The Experts below are selected from a list of 747 Experts worldwide ranked by ideXlab platform
James D M Nicopoullos - One of the best experts on this subject based on the ideXlab platform.
-
a decade of the Sperm Washing programme correlation between markers of hiv and seminal parameters
Hiv Medicine, 2011Co-Authors: James D M Nicopoullos, Paula A Almeida, Maria Vourliotis, C GillingsmithAbstract:Objectives The aim of the study was to use a decade of experience of Sperm Washing to assess the effect of HIV disease on semen parameters and to highlight the continuing importance of risk reduction when some controversially advocate the safety of timed unprotected intercourse for conception in the ‘stable’ HIV-positive man. Methods Semen parameters of 439 fresh samples used for Sperm Washing/intrauterine insemination (IUI) were correlated against markers of HIV disease [CD4 cell count, viral load (VL), duration of HIV infection and use of antiretroviral therapy] and the risk of detectable virus in semen was assessed. Results A significant positive correlation was observed between CD4 cell count and total Sperm count, progressive motility, post-preparation/insemination concentration, progressive motility and total motile count inseminated (TMCI), and a significant negative correlation was observed between CD4 cell count and normal Sperm morphology (Spearman's correlation; P<0.05). There was no significant difference in any parameter between samples in which VL was detectable and those in which it was undetectable. The use of highly active antiretroviral therapy (HAART) significantly decreased total Sperm count, progressive motility, post-preparation count and TMCI and significantly increased proportion of abnormal forms (Mann–Whitney tests; P<0.05). There was a significant negative correlation between duration of HAART use and concentration, total Sperm count and post-preparation motility and between years since diagnosis and post-preparation motility. In 9.7% of IUI cycles performed with fresh Sperm in men on HAART with undetectable VL, detectable HIV was found in either pre- or post-wash seminal samples. Conclusion Our data suggest a negative effect of low CD4 cell count and the use of HAART on semen. The significant proportion of ‘stable’; men with undetectable serum VL but virus in semen confirms the continued importance of such risk reduction.
-
a decade of the united kingdom Sperm Washing program untangling the transatlantic divide
Fertility and Sterility, 2010Co-Authors: James D M Nicopoullos, Paula A Almeida, Maria Vourliotis, Carole GillingsmithAbstract:Fertility assistance to HIV-positive men is now accepted practice in many parts of the world. We analyze the legislative, ethical, and clinical factors that explain the differences across continents with the aim of opening up the debate within the United States on whether clinics can justify denying HIV-infected men the opportunity of parenting through a now well-established risk reduction method with a proved safety record.
-
a decade of the Sperm Washing programme where are we now
Human Fertility, 2010Co-Authors: James D M Nicopoullos, Paula A Almeida, Maria Vourliotis, Rebecca E Goulding, Carole GillingsmithAbstract:Since 1999, we have treated HIV-positive men with Sperm Washing as part of a risk-reduction programme with a year-on-year increase in total infectious cycles performed to over 200 in 2008. Four hundred and thirty nine cycles of IUI, 114 cycles of IVF and 117 cycles of ICSI have been performed in HIV positive men over the decade and of the 259 couples treated, a pregnancy rate and ongoing pregnancy rate per couple of 45.4% and 36.3% have been achieved with over 100 children born with no seroconversions. We outline the continued importance of such risk-reduction measures with 9.7% of samples from men with ‘stable’ disease on anti-retroviral treatment and undetectable viral load demonstrating detectable viral particles in seminal fluid and discuss measures to improve outcome in this patient group.
-
A decade of the Sperm-Washing programme: correlation between markers of HIV and seminal parameters.
