and found to be negative. The patient conceived on her third attempt with IUI. Both mother and child were HIV‐seronegative at delivery and three months postpartum.

Case History 2: An HIV‐seropositive male wished to have a child. He was medically stable and taking antiretroviral therapy resulting in undetectable viral loads and a CD4 count above 400 cells/mm3. His wife takes pre‐exposure prophylaxis (PrEP) daily. They chose to have timed unprotected sexual intercourse using ovulation kits but had no success after 6 months attempting pregnancy. At the time of his infertility evaluation, he was noted to have low testosterone levels and oligo‐astheno‐teratospermia. He was prescribed clomiphene citrate, 25 mg daily for 25 days, followed by a break of 5 days, for 6 months. He was advised to repeat the semen analysis in six months, with some improvement in all parameters noted on repeat testing. However, the specimen overall remained below normal counts and morphology. A decision was made to proceed with intra‐cytoplasmic sperm injection (ICSI), which was performed several weeks later following density gradient sperm washing with swim up on the semen sample. The patient conceived following the transfer of one blastocyst. Both mother and child were HIV‐seronegative at delivery.