HIV+ and Ready for Parenthood

You may be considering becoming a parent but feel held back by certain circumstances in your life. For instance, you might single, not fully understand the path to biological parenthood, or, you might be HIV+. And what if you're gay? Isn't there a lot of skepticism or even hostility toward gay dads?

None of that is necessarily true – and certainly not at The Prelude Network, North America's largest and fastest-growing network of fertility clinics.

Brian Rosenberg, founder of Gay With Kids Academy – which helps queer families and single gay men navigate the various avenues to parenthood – makes a point, whenever possible, to share his own journey to fatherhood despite being HIV+.

"My HIV status absolutely made me think I could never be a dad," says Rosenberg, who tested positive for the virus at the height of the AIDS epidemic in the early 1990s. In his twenties, Rosenberg recalls, he attended dozens of funerals for fallen friends, all of them casualties of the epidemic, and he wondered if he would be lucky enough to see forty.

"Thankfully, I got a new lease on life thanks to the so-called HIV cocktail," Rosenberg recounts, adding that, eventually, "my doctor confirmed that I could expect to live a long and happy life.

"That's around the time my husband convinced me that I would not have a fulfilled life unless I got to experience fatherhood," Rosenberg recalls. "He had seen over the years how much I loved spending time with our nieces and nephews, even kids of friends and neighbors."

As with many gay couples who become fathers, IVF became a means to build their family. Rosenberg and his husband had adopted their first child, but utilized IVF for their second and third, making it possible for Rosenberg to be the "bio-dad," as he puts it – though, he adds, "It never mattered to me if I was a biological parent. I just wanted to parent, and I wanted to do so alongside my then-partner, now husband."

But what is the science that allows HIV+ individuals seeking to build their families to use IVF safely in order to have their own genetically-related offspring?

Dr. Seif Eldin Sadek of the Center for Reproductive Medicine in Orlando, Florida, explains the procedures, pointing out that they are not much different from the typical IVF experience.

Let's start with the basics: IVF involves stimulating the release of eggs from either a donor or a patient with ovaries. Once retrieved, the eggs are fertilized using sperm sourced either from a donor or from a patient, and the resulting embryos are monitored and tested for several days before one embryo is implanted in either a gestational carrier or the patient.

When it comes to families where one or more of the prospective parents are HIV+, Dr. Sadek notes, "It really depends which parent is HIV+, and how well their CD4 count is controlled – is it high? Is it low?"

Also important: "If they're on treatment or not," Dr. Sadek says. "Obviously, one of the most important factors in one having a successful treatment, but also having a successful and safe pregnancy, is making sure that the CD4 count is fine and they're under treatment" when it comes to HIV+ prospective parents.

"In terms of preparation for the female partner, it wouldn't differ at all in terms of the ovarian stimulation," Dr. Sadek says, noting that "the only precaution we would take because of the patient's HIV status is we would be extra cautious with needle sticks and sharp objects. But in terms of the retrieval, it would be exactly the same," as would the fertilization, monitoring and testing, and implantation procedures.

HIV+ sperm providers would also go through the same steps as their non-positive counterparts – including literally washing the sperm.

"You place the sperm into a buffer media, and then you centrifuge it," Dr. Sadek outlines, pointing out that sperm washing "is a routine process, but it is an even more important process in HIV positive men.

"The sperm washing can significantly reduce the risk of HIV transmission," Dr. Sadek explains, "because the virus is mainly in the seminal fluid – not only in the sperm, but in the white blood cells that are present in the seminal fluid."

Though it's now generally acknowledged that HIV+ individuals on an effective treatment regimen whose viral loads are undetectable cannot transmit the virus through sexual contact – or, at least, the risk, if any, is very low – these standard precautions are still deemed necessary, and not just when sourcing the sperm and the eggs. HIV can complicate a pregnancy, Dr. Sadek notes, because it can pose "a risk [of] sepsis in the mother. Also, the virus can cross the placenta to the baby, and so the baby can be born HIV+."

Though effective medication regimens for HIV+ prospective parents and sperm washing all but eliminate the risk of transmitting the virus, there's still another precaution.

"Each lab has their own protocol for infectious disease states and agents," Dr. Sadek notes, "and sometimes, due to the theoretical risk – which is very, very unlikely – these embryos may be stored in a separate cryotank from other patients who are non-HIV positive" – though, he adds, "I don't think there's ever been a reported case of transition that way."

With so many procedures already in place to make the process safe as well as effective, the science behind IVF is sound. But there's more to it than medical expertise. Fertility clinics belonging to The Prelude Network take pride in serving queer individuals and families seeking to fulfill their dreams of parenthood with respect and validation, and that extends to their HIV+ clientele.

"Obviously, the status of the patient is only known to the treatment team," Dr. Sadek emphasizes, noting that it's a "big factor" for patients, who "prefer their privacy in terms of treatment.

"In terms of the language" used on forms and in communicating with their patients, "we typically say 'patient' or 'partner,' whether they're male or female," Dr. Sadek clarifies. "I think that is important in not just saying 'female' and 'male,' because those are not our only patients. We have male and male partners; we have female and female partners; and we have transgender patients also undergoing this process.

"So it's important to use neutral terms when describing our patients, whether it be patient or partner," Dr. Sadek continues, "and most of the time we try to go by the patient's name instead of by gender. That is how we like to talk to people, is use their first names. We don't like to just use 'female' or 'male'."

That inclusive and respectful approach is part of a philosophy that treats not just a donor making use of a surrogate, or a patient seeking to carry a child conceived by way of donated sperm, but the family that is being built through IVF.

"We like to talk to both partners, involve them in the history taking, involve them in the process, make them understand the steps and the importance of each step," Dr. Sadek points out. "We don't just treat the person carrying the pregnancy or the person with the eggs – we treat the couple."

In other words, it's a family experience and the family is treated as such, with both members of a queer couple receiving attentive and individualized care.

It's a substantial commitment in terms of focus and effort – and it's worth it.

"We monitor the patients up until eight or nine weeks of pregnancy, depending on the patient, but just seeing them happy, and then seeing those pictures come back after they deliver, is the joy of the of the job," Dr. Sadek relates. "You see the hard work of the entire team coming to fruition. The whole team is helping the family grow, and you see what it means to them.

"And the letters they write," Dr. Sadek smiles, "the pictures they send, is uplifting."