Care programme for prospective parents with an infectious disease

The CRG of UZ Brussel has a worldwide reputation for its expertise in Assisted Reproductive Treatment (ART) and all related treatments.
In our work, patient care is key and over the years we have always paid a great deal of attention to improving – in terms of comfort and effectiveness – our treatments.

Based on this philosophy, we have developed an appropriate treatment plan (or care programme) for prospective parents with an infectious disease.
Whether you are a man or a woman who is infected, or perhaps you are both infected, it is possible to bring a healthy child into the world.

Care programme for HIV

Preventive measure

There is no vaccine against hepatitis HIV.
To keep the risk of infection during sexual contact as low as possible, we generally recommend the use of condoms.

An infection with HIV (human immunodeficiency virus) occurs mainly:
  • through sexual contact (exchange of bodily fluids); and
  • through transmission from the mother to the child during pregnancy or delivery. We call this vertical transmission.
Other possible sources of infection are:
  • infected material (e.g. needles) during intravenous drug use; and
  • unscreened blood or blood products (e.g. during transfusions).

As soon as infection has taken place, the virus remains in the body. There is still no definitive cure.
Current antiviral treatments do, however, work very well and enable the infection to be kept under control.
As a result of this, family planning for HIV patients has become possible. Nonetheless, certain measures are needed to prevent your partner from contracting HIV or the baby being infected during pregnancy or delivery.

There is data indicating that ‘natural fertilisation’ can be safe for a couple where one of the partners (or even both partners) is HIV-positive. This means that you can try to become pregnant through sexual intercourse without using a condom.

  • There are, however, strict conditions attached to this:
  • you use the antiviral medication correctly;
  • the virus is sufficiently suppressed in your blood;
  • you do not have any other sexually transmissible infections; and
  • you have no other sexual relations than with your fixed partne
 

The option of natural fertilisation will be considered thoroughly beforehand and discussed with you by the doctors concerned.

Apart from the aforementioned ways - exchange of infected bodily fluids and blood - transmission of HIV is also possible via infected eggs, sperm and embryos. Hence the legal obligation of fertility centres to test for infection every three months over the course of an ART treatment.

A baby is exposed to the risk of infection during birth by contact with blood or other bodily fluids from the mother. The risk of transmission via the placenta during pregnancy is, although very low, not impossible.

Before starting a fertility treatment in the CRG you must get the approval from the multidisciplinary committee that decides on this. The committee members include a microbiologist, a doctor of the AIDS reference centre (ARC) who specialises in infectious diseases, a CRG gynaecologist, an embryologist, a psychologist, and CRG staff from the laboratory and administration.
Three consultations are carried out before the committee makes its decision:
  • at the infectious diseases department of the UZ Brussel
  • at the CRG, with the coordinating fertility doctor of the care programme for prospective parents with an infectious disease; and
  • at the CRG, with the psychologist.
During the monthly meeting, the committee discusses all the files of HIV-positive prospective parents. This meeting decides whether or not to approve the application. If the decision is positive, the ART treatment can start.
The period between making the application and start of any treatment is approximately two months.

If your partner is not HIV-positive and you do not have any specific fertility problems, you do not necessarily have to undergo an ART treatment at the CRG. You can organise the fertilisation at home by self-insemination.
If you choose to do this, it is best to ask your fertility doctor for advice. Some technical procedures when carrying out self-insemination may increase your chances of success.

Just as with natural fertilisation, you may need to try several times before you become pregnant using this method.
If you do not succeed in becoming pregnant with self-insemination, or if you do not wish to use this method, the CRG will help you with another type of ART treatment: IUI, IVF or ICSI.
Which method is best for you depends on your fertility problem. The CRG doctor who is treating you will discuss your options during consultation.

During pregnancy

Proper medical support reduces the risk of your baby becoming infected. The use of antiretroviral medication is generally necessary, certainly in the last three months of pregnancy and during delivery. The medication is intended to keep the amount of HIV virus in the body as low as possible and to minimise the risk of transmission to the baby.
If you take this medication, the course of your pregnancy will be similar to that of an uninfected woman. However, since you are more likely to have certain complications, we will provide closer monitoring.

Delivery

The risk of transmission of the virus to the baby is greatest during delivery. As soon as the waters break, the baby comes into contact with the virus present in the mother’s body.
The more virus in the body and the longer the baby is exposed to it, the greater the risk of transmission.
However, if the viral load is suppressed by the medication, a vaginal delivery is the first choice. A caesarean section is then only necessary in case of obstetric problems.
On the other hand, if the HIV virus can be detected at the time of delivery, the obstetrician will be more likely to opt for a caesarean section.

After birth

So long as your pregnancy has been adequately monitored and the baby has been delivered under proper medical supervision, the risk of infection is very small. Nevertheless, your baby will be monitored in the first two years of his/her life. This will be done by a paediatrician connected to the AIDS reference centre.
To find out whether your child is infected or not, a number of blood tests need to be performed:
  • at birth;
  • at three weeks of age;
  • after two to three months;
  • after six, twelve and eighteen months.

If no virus is detected after three blood tests, there is a good chance the child is not infected. The final blood test after 18 months provides the definitive result.

After birth, the baby is given medication in the form of a syrup. The choice of medication and how long depends, above all, on your viral load at the time of delivery.
Unfortunately, breastfeeding is not recommended. As the risk of infection is too great, bottle feeding is recommended.

If you are an HIV-positive man and you want a child of your own, you are referred for an ART treatment with ICSI, regardless of your (female) partner's HIV status.
In this treatment, your sperm will first be ‘washed’: in successive washing steps, we separate the sperm from the seminal fluid and the surrounding cells in which the virus is contained.

After this washing procedure the sperm will be tested again for the presence of the HIV virus. This is done with an HIV test on a fraction of the washed sample. The other washed sperm are frozen in anticipation of the test result.
If the test shows that the sperm are virus-free, they can be used for your ICSI treatment after thawing.

Pregnancy

If your partner is and remains HIV-negative during the pregnancy, the baby will also be HIV-negative.
If your partner is also HIV-positive, the risk of transmission to the child depends on the effectiveness of the antiviral treatment and what is described in situation 1 applies.

During pregnancy and delivery, and after birth

A man's HIV infection does not have any effect on the course of pregnancy and birth, or during the period following birth.