Family and pregnancy planning issues are important among human immunodeficiency virus (HIV)-positive individuals and couples. However, access to fertility services may be limited for this population. HIV infected women may have decreased reproductive potential in terms of ovarian response to stimulation, fertilization, and implantation.
There are several factors associated with HIV infection that can potentially affect fertility in PLWHIV (people living with human immunodeficiency virus). These factors can be categorized into biological factors, psychological factors, and social factors (Pic. 5).
Biological changes caused by HIV, including systemic illnesses, stress, and weight loss, may affect the function of reproductive organs and result in infertility. Newly diagnosed HIV infection may cause psychological trauma and decrease in sexual drive and sexual activity.
Several HIV/acquired immune deficiency syndrome (AIDS)-related comorbidities have been reported to be associated with infertility. These include orchitis, acute epididymitis, and pelvic inflammatory disease caused by opportunistic pathogens and coinfections with sexually transmitted infections (STIs) acquired through a similar route of transmission as HIV. The common STIs caused by Neisseria gonorrhoeae, Chlamydia trachomatis, Ureaplasma urealyticum, Treponema pallidum, herpes simplex virus-2, and Trichomonas vaginalis can damage the reproductive system and cause infertility.
Hypogonadism especially in men with AIDS is one of the important endocrine disorders that causes infertility. Although cART provides significant benefits in reducing morbidity and mortality among HIV-infected persons, some antiretroviral drugs, including nucleoside reverse transcriptase inhibitors, are toxic to cellular mitochondria and may affect the mitochondrial biogenesis of sperm and oocytes.
HIV infected women may have decreased reproductive potential in terms of ovarian response to stimulation, fertilization, and implantation.
HIV-infected individuals may have limited access to reproductive care given the severity of their disease, cost of care, stigmatization, and lack of specific HIV infection/infertility knowledge among their providers. In the post–cART era, reproductive care has become an important issue to be comanaged with HIV care. Reproductive care includes not only comprehensively managing HIV infection but also minimizing the risk of horizontal HIV transmission in serodiscordant couples, providing suitable options for unprotected timed in‐tercourse, intrauterine insemination with partner or donor sperm, in vitro fertilization with intracytoplasmic sperm injection (IVF/ICSI), embryo donation, and adoption.