How to Get Pregnant If You or Your Partner Has HIV

With major advances in antiretroviral therapy, couples living with HIV have a far better chance of having children than ever before—allowing them to pursue pregnancy while minimizing the risk of transmission to both the child and uninfected partner.

Couple looking at pregnancy test
Wavebreakmedia / iStock / Getty Images

According to the United Nations, nearly half of all couples living with HIV worldwide are serodiscordant, meaning that one partner is HIV-positive and the other is HIV-negative. In the United States alone, it is estimated that there are over 140,000 serodiscordant heterosexual couples, a great many of whom are of child-bearing age.

Newer preventive strategies have virtually eliminated the risk of HIV transmission if the prescribed therapy (or therapies) are taken as directed.

Preconception Strategies

Serodiscordance does not mean the HIV-negative partner is inherently at risk of infection. Today, there are extremely effective ways to prevent either getting or passing the virus.

HIV PrEP

HIV pre-exposure prophylaxis (PrEP) is a preventive strategy in which the daily use of the combination antiretroviral drug Truvada (emtricitabine + tenofovir disoproxil fumarate) or Descovy (emtricitabine + tenofovir alafenamide) can reduce the risk of getting HIV by up to 99%.

It requires a commitment on the part of the HIV-negative partner—not only to take the drug every day but to undergo lab tests every three months to check for side effects and ensure that HIV transmission has not occurred.

Once PrEP is started, it takes around 21 days before the drug concentration in the bloodstream reaches maximum protection. Until then, condoms should be used during sex.

Most health insurers will cover the cost of PrEP, and there are even copay assistance programs that can help cover out-of-pocket costs.

Treatment as Prevention (TasP)

While PrEP can dramatically reduce the odds of getting HIV, there are measures the HIV-positive partner can take to all but eliminate the risk.

In 2019, a landmark study published in The Lancet concluded that people with HIV can reduce the risk of transmission to zero by sustaining an undetectable viral load while on antiretroviral therapy. The eight-year study, involving 777 serodiscordant couples, reported that not one infection occurred in couples for whom the HIV-positive partner was virally suppressed.

The strategy, referred to as treatment as prevention (TasP), does not mean that the couple no longer has to worry about HIV. This is because the one factor needed for TasP to work—an undetectable viral load—occurs less frequently than one might think.

According to data from the Centers for Disease Control and Prevention (CDC), only around 65% of people on antiretroviral therapy are able to achieve complete viral suppression. Poor drug adherence is the main cause of this.

If a serodiscordant couple fully intends to get pregnant, it is essential that the HIV-positive partner achieves an undetectable viral load and is routinely tested to ensure that viral control is sustained.

In addition, STD screening should be pursued prior to embarking on a conception plan. This is because sexually transmitted diseases can increase the risk of HIV transmission even in people with an undetectable viral load due to a phenomenon called genital shedding.

If Both Partners Have HIV

Even if both partners have HIV, it is important that both have an undetectable viral load to prevent reinfection. Reinfection can lead to transmitted resistance, in which a drug-resistant strain of HIV is passed to a partner, potentially undermining the effectiveness of the drugs they are taking.

Safer Conception

Having both partners on treatment—one on PrEP and the other on permanent antiretroviral therapy—greatly reduces the risk of transmission but also protects the baby as well.

If the female partner has HIV, sustaining an undetectable viral load reduces the risk of transmission from mother to child to around 0.1% to 0.3%. Recent studies have suggested that having an undetectable viral load before conceiving may reduce the risk to zero.

If PrEP is not an option due to drug intolerance or treatment contraindications, the couple can still conceive if the HIV-positive partner is virally suppressed.

Once this is achieved, intercourse can be scheduled using ovulation detection methods (like the Clearblue Easy or First Response urine tests) to ensure that you only have unprotected sex when conception is possible. Outside this "fertile window," condoms should be used.

Once a pregnancy is confirmed, the HIV-positive partner would continue antiretroviral therapy while the HIV-negative partner can decide whether to continue PrEP or not.

Limited studies have shown that Truvada is generally considered safe during pregnancy. Even so, it is important to speak with your doctor to fully understand the benefits and risks of treatment.

All other provisions to ensure a safe pregnancy would then be implemented.

At present, Descovy is not approved for use in PrEP in cisgender women and transgender men due to the lack of these participants in clinical trials. Gilead Sciences, the manufacturer of Descovy, is currently conducting studies evaluating PrEP in individuals who engage in receptive vaginal sex.

Alternative Strategies

If for any reason a couple decides not to conceive naturally, they can work with a fertility specialist to explore assisted fertility options depending on which partner has HIV.

If the female partner has HIV, options include:

If the male partner has HIV (or both partners have HIV), sperm washing significantly reduces the risk of transmission. This involves separating the mature sperm (spermatozoa) from the HIV-infected seminal fluid (semen) for use either in IUI or IVF.

