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Hum. Reprod. Advance Access published online on July 8, 2004
Human Reproduction, doi:10.1093/humrep/deh426
© 2004 by European Society of Human Reproduction and Embryology
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Received April 13, 2004
Accepted June 26, 2004

Article

The effect of human immunodeficiency virus on sperm parameters and the outcome of intrauterine insemination following sperm washing

James D.M. Nicopoullos 1*, Paula A. Almeida 1, Jonathan W.A. Ramsay 2, Carole Gilling-Smith 1

1 Assisted Conception Unit, Chelsea & Westminster Hospital, London SW10 9NH, UK
2 Assisted Conception Unit, Chelsea & Westminster Hospital, London SW10 9NH, UK; Clinical Director of Surgery, Charring Cross Hospital, London W6 8RF, UK

* To whom correspondence should be addressed. E-mail: james.nicopoullos{at}chelwest.nhs.uk.


  Abstract

BACKGROUND: This is the first study to assess the outcome of sperm washing and intrauterine insemination (IUI) cycles in human immunodeficiency virus-positive (HIV+) men to determine any predictors of success, as well as evaluating the effect of HIV on sperm parameters. METHODS: Semen characteristics were evaluated in 106 HIV+ men and a control group of 234 HIV- men, and the effect of markers of HIV disease assessed. Age, stimulation regime, sperm parameters, markers of HIV disease and the use of anti-retrovirals were assessed as predictors of the outcome of sperm washing/IUI cycles in the HIV+ men. RESULTS: Ejaculate volume, sperm concentration, total count, progressive motility and normal morphology were all significantly higher in the control group compared to the HIV+ men (P<0.05). A significant positive correlation was observed between CD4 count and sperm concentration, total count, motility, progressive motility type ‘a’+‘b’ and post-preparation concentration and a significant negative correlation with normal sperm morphology of both raw and post-preparation samples. No correlation was observed between viral load (VL), years since diagnosis, use of anti-retrovirals or duration of use and any sperm parameter. The only factors that significantly improved IUI outcome were a VL <1000 copies/ml and the use of anti-retrovirals. CONCLUSIONS: These data demonstrate that sperm parameters are significantly impaired by the presence of HIV infection and in particular correlate with CD4 count. Undetectable VL and the use of anti-retrovirals improve the outcome of IUI/sperm washing in HIV+ men.

Keywords: HIV; intrauterine insemination; predictors of outcome; sperm washing.
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