Hiv Medicine, 2010Co-Authors: James D M Nicopoullos, Paula A Almeida, Maria Vourliotis, Carole Gilling-smithAbstract:Objectives The aim of the study was to use a decade of experience of Sperm Washing to assess the effect of HIV disease on semen parameters and to highlight the continuing importance of risk reduction when some controversially advocate the safety of timed unprotected intercourse for conception in the ‘stable’ HIV-positive man. Methods Semen parameters of 439 fresh samples used for Sperm Washing/intrauterine insemination (IUI) were correlated against markers of HIV disease [CD4 cell count, viral load (VL), duration of HIV infection and use of antiretroviral therapy] and the risk of detectable virus in semen was assessed. Results A significant positive correlation was observed between CD4 cell count and total Sperm count, progressive motility, post-preparation/insemination concentration, progressive motility and total motile count inseminated (TMCI), and a significant negative correlation was observed between CD4 cell count and normal Sperm morphology (Spearman's correlation; P
-
a decade of Sperm Washing clinical correlates of successful insemination outcome
Human Reproduction, 2010Co-Authors: James D M Nicopoullos, Paula A Almeida, Maria Vourliotis, Rebecca E Goulding, Carole GillingsmithAbstract:background: Since 1999, we have treated HIV-positive men with Sperm Washing as part of a risk-reduction programme. methods: Retrospective analysis of the Sperm-Washing database from the treatment of 245 couples with 439 cycles of intrauterine insemination assessed the effects of patient factors (age, maternal FSH, rank of attempt), markers of HIV-disease [time since diagnosis, CD4 count, viral load (VL), use of highly active antiretroviral therapy (HAART)], cycle factors (natural versus stimulated, number of follicles, fresh versus frozen Sperm) and Sperm parameters on clinical (CPR) and ongoing pregnancy rate (OPR). results: Overall 111–245 (45.4%) couples achieved a clinical pregnancy (CPR: 13.5% and OPR: 9.6% per insemination) with no seroconversions. The mean duration since HIV diagnosis was 5.8 years, 73% of men were on antiretroviral therapy, there was an undetectable VL in 64% and the median CD4 was 409 cells/mm 3 . A significantly decreased OPR and a non-significantly increased miscarriage rate (MR) was observed after the female age of 40. Similarly, there was a significant increased OPR and decreased MR for women with a mean cycle maternal FSH of ,6.4 IU/l. There was no effect of VL, CD4 count, use of HAART or time since diagnosis on the outcome. Nor was there a difference in the OPR according to paternal age, rank of attempt, cycle regime or number of follicles. Semen volume, Sperm concentration, total count and progressive motility and post-wash concentration, progressive motility and total motile count inseminated were significantly higher in successful cycles. The use of frozen Sperm had a significant negative impact on outcome. conclusions: This study of the potential safe and successful reproductive options available to HIV-positive men demonstrates that maternal age and semen quality, rather than HIV factors, remain the most important determinants of cycle success.
Carole Gillingsmith - One of the best experts on this subject based on the ideXlab platform.
-
a decade of the united kingdom Sperm Washing program untangling the transatlantic divide
Fertility and Sterility, 2010Co-Authors: James D M Nicopoullos, Paula A Almeida, Maria Vourliotis, Carole GillingsmithAbstract:Fertility assistance to HIV-positive men is now accepted practice in many parts of the world. We analyze the legislative, ethical, and clinical factors that explain the differences across continents with the aim of opening up the debate within the United States on whether clinics can justify denying HIV-infected men the opportunity of parenting through a now well-established risk reduction method with a proved safety record.
-
a decade of the Sperm Washing programme where are we now
Human Fertility, 2010Co-Authors: James D M Nicopoullos, Paula A Almeida, Maria Vourliotis, Rebecca E Goulding, Carole GillingsmithAbstract:Since 1999, we have treated HIV-positive men with Sperm Washing as part of a risk-reduction programme with a year-on-year increase in total infectious cycles performed to over 200 in 2008. Four hundred and thirty nine cycles of IUI, 114 cycles of IVF and 117 cycles of ICSI have been performed in HIV positive men over the decade and of the 259 couples treated, a pregnancy rate and ongoing pregnancy rate per couple of 45.4% and 36.3% have been achieved with over 100 children born with no seroconversions. We outline the continued importance of such risk-reduction measures with 9.7% of samples from men with ‘stable’ disease on anti-retroviral treatment and undetectable viral load demonstrating detectable viral particles in seminal fluid and discuss measures to improve outcome in this patient group.
