Lights and Shadows about the Effectiveness of IVF in HIV Infected Women: A Systematic Review

Background. 

HIV infected women have higher rates of infertility. 

Objective. 

The purpose of this literature review is to evaluate the effectiveness of fresh IVF/ICSI cycles in HIV infected women. 

Materials and Methods. 

A search of the PubMed database was performed to identify studies assessing fresh nondonor oocyte IVF/ICSI cycle outcomes of serodiscordant couples with an HIV infected female partner. 

Results and Discussion. 

Ten studies met the inclusion criteria. Whenever a comparison with a control group was available, with the exception of one case, ovarian stimulation cancelation rate was higher and pregnancy rate (PR) was lower in HIV infected women. However, statistically significant differences in both rates were only seen in one and two studies, respectively. A number of noncontrolled sources of bias for IVF outcome were identified. This fact, added to the small size of samples studied and heterogeneity in study design and methodology, still hampers the performance of a meta-analysis on the issue. 

Conclusion. 

Prospective matched case-control studies are necessary for the understanding of the specific effects of HIV infection on ovarian response and ART outcome.

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By:  Marques C1, Guerreiro C2, Soares SR3.

• 1Maternidade Dr. Alfredo da Costa, Rua Viriato, 1069-089 Lisboa, Portugal.
• 2Fetal Maternal Department, Maternidade Dr. Alfredo da Costa, Lisbon, Portugal.
• 3Instituto Valenciano de Infertilidade (IVI-Lisboa), Lisbon, Portugal. 
• Infect Dis Obstet Gynecol. 2015;2015:517208. doi: 10.1155/2015/517208. Epub 2015 Dec 8.

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Women Infected with HIV Type 1 Have Poorer Assisted Reproduction Outcomes

OBJECTIVE:

To compare the efficacy of assisted reproductive technology (ART) in women infected with human immunodeficiency virus type 1 (HIV-1) versus HIV-negative controls.

INTERVENTION(S):

Ovarian stimulation, oocytes retrieval, standard in vitro fertilization (IVF) or intracytoplasmic sperm injection, embryo transfer.

MAIN OUTCOME MEASURE(S):

Clinical pregnancies and live-birth rates.

RESULT(S):

After oocyte retrieval, all women infected with HIV-1 infected were matched 1:1 to HIV-negative controls according to the following criteria: date of ART attempt, age, parity, main cause of infertility, ART technique, and rank of attempt. Only the first IVF cycle during the study period was considered for each couple. We found no statistically significant differences between the two groups for ovarian stimulation data, fertilization rate, or average number of embryos transferred. The clinical pregnancy rate per transfer was statistically significantly lower for the cases compared with the controls (12% vs. 32%), as were the implantation rate (10% vs. 21%) and the live-birth rate (7% vs. 19%).

CONCLUSION(S):

In one of the largest studies to pair six factors that influence the results of ART, HIV infection in women was associated with poorer outcomes after ART. These results suggest that women with controlled HIV-1-infection should be counseled not to delay ART in cases of self-insemination failure or other causes of infertility. Fertility preservation by vitrification of oocytes in women whose pregnancy should be delayed may be an important future consideration.

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By:  Stora C1, Epelboin S2, Devouche E1, Matheron S1, Epelboin L1, Yazbeck C1, Damond F1, Longuet P1, Dzineku F1, Rajguru M1, Delaroche L1, Mandelbrot L1,Luton D1, Patrat C1.

• 1Centre d'Assistance Médicale à la Procréation, Service de Gynécologie-Obstétrique, Hôpital Bichat-Claude Bernard, Paris, France.
• 2Centre d'Assistance Médicale à la Procréation, Service de Gynécologie-Obstétrique, Hôpital Bichat-Claude Bernard, Paris, France. Electronic address: sylvie.epelboin@aphp.fr.
• Fertil Steril. 2016 Jan 19. pii: S0015-0282(16)00004-2. doi: 10.1016/j.fertnstert.2015.12.138. 

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Realizing a Desired Family Size: When Should Couples Start?

Below:  Relationship between the female age at which couples start building a family and the chance of realizing a family with one child, with and without use of IVF. The short lines above and below each point in the graph indicate the 95% confidence intervals.

Below:  Relationship between the female age at which couples start building a family and the chance of realizing a family with two children, with and without use of IVF. The short lines above and below each point in the graph indicate the 95% confidence intervals.

Below:  Relationship between the female age at which couples start building a family and the chance of realizing a family with three children, with and without use of IVF. The short lines above and below each point in the graph indicate the 95% confidence intervals.

In order to have a chance of at least 90% to realize a one-child family, couples should start trying to conceive when the female partner is 35 years of age or younger, in case IVF is an acceptable option. For two children, the latest starting age is 31 years, and for three children 28 years. Without IVF, couples should start no later than age 32 years for a one-child family, at 27 years for a two-child family, and at 23 years for three children. When couples accept 75% or lower chances of family completion, they can start 4–11 years later. The results appeared to be robust for plausible changes in model assumptions.

Our conclusions would have been more persuasive if derived directly from large-scale prospective studies. An evidence-based simulation study (as we did) is the next best option. We recommend that the simulations should be updated every 5–10 years with new evidence because, owing to improvements in IVF technology, the assumptions on IVF success chances in particular run the risk of becoming outdated.

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