How to Get Pregnant If You or Your Partner Has HIV

Advances in HIV treatment and prevention have allowed couples living with HIV to get pregnant without the risk of passing the virus to the baby. At the same time, HIV medications (called antiretrovirals) can ensure that HIV is not passed between partners trying to conceive

According to the World Health Organization, nearly half of all couples living with HIV around the world are serodiscordant, meaning that one partner has HIV and the other doesn't. In the United States, it is estimated that there over 140,000 different-sex couples are serodiscordant.

This article takes an in-depth look at the tools and strategies serodiscordant couples can use to safely conceive irrespective of which partner has HIV.

Preconception Strategies

If a couple with HIV is planning to conceive, preparation is needed. During the preconception stage, the strategy would ideally aim to do two things:

1. Reduce the vulnerability of the HIV-negative partner to infection using antiretroviral drugs.
2. Reduce the infectivity of the HIV-positive partner also with antiretroviral drugs.

HIV PrEP

For the partner without HIV, pre-exposure prophylaxis (PrEP) is a preventive strategy that can reduce the risk of getting HIV by up to 99%.

PrEP traditionally involves the antiretroviral drugs Truvada  (emtricitabine and tenofovir disoproxil fumarate) or Descovy (emtricitabine and tenofovir alafenamide), which are taken every day by mouth. But in 2021, a new extended-release antiretroviral called Apretude (cabotegravir) was released that offered protection from HIV for two whole months with a single injection.

There are benefits and risks to each of these options.

Pre-market studies have found that people who used Apretude were between 69% and 90% less likely to get HIV compared to Truvada. With that said, there is little data currently available to assess the drug's safety in pregnancy.

By contrast, a 2020 study suggested that oral versions of PrEP are generally safe for use in people with pregnancy as well as their babies.

Treatment as Prevention (TasP)

There are also steps the partner with HIV can take to all but eliminate the risk of passing the virus to their partner. A landmark study published in 2019 reported that people with HIV can reduce the risk of transmission to zero by achieving and maintaining an undetectable viral load while on antiretroviral therapy.

The eight-year study involving 777 HIV serodiscordant couples reported that not one infection occurred in couples for whom the HIV-positive partner had an undetectable viral load.

The strategy, referred to as treatment as prevention (TasP), traditionally requires the partner with HIV to take their medications every day as prescribed to remain fully undetectable.

However, in 2021, a new antiretroviral therapy called Cabenuva (cabotegravir and rilpivirine) was approved that can suppress the virus to undetectable levels with just two shots given once monthly.

Safer Conception

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

If the female partner has HIV, maintaining an undetectable viral load during the pregnancy reduces the risk of transmission from mother to child to between 0.1% and 0.3%. Some studies suggest that having an undetectable viral load before conceiving may reduce the risk to zero.

If PrEP cannot be used for any reason, the couple can still conceive if the partner with HIV is virally suppressed.

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

Once a pregnancy is confirmed, the partner with HIV would continue antiretroviral therapy. The partner without HIV can decide whether to continue PrEP or not.

From that point forward, the focus would be placed on ensuring a safe pregnancy.

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. The options vary based on which partner has HIV.

If the female partner has HIV, the options include:

• Intrauterine insemination (IUI), in which sperm from the male partner is inserted into the vagina of the female partner
• In vitro fertilization (IVF), in which an egg is fertilized in a lab and placed in the uterus (womb) for implantation

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

Summary

If you or your partner have HIV and want to have children, it is possible to conceive safely. The partner with HIV would need to be on antiretroviral therapy to suppress the virus to undetectable levels. The partner without HIV should consider using pre-exposure prophylaxis (PrEP) to lower the risk of getting HIV.

When these strategies are used together, the risk of HIV transmission can be eliminated.

Other strategies can prevent HIV transmission (including sperm washing, intrauterine insemination, and in vitro fertilization) but these tend to be more complicated and expensive without necessarily being "better" than PrEP and antiretroviral therapy.

A Word From Verywell

If you have HIV and want to get pregnant, it's always a good idea to connect your HIV specialist with your obstetrician-gynecologist (OB-GYN) and/or fertility specialist.

Among the concerns, there are certain antiretrovirals, like Sustiva (efavirenz) that are contraindicated for use in people with pregnancy and should be changed before trying to conceive.

Similarly, HIV can sometimes cause fertility problems in either partner that may need to be addressed before assisted fertility is pursued.