-
a decade of Sperm Washing clinical correlates of successful insemination outcome
Human Reproduction, 2010Co-Authors: James D M Nicopoullos, Paula A Almeida, Maria Vourliotis, Rebecca E Goulding, Carole GillingsmithAbstract:background: Since 1999, we have treated HIV-positive men with Sperm Washing as part of a risk-reduction programme. methods: Retrospective analysis of the Sperm-Washing database from the treatment of 245 couples with 439 cycles of intrauterine insemination assessed the effects of patient factors (age, maternal FSH, rank of attempt), markers of HIV-disease [time since diagnosis, CD4 count, viral load (VL), use of highly active antiretroviral therapy (HAART)], cycle factors (natural versus stimulated, number of follicles, fresh versus frozen Sperm) and Sperm parameters on clinical (CPR) and ongoing pregnancy rate (OPR). results: Overall 111–245 (45.4%) couples achieved a clinical pregnancy (CPR: 13.5% and OPR: 9.6% per insemination) with no seroconversions. The mean duration since HIV diagnosis was 5.8 years, 73% of men were on antiretroviral therapy, there was an undetectable VL in 64% and the median CD4 was 409 cells/mm 3 . A significantly decreased OPR and a non-significantly increased miscarriage rate (MR) was observed after the female age of 40. Similarly, there was a significant increased OPR and decreased MR for women with a mean cycle maternal FSH of ,6.4 IU/l. There was no effect of VL, CD4 count, use of HAART or time since diagnosis on the outcome. Nor was there a difference in the OPR according to paternal age, rank of attempt, cycle regime or number of follicles. Semen volume, Sperm concentration, total count and progressive motility and post-wash concentration, progressive motility and total motile count inseminated were significantly higher in successful cycles. The use of frozen Sperm had a significant negative impact on outcome. conclusions: This study of the potential safe and successful reproductive options available to HIV-positive men demonstrates that maternal age and semen quality, rather than HIV factors, remain the most important determinants of cycle success.
-
Sperm Washing for serodiscordant couples who want a child
NEJM Journal Watch, 2006Co-Authors: Elizabeth R Jennyavital, Carole Gillingsmith, Lori PantherAbstract:Elizabeth Jenny-Avital, MDA serodiscordant couple from Togo comes to the HIV clinic seeking fertility advice. The man has HIV-1 infection of unknown
-
the effect of human immunodeficiency virus on Sperm parameters and the outcome of intrauterine insemination following Sperm Washing
Human Reproduction, 2004Co-Authors: James D M Nicopoullos, Jonathan W A Ramsay, Paula A Almeida, Carole GillingsmithAbstract: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.
Ashok Agarwal - One of the best experts on this subject based on the ideXlab platform.
-
Sperm Preparation for Intrauterine Insemination Using Density Gradient Separation
Andrological Evaluation of Male Infertility, 2016Co-Authors: Ashok Agarwal, Sajal Gupta, Rakesh SharmaAbstract:Sperm Washing is performed to remove seminal plasma and increase Sperm density prior to intrauterine insemination (IUI). Gradient Sperm Washing is highly effective at isolating motile Sperm from the ejaculate of most men. IUI may be indicated in cases of poor postcoital testing due to hostile or absent cervical mucus, oligoSpermia, or the presence of Sperm antibodies. It may be used in conjunction with artificial insemination or IVF procedures.
-
Sperm Preparation for Intrauterine Insemination (IUI) by Swim-Up Method
Andrological Evaluation of Male Infertility, 2016Co-Authors: Ashok Agarwal, Sajal Gupta, Rakesh SharmaAbstract:Preparation of the Sperm for IUI combines Sperm Washing with swim-up to remove seminal plasma and concentrate the most motile Spermatozoa in a very small volume of Sperm wash media (HTF).
