For those with HIV, the progress of antiretroviral therapy (ART) has revolutionized the course of the disease, enabling many to live healthy, fulfilling, and long lives. With better health prospects, building a family has become an issue of major interest. Yet, even with good treatment, HIV can subtly affect male fertility, notably sperm health.
In an exclusive interaction with the editorial team of Onlymyhealth, Dr Bhumesh Tyagi, Consultant, General Medicine and Physician, Shardacare, Health City, Noida explained whereas most of the issues with HIV and fertility center on preoccupying efforts to avoid transmission to partners and children, it's also important to learn about direct effects on sperm and overall male fertility function.
Multifaceted Impact of HIV and Sperm
It should be noted that HIV itself is not transmitted in individual sperm. The virus exists most often within the seminal plasma (the fluid that contains sperm) and within immune cells found in semen, including lymphocytes and macrophages. Yet, despite being present within the male reproductive tract, HIV can still cause a number of harmful effects to the sperm quality:
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Impaired Semen Parameters: Research has repeatedly demonstrated that HIV-positive men, even those with stable ART, frequently have impaired semen parameters compared to HIV-negative men. This may involve:
- Reduced sperm motility: Sperm can be less active and have less capability to swim well.
- Reduced sperm concentration: The concentration of sperm per milliliter of semen can be lower.
- Abnormal sperm morphology: More sperm have abnormally shaped or structured sperm, which can impair their capacity to penetrate an egg.
- Decreased ejaculate volume: The total semen volume is less.
- Increased semen viscosity: Semen becomes thicker, making it difficult for the sperms to move.
- Sperm DNA Fragmentation: One of the more unsettling effects of HIV on sperm is a higher rate of DNA fragmentation. That is, breaks or damage within sperm genetic material.
- The underlying mechanisms for this fragmentation continue to be researched, but oxidative stress and inflammation of the reproductive tract resulting from HIV infection are believed to contribute significantly. Other research indicates that some of the ART drugs could further lead to mitochondrial damage to sperm, thereby affecting their health and integrity of DNA as well.
- Inflammation and Oxidative Stress: HIV infection may result in chronic inflammation and elevated oxidative stress in the male reproductive tract. Such an environment may have a direct impact on sperm cells, causing reduced viability and function.
- Hormonal Imbalances: HIV infection can also influence the endocrine system of the body, including testosterone levels. Reduced testosterone (hypogonadism) may result in decreased sperm production and lowered libido, further resulting in fertility issues.
- Opportunistic Infections: A compromised immune system resulting from HIV infection has the potential to predispose individuals to other infections in the genital tract, which may further compromise sperm and genital organs.
The Role of Antiretroviral Therapy (ART)
Although ART has dramatically altered the treatment of HIV, its immediate effect on sperm quality is an intricate topic. Some research has indicated that ART is capable of enhancing some semen parameters through the inhibition of viral replication and inflammation. But other studies indicate that certain ART regimens may be linked to higher sperm DNA fragmentation or other subtle alterations. It's a subtle landscape, and the net benefit of ART to enhance health and minimize transmission risk greatly outweighs any minor effects on sperm quality.
Building Families Safely: Options for HIV-Positive Men
Despite these potential impacts on sperm, HIV-positive men have several safe and effective options to build families with their partners:
- Effective ART and Undetectable Viral Load (U=U): The foundation of safe conception for people living with HIV is to become and remain undetectable. "Undetectable = Untransmittable" (U=U) implies that an HIV-positive individual on successful ART who has an undetectable viral load cannot sexually pass HIV to others. It lowers the risk a negative partner takes during conception by a great degree.
- Sperm Washing: This laboratory technique involves separating healthy, moving sperm from seminal fluid and other cells that could harbor the virus. The cleaned sperm, having been proven to be HIV-free, can then be utilized for assisted reproductive technologies such as intrauterine insemination (IUI) or in vitro fertilization (IVF). Sperm washing has a long history of success as an HIV prevention method.
- Assisted Reproductive Technologies (ART): Procedures like IUI and IVF, often in conjunction with sperm washing, offer safe pathways to parenthood for HIV-discordant couples (where one partner is HIV-positive and the other is HIV-negative) or couples where both partners are HIV-positive.
- Sperm Banking: In men who are concerned about fertility in the future, or are treated for procedures that might affect the production of sperm, sperm banking provides the opportunity to cryopreserve semen for future use. This can be accomplished with pre-washing of sperm if HIV positive.
Importance of Open Communication and Specialised Care
Undergoing fertility as an HIV-positive male involves frank discussion with HIV-managing healthcare professionals as well as those with special expertise in reproductive medicine. A thorough assessment, including semen analysis and ART regimen discussion, can identify the safest and most ideal route to parenthood.
Bottomline
Although HIV may affect sperm quality and male fertility by numerous mechanisms, the face of HIV care has dramatically changed. With successful ART and advanced reproductive technologies, HIV-positive men can now confidently embark on their aspiration of fatherhood, assuring their own well-being and that of their families.