Reproducción asistida en varones seropositivos para el VIH-1

espanolObjetivos: El varon seropositivo para el VIH-1 ha de renunciar a tener hijos o asumir el riesgo de contagiar a su pareja. Las tecnicas de de permiten separar los espermatozoides moviles de los componentes seminales infectados y utilizarlos en la reproduccion asistida. El objetivo de este trabajo es presentar la experiencia del Instituto CEFER en reproduccion asistida con semen lavado de varones seropositivos para el VIH. Metodos: Se trato con inseminacion artificial (IA) a 302 parejas y con fecundacion in vitro (FIV) con microinyeccion espermatica (intracytoplasmic sperm injection [ICSI]) a 88. El lavado de semen se hizo mediante centrifugacion en gradientes discontinuos de PureSperm (el 90, el 70 y el 50%, a 300 g durante 20 min); seguida de swim-up. En la fraccion obtenida se estudio la presencia de VIH-1 con la tecnica de la reaccion en cadena de la polimerasa (PCR). Se efectuaron 621 ciclos de IA y 133 de FIV-ICSI. Resultados: En las IA efectuadas a 302 mujeres, se obtuvieron 153 gestaciones clinicas (un 24,6% de gestaciones por ciclo y un 50,6% por mujer). Hubo 25 abortos (16,3%) y 120 nacimientos; 10 partos gemelares (6,5%) y 140 ninos nacidos. En los 133 ciclos de FIV-ICSI efectuados a 88 mujeres, se obtuvieron 59 gestaciones clinicas (un 44,4% de gestaciones por ciclo y un 67,04% por mujer). Hubo 16 abortos (27,1%), 37 nacimientos, 5 partos gemelares (8,5%) y 47 ninos nacidos. Ninguna mujer tratada se seroconvirtio. Todos los ninos nacidos fueron seronegativos para el VIH-1. Discusion: La metodologia descrita y la experiencia presentada permiten afirmar que el varon seropositivo para el VIH puede tener hijos propios sin contagiar a su pareja y no precisa usar semen de banco. La IA es una tecnica valida para este colectivo, y la FIV-ICSI se ha de utilizar solo cuando este indicada, como en parejas seronegativas para el VIH. EnglishObjectives: HIV-1-seropositive men must forgo having biological children or accept the risk of infecting their female partners. Techniques of semen washing allow motile spermatozoa to be separated from infected semen components and used in assisted reproduction. The aim of the present study was to present the experience of the CEFER Institute in assisted reproduction using washed semen from HIV-seropositive men. Methods: Three hundred two couples underwent artificial insemination (AI). Eighty-eight couples underwent in vitro fertilization (IVF)-intracytoplasmic sperm injection (ICSI). Semen washing was performed through discontinuous centrifugation gradients of Pure Sperm (90%, 70% and 50% at 300 g for 20 minutes), followed by swimm-up. The presence of HIV-l was examined in the fraction obtained using polymerase chain reaction. A total of 621 AI cycles and 133 IVF-ICSI cycles were performed. Results: In the IA performed in 302 women, 153 clinical pregnancies were obtained. The pregnancy rate per cycle was 24.6% and the pregnancy rate per patient was 50.6%. There were 25 miscarriages (16.3%) and 120 births. There were 10 twin deliveries (6.5%) and 140 neonates. In the 133 IVF-ICSI cycles performed in 88 women, 59 clinical pregnancies were obtained. The pregnancy rate per cycle was 44.4% and the pregnancy rate per patient was 67.04%. There were 16 miscarriages (27.1%), 37 births, 5 twin deliveries (8.5%) and 47 newborns. None of the treated women became seropositive and all of the newborns were HIV-1-seronegative. Discussion: The methodology and experience described show that HIV-seropositive men can have biological children without infecting their female partners. It is not necessary to use semen from a sperm bank. AI is a valid technique for this collective while IVF-ICSI should only be used when, as in HIV-seronegative couples, it is indicated.