-
effect of centrifuge speed refrigeration medium and Sperm Washing medium on cryopreserved Sperm quality after thawing
Archives of Andrology, 1997Co-Authors: Rakesh Sharma, S Vemulapalli, S Kohn, Ashok AgarwalAbstract:Cryopreservation and subsequent thawing of semen for assisted reproductive procedures decreases Sperm motility; motility further reduces when the cryoprotectant medium is removed because of the osmotic shock and centrifugation done to prepare the Sperm. To compare motility and thus pregnancy rates, this study examined the effects of adding an additional refrigeration medium and three different centriftigation speeds for Sperm preparation. Semen samples from 16 healthy normal volunteers were obtained by masturbation after 48 h of abstinence. Sperm motility and other motion characteristics were analyzed with a computer-assisted semen analyzer before freezing, after thawing, and after centrifugation. Each sample was divided into 6 aliquots and frozen using the liquid nitrogen vapor method. After thawing, human tubal fluid (HTF) with 5% human serum albumin was added to 3 aliquots, and refrigeration medium (identical to freezing medium without glycerol) was added to the remaining 3 tubes for each specimen. The...
-
effect of centrifuge speed refrigeration medium and Sperm Washing medium on cryopreserved Sperm quality after thawing
Annual Meeting of the American Society of Andrology, 1997Co-Authors: Rakesh Sharma, S Vemulapalli, S Kohn, Ashok AgarwalAbstract:Cryopreservation and subsequent thawing of semen for assisted reproductive procedures decreases Sperm motility; motility further reduces when the cryoprotectant medium is removed because of the osmotic shock and centrifugation done to prepare the Sperm. To compare motility and thus pregnancy rates, this study examined the effects of adding an additional refrigeration medium and three different centrifugation speeds for Sperm preparation. Semen samples from 16 healthy normal volunteers were obtained by masturbation after 48 h of abstinence. Sperm motility and other motion characteristics were analyzed with a computer-assisted semen analyzer before freezing, after thawing, and after centrifugation. Each sample was divided into 6 aliquots and frozen using the liquid nitrogen vapor method. After thawing, human tubal fluid (HTF) with 5% human serum albumin was added to 3 aliquots, and refrigeration medium (identical to freezing medium without glycerol) was added to the remaining 3 tubes for each specimen. The tubes containing the two media were then washed by centrifugation at 100g, 300g, and 500g for 10 min. Aliquots with refrigeration medium did not significantly differ from those with HTF for percent motility, curvilinear velocity, straight-line velocity, and amplitude of lateral head displacement at any centrifugation speed. Motile Sperm count was significantly greater only at 100g and 300g for refrigeration medium (p = .02 and .01) and HTF (p 0.001); at 300g, average path velocity in refrigeration medium aliquots (p = .01) and linearity in HTF (p = .01) were greater. The results indicated that the reduction in motility and other motion characteristics probably cannot be overcome by changing factors such as the Sperm preparation medium or centrifugation speed. More effective cryopreservation techniques or preparation methods that eliminate centrifugation need to be developed.
-
effect of Sperm Washing on levels of reactive oxygen species in semen
Archives of Andrology, 1994Co-Authors: Ashok Agarwal, Isao Ikemoto, Kevin R. LoughlinAbstract:The possibility was evaluated that the production of reactive oxygen species (ROS) by human Sperm is stimulated by the repeated cycles of centrifugation and resuspension involved in conventional Sperm preparation. ROS generation by human Sperm was monitored before and after the Washing of Sperm from 55 men (43 men with suspected subfertility and 12 normal volunteers). The ROS activity of all 55 specimens before Washing was inversely correlated with original Sperm motility (r =. 278, p <. 05). The mean level of ROS activity was significantly higher after Washing than before processing (p <. 05) for the 26 specimens with normal Sperm motility, the 20 specimens with normal Sperm morphology, and the 12 specimens with both normal motility and normal morphology. In contrast, the mean ROS level was not significantly changed after Washing in the 27 specimens with poor Sperm motility, the 16 specimens with abnormal Sperm morphology, or the 13 specimens with both abnormal motility and abnormal morphology. It would ...
Paula A Almeida - One of the best experts on this subject based on the ideXlab platform.