The one major limiting factor of IUI and IVF is cost. With IUI, the price without insurance can range anywhere from $300 to $1,000 per attempt. With IVF, the fee for one cycle (including medicines, procedures, anesthesia, ultrasounds, blood tests, lab work, and embryo storage) runs around $15,000, according to Planned Parenthood.

Side effects from IVF can also be extensive, including nausea, breast tenderness, bloating, hot flashes, mood swings, pelvic pain, multiple births, and ovarian hyperstimulation syndrome (OHSS).

Before embarking on IUI or IVF, make sure that your HIV doctor is in the loop. Men and women with HIV have higher rates of infertility due to hormonal irregularities, prior infections, and other factors that impair fertility.

By working together, you and your doctors can find the best options for you based on your current health and medical histories.

A Word From Verywell

If you are a woman with HIV and intend to get pregnant, most antiretroviral drugs are considered safe during pregnancy. If you are currently on treatment, you will likely be advised to continue if you become pregnant as long as you have an undetectable viral load.

The one exception is Sustiva (efavirenz), a drug that has long been avoided in pregnancy due to concerns about birth defects. If you are on Sustiva and become pregnant (or are actively pursuing pregnancy), you may be switched to another drug just in case.

Although data from the Antiretroviral Pregnancy Register (APR) has shown that the rate of birth defects in mothers who take Sustiva is no different than that of the general population, the Food and Drug Administration still advises against its use in the first trimester.

Was this page helpful?
Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. United Nations Joint Programme on HIV/AIDS. UNAIDS World AIDS Day Report 2011. December 1, 2011.

  2. Mmeje O, Cohen CR, Cohan D. Evaluating safer conception options for HIV-serodiscordant couples (HIV-infected female/HIV-uninfected male): A closer look at vaginal inseminationInfect Dis Obstet Gynecol. 2012;2012:587651. doi:10.1155/2012/587651

  3. Centers for Disease Control and Prevention. How effective is PrEP? Updated November 3, 2020.

  4. Centers for Disease Control and Prevention. Preexposure prophylaxis for the prevention of HIV infection in the United States – 2017 update. Updated March 2018.

  5. Rodger A., Cambiano V, Bruun T, et al. Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational studyLancet. 2019 May 2; pii: S0140-6736(19)30418-0. doi:10.1016/S0140-6736(19)30418-0

  6. Centers for Disease Control and Prevention. What is the HIV care continuum? Updated February 4, 2021.

  7. Patel E, Kirkpatrick A, Grabowski M, et al. Penile immune activation and risk of HIV shedding: A prospective cohort studyClin Infect Dis. 2017;64(6):776-84. doi:10.1093/cid/ciw847

  8. Panichsillapakit T, Smith DM, Wertheim JO, Richman DD, Little SJ, Mehta SR. Prevalence of transmitted HIV drug resistance among recently infected persons in San Diego, CA 1996-2013J Acquir Immune Defic Syndr. 2016;71(2):228-36. doi:10.1097/QAI.0000000000000831

  9. Peters H, Francis K, Sconza R, et al. UK mother-to-child HIV transmission rates continue to decline: 2012–2014Clin Infect Dis. 2017;64:527-8. doi:10.1093/cid/ciw791

  10. Mandelbrot L, Tubiana R, Le Chenadec J, et al. No perinatal HIV-1 transmission from women with effective antiretroviral therapy starting before conceptionClin Infect Dis. 2015 Dec;61(11):1715-25. doi:10.1093/cid/civ578

  11. Gilead Sciences. Package insert - Descovy. Updated October 2019.

  12. Gilead Sciences. Gilead statement on commitment to advancing Descovy for PrEP study in cisgender women & adolescent females. December 3, 2019.

  13. Zafer M, Horvath H, Mmeje O, et al. Effectiveness of semen washing to prevent HIV transmission and assist pregnancy in HIV-discordant couples: A systematic review and meta-analysis. Fertil Steril. 2016;105(3):645-55.e2. doi:10.1016/j.fertnstert.2015.11.028

  14. Planned Parenthood. What is intrauterine insemination (IUI)? Updated 2021.

  15. Planned Parenthood. What is in-vitro fertilization (IVF)? Updated 2021.

  16. Marques C, Guerreiro C, Reis Soares C. Lights and shadows about the effectiveness of IVF in HIV infected women: A systematic reviewInfect Dis Obstet Gynecol. 2015;2015:517208. doi:10.1155/2015/517208

  17. Bristol-Myers Squibb. Package insert - Sustiva. Updated March 2016.

  18. Antiretroviral Pregnancy Registry Steering Committee. Antiretroviral Pregnancy Registry international interim report for 1 January 1989-31 July 2020. 2020.

Additional Reading