Features of reproductive function realization in women with infertility and HIV infection in assisted reproductive technology programs
Objective. To evaluate the clinical and laboratory characteristics and efficiency of assisted reproductive technology (ART) programs in patients with HIV infection. Subjects and methods. A prospective case-control study was conducted in 94patients who had consulted a doctor about ART programs. A study group included 38 women with HIV infection; a control group consisted of 56 HIV-seronegative patients. The study group underwent 74 in vitro fertilization (IVF) cycles, including 44 therapy cycles and 30 cryo ones. The control group had 59 and 30 cycles, respectively. The patients’ HIV infection status was assessed on the basis of the stage and phase of the disease, the level of viral load, CD3+,CD4+, and CD8+ lymphocytes, immunoreactive index, and the duration of antiretroviral treatment (ARVT). Results. The duration of HIV infection was 10 years (median (interquartile range) 6-13 years); its subclinical stage 3 was dominant (68.4 %). All the patients received combined ARVT. The median duration of drug use was 4 years (2-6.2 years). No blood viral load was detectable in 100% of cases. The patients in both groups were matched for age (median 34 and 32 years; p = 0.160) and infertility duration (5 and 5years; p = 0.430). Tuboperitoneal (39.5 and 30.4%, p = 0.467) and combined (23.6and 21.4%;p = 0.540) infertility factors were equally common in both groups. Anti