-
a decade of the Sperm Washing programme correlation between markers of hiv and seminal parameters
Hiv Medicine, 2011Co-Authors: James D M Nicopoullos, Paula A Almeida, Maria Vourliotis, C GillingsmithAbstract:Objectives The aim of the study was to use a decade of experience of Sperm Washing to assess the effect of HIV disease on semen parameters and to highlight the continuing importance of risk reduction when some controversially advocate the safety of timed unprotected intercourse for conception in the ‘stable’ HIV-positive man. Methods Semen parameters of 439 fresh samples used for Sperm Washing/intrauterine insemination (IUI) were correlated against markers of HIV disease [CD4 cell count, viral load (VL), duration of HIV infection and use of antiretroviral therapy] and the risk of detectable virus in semen was assessed. Results A significant positive correlation was observed between CD4 cell count and total Sperm count, progressive motility, post-preparation/insemination concentration, progressive motility and total motile count inseminated (TMCI), and a significant negative correlation was observed between CD4 cell count and normal Sperm morphology (Spearman's correlation; P<0.05). There was no significant difference in any parameter between samples in which VL was detectable and those in which it was undetectable. The use of highly active antiretroviral therapy (HAART) significantly decreased total Sperm count, progressive motility, post-preparation count and TMCI and significantly increased proportion of abnormal forms (Mann–Whitney tests; P<0.05). There was a significant negative correlation between duration of HAART use and concentration, total Sperm count and post-preparation motility and between years since diagnosis and post-preparation motility. In 9.7% of IUI cycles performed with fresh Sperm in men on HAART with undetectable VL, detectable HIV was found in either pre- or post-wash seminal samples. Conclusion Our data suggest a negative effect of low CD4 cell count and the use of HAART on semen. The significant proportion of ‘stable’; men with undetectable serum VL but virus in semen confirms the continued importance of such risk reduction.
-
a decade of the united kingdom Sperm Washing program untangling the transatlantic divide
Fertility and Sterility, 2010Co-Authors: James D M Nicopoullos, Paula A Almeida, Maria Vourliotis, Carole GillingsmithAbstract:Fertility assistance to HIV-positive men is now accepted practice in many parts of the world. We analyze the legislative, ethical, and clinical factors that explain the differences across continents with the aim of opening up the debate within the United States on whether clinics can justify denying HIV-infected men the opportunity of parenting through a now well-established risk reduction method with a proved safety record.
-
a decade of the Sperm Washing programme where are we now
Human Fertility, 2010Co-Authors: James D M Nicopoullos, Paula A Almeida, Maria Vourliotis, Rebecca E Goulding, Carole GillingsmithAbstract:Since 1999, we have treated HIV-positive men with Sperm Washing as part of a risk-reduction programme with a year-on-year increase in total infectious cycles performed to over 200 in 2008. Four hundred and thirty nine cycles of IUI, 114 cycles of IVF and 117 cycles of ICSI have been performed in HIV positive men over the decade and of the 259 couples treated, a pregnancy rate and ongoing pregnancy rate per couple of 45.4% and 36.3% have been achieved with over 100 children born with no seroconversions. We outline the continued importance of such risk-reduction measures with 9.7% of samples from men with ‘stable’ disease on anti-retroviral treatment and undetectable viral load demonstrating detectable viral particles in seminal fluid and discuss measures to improve outcome in this patient group.
-
A decade of the Sperm-Washing programme: correlation between markers of HIV and seminal parameters.
