P-031 Viral crossroads: revisiting sperm processing in the context of Human Immunodeficiency Virus (HIV) infection
Authors: Bosman T , Mateizel I , Boudry L , De Geyter D , Krunic M , Schoemans C , Wouters K , Tournaye H , De Munck N 
Published: July 2024

Abstract

Study question
Is extensive sperm washing, followed by viral load testing, necessary to ensure safety of assisted reproductive techniques in HIV-positive men?

Summary answer
In context of viral suppression, there is no added value of extensive sperm washing followed by viral load testing for HIV-positive men seeking fertility treatment.

What is known already
Sperm washing was initially introduced as a safe reproductive strategy for serodiscordant couples in which the male partner is seropositive. This technique uses a combination of density gradient centrifugation (DGC) and swim-up (SU) to separate the HIV-free spermatozoa from the seminal plasma containing most of the viral particles.
Nowadays, due to the increased availability and efficacy of antiretroviral drugs, more patients are adequately suppressed and have no risk of transmitting HIV, which is reinforced by the ‘Undetectable Equals Untransmittable’ principle. This questions the need for extensive sperm washing followed by quantitative polymerase chain reaction (qPCR) testing in the IVF laboratory.

Study design, size, duration
This single center retrospective study investigates the effectiveness of our existing sperm washing procedures by evaluating the HIV viral load (VL) both in the raw and processed semen fractions, while considering the patient’s viral suppression status. All sperm wash procedures performed on fresh ejaculates between 2012 and 2023 were included. Additionally, clinical outcomes of the subsequent intracytoplasmic sperm injection (ICSI)-cycles were collected.

Participants/materials, setting, methods
Type 1 (wash-DGC-SU), type 2 (wash-DGC) or type 3 (double wash) sperm processing was executed based on the concentration and motility of the raw sample. The processed fraction was cryopreserved, and the VL was determined in both the raw and processed semen fraction using qPCR. A semen VL below 20 copies/mL was considered negative. Only processed fractions with a negative VL were suitable for further therapeutic use. Threshold for viral suppression was 50 copies/mL.

Main results and the role of chance
A number of 82 sperm processing procedures were performed for 68 seropositive men, with a mean age at donation of 41.9 ± 7.0 years. All patients were confirmed to be HIV-1 positive, with the exception of one individual presenting a co-infection with both HIV-1 and HIV-2.
Incidences for type 1, type 2 and type 3 processing were 23.2%, 62.2% and 14.6%, with mean initial concentration of 91.3(±63.6), 42.1(±47.9) and 0.12(±0.15) million/mL, and mean progressive motility of 54(±12.7)%, 33(±16.8)% and 4(±3.6)% in the respective groups.
In 91.5% (n = 75/82) of cases, the patient was suppressed at the time of sperm processing. In case of viral suppression, only one raw sample (n = 1/75, 1.3%) tested positive for HIV (94 copies/mL), likely due to the phenomenon of “viral shedding”. After processing, none of the fractions contained a residual VL. Post-thaw progressive motile sperm survival rate was on average 0.40 ± 0.26.
Overall, 61 couples underwent a total of 120 ICSI-cycles, resulting in cumulative clinical pregnancy and cumulative live birth rates per couple of 57.4% (n = 35/61) and 42.6% (n = 26/61), respectively.

Limitations, reasons for caution
Given that HIV-positive individuals represent a minority within our patient population, the limited prevalence of sperm wash procedures performed over the past decade has led to a relatively small sample size for this study.

Wider implications of the findings
These findings have the potential to shape future guidelines concerning the use of sperm samples from HIV-positive men. This may optimize the efficiency of sperm processing protocols, while maintaining both the safety and efficacy of assisted reproductive techniques for this specific patient population.

Trial registration number
Not applicable