Fertility services for human immunodeficiency virus–positive patients: provider policy, practice, and perspectives

ObjectiveTo examine demand for, and access to, fertility services for HIV-positive patients in the United States.DesignAn electronic survey.SettingThe URL for the Web-based survey was e-mailed to those surveyed.Patient(s)The 916 members of the Society of Reproductive Endocrinology and Infertility of the American Society of Reproductive Medicine.Main Outcome Measure(s)Policy and practice in evaluation and treatment of HIV-positive and HIV-serodiscordant couples who desire conception, demand for services, and perceived barriers to providing these services.Result(s)The response rate was 22%. Forty percent of respondents reported policies. Fifty-one percent reported requests. Sixty-four percent reported offering treatment to HIV-serodiscordant couples, and 57% reported offering treatment to HIV-positive couples. Treatments most frequently offered to HIV-serodiscordant male-positive couples were reproductive surgery (50%), ovulation induction (46%), and intracytoplasmic sperm injection (45%). Twenty-nine percent of those offering treatment test-washed specimens for HIV. Factors limiting care included the following: low volume of requests (45%), concern for child welfare (37%), no laboratory policy (32%), and legal risk (32%).Conclusion(s)Patients who are HIV-positive are seeking fertility services in the United States. The small demand is a major limiting factor to provision of services. There is a lack of global application of current American Society of Reproductive Medicine guidelines. Provider education is needed to ensure that the safest reproductive services are offered to HIV-positive patients. Legal reform is imperative to improve access to reproductive services for the HIV-positive population.