Hiv Medicine, 2010Co-Authors: James D M Nicopoullos, Paula A Almeida, Maria Vourliotis, Carole Gilling-smithAbstract:Objectives The aim of the study was to use a decade of experience of Sperm Washing to assess the effect of HIV disease on semen parameters and to highlight the continuing importance of risk reduction when some controversially advocate the safety of timed unprotected intercourse for conception in the ‘stable’ HIV-positive man. Methods Semen parameters of 439 fresh samples used for Sperm Washing/intrauterine insemination (IUI) were correlated against markers of HIV disease [CD4 cell count, viral load (VL), duration of HIV infection and use of antiretroviral therapy] and the risk of detectable virus in semen was assessed. Results A significant positive correlation was observed between CD4 cell count and total Sperm count, progressive motility, post-preparation/insemination concentration, progressive motility and total motile count inseminated (TMCI), and a significant negative correlation was observed between CD4 cell count and normal Sperm morphology (Spearman's correlation; P
-
a decade of Sperm Washing clinical correlates of successful insemination outcome
Human Reproduction, 2010Co-Authors: James D M Nicopoullos, Paula A Almeida, Maria Vourliotis, Rebecca E Goulding, Carole GillingsmithAbstract:background: Since 1999, we have treated HIV-positive men with Sperm Washing as part of a risk-reduction programme. methods: Retrospective analysis of the Sperm-Washing database from the treatment of 245 couples with 439 cycles of intrauterine insemination assessed the effects of patient factors (age, maternal FSH, rank of attempt), markers of HIV-disease [time since diagnosis, CD4 count, viral load (VL), use of highly active antiretroviral therapy (HAART)], cycle factors (natural versus stimulated, number of follicles, fresh versus frozen Sperm) and Sperm parameters on clinical (CPR) and ongoing pregnancy rate (OPR). results: Overall 111–245 (45.4%) couples achieved a clinical pregnancy (CPR: 13.5% and OPR: 9.6% per insemination) with no seroconversions. The mean duration since HIV diagnosis was 5.8 years, 73% of men were on antiretroviral therapy, there was an undetectable VL in 64% and the median CD4 was 409 cells/mm 3 . A significantly decreased OPR and a non-significantly increased miscarriage rate (MR) was observed after the female age of 40. Similarly, there was a significant increased OPR and decreased MR for women with a mean cycle maternal FSH of ,6.4 IU/l. There was no effect of VL, CD4 count, use of HAART or time since diagnosis on the outcome. Nor was there a difference in the OPR according to paternal age, rank of attempt, cycle regime or number of follicles. Semen volume, Sperm concentration, total count and progressive motility and post-wash concentration, progressive motility and total motile count inseminated were significantly higher in successful cycles. The use of frozen Sperm had a significant negative impact on outcome. conclusions: This study of the potential safe and successful reproductive options available to HIV-positive men demonstrates that maternal age and semen quality, rather than HIV factors, remain the most important determinants of cycle success.
Maria Vourliotis - One of the best experts on this subject based on the ideXlab platform.
-
a decade of the Sperm Washing programme correlation between markers of hiv and seminal parameters
Hiv Medicine, 2011Co-Authors: James D M Nicopoullos, Paula A Almeida, Maria Vourliotis, C GillingsmithAbstract:Objectives The aim of the study was to use a decade of experience of Sperm Washing to assess the effect of HIV disease on semen parameters and to highlight the continuing importance of risk reduction when some controversially advocate the safety of timed unprotected intercourse for conception in the ‘stable’ HIV-positive man. Methods Semen parameters of 439 fresh samples used for Sperm Washing/intrauterine insemination (IUI) were correlated against markers of HIV disease [CD4 cell count, viral load (VL), duration of HIV infection and use of antiretroviral therapy] and the risk of detectable virus in semen was assessed. Results A significant positive correlation was observed between CD4 cell count and total Sperm count, progressive motility, post-preparation/insemination concentration, progressive motility and total motile count inseminated (TMCI), and a significant negative correlation was observed between CD4 cell count and normal Sperm morphology (Spearman's correlation; P<0.05). There was no significant difference in any parameter between samples in which VL was detectable and those in which it was undetectable. The use of highly active antiretroviral therapy (HAART) significantly decreased total Sperm count, progressive motility, post-preparation count and TMCI and significantly increased proportion of abnormal forms (Mann–Whitney tests; P<0.05). There was a significant negative correlation between duration of HAART use and concentration, total Sperm count and post-preparation motility and between years since diagnosis and post-preparation motility. In 9.7% of IUI cycles performed with fresh Sperm in men on HAART with undetectable VL, detectable HIV was found in either pre- or post-wash seminal samples. Conclusion Our data suggest a negative effect of low CD4 cell count and the use of HAART on semen. The significant proportion of ‘stable’; men with undetectable serum VL but virus in semen confirms the continued importance of such risk reduction.
-
a decade of the united kingdom Sperm Washing program untangling the transatlantic divide
Fertility and Sterility, 2010Co-Authors: James D M Nicopoullos, Paula A Almeida, Maria Vourliotis, Carole GillingsmithAbstract:Fertility assistance to HIV-positive men is now accepted practice in many parts of the world. We analyze the legislative, ethical, and clinical factors that explain the differences across continents with the aim of opening up the debate within the United States on whether clinics can justify denying HIV-infected men the opportunity of parenting through a now well-established risk reduction method with a proved safety record.
-
a decade of the Sperm Washing programme where are we now
Human Fertility, 2010Co-Authors: James D M Nicopoullos, Paula A Almeida, Maria Vourliotis, Rebecca E Goulding, Carole GillingsmithAbstract:Since 1999, we have treated HIV-positive men with Sperm Washing as part of a risk-reduction programme with a year-on-year increase in total infectious cycles performed to over 200 in 2008. Four hundred and thirty nine cycles of IUI, 114 cycles of IVF and 117 cycles of ICSI have been performed in HIV positive men over the decade and of the 259 couples treated, a pregnancy rate and ongoing pregnancy rate per couple of 45.4% and 36.3% have been achieved with over 100 children born with no seroconversions. We outline the continued importance of such risk-reduction measures with 9.7% of samples from men with ‘stable’ disease on anti-retroviral treatment and undetectable viral load demonstrating detectable viral particles in seminal fluid and discuss measures to improve outcome in this patient group.
-
A decade of the Sperm-Washing programme: correlation between markers of HIV and seminal parameters.
Hiv Medicine, 2010Co-Authors: James D M Nicopoullos, Paula A Almeida, Maria Vourliotis, Carole Gilling-smithAbstract:Objectives The aim of the study was to use a decade of experience of Sperm Washing to assess the effect of HIV disease on semen parameters and to highlight the continuing importance of risk reduction when some controversially advocate the safety of timed unprotected intercourse for conception in the ‘stable’ HIV-positive man. Methods Semen parameters of 439 fresh samples used for Sperm Washing/intrauterine insemination (IUI) were correlated against markers of HIV disease [CD4 cell count, viral load (VL), duration of HIV infection and use of antiretroviral therapy] and the risk of detectable virus in semen was assessed. Results A significant positive correlation was observed between CD4 cell count and total Sperm count, progressive motility, post-preparation/insemination concentration, progressive motility and total motile count inseminated (TMCI), and a significant negative correlation was observed between CD4 cell count and normal Sperm morphology (Spearman's correlation; P
-
a decade of Sperm Washing clinical correlates of successful insemination outcome
Human Reproduction, 2010Co-Authors: James D M Nicopoullos, Paula A Almeida, Maria Vourliotis, Rebecca E Goulding, Carole GillingsmithAbstract:background: Since 1999, we have treated HIV-positive men with Sperm Washing as part of a risk-reduction programme. methods: Retrospective analysis of the Sperm-Washing database from the treatment of 245 couples with 439 cycles of intrauterine insemination assessed the effects of patient factors (age, maternal FSH, rank of attempt), markers of HIV-disease [time since diagnosis, CD4 count, viral load (VL), use of highly active antiretroviral therapy (HAART)], cycle factors (natural versus stimulated, number of follicles, fresh versus frozen Sperm) and Sperm parameters on clinical (CPR) and ongoing pregnancy rate (OPR). results: Overall 111–245 (45.4%) couples achieved a clinical pregnancy (CPR: 13.5% and OPR: 9.6% per insemination) with no seroconversions. The mean duration since HIV diagnosis was 5.8 years, 73% of men were on antiretroviral therapy, there was an undetectable VL in 64% and the median CD4 was 409 cells/mm 3 . A significantly decreased OPR and a non-significantly increased miscarriage rate (MR) was observed after the female age of 40. Similarly, there was a significant increased OPR and decreased MR for women with a mean cycle maternal FSH of ,6.4 IU/l. There was no effect of VL, CD4 count, use of HAART or time since diagnosis on the outcome. Nor was there a difference in the OPR according to paternal age, rank of attempt, cycle regime or number of follicles. Semen volume, Sperm concentration, total count and progressive motility and post-wash concentration, progressive motility and total motile count inseminated were significantly higher in successful cycles. The use of frozen Sperm had a significant negative impact on outcome. conclusions: This study of the potential safe and successful reproductive options available to HIV-positive men demonstrates that maternal age and semen quality, rather than HIV factors, remain the most important determinants of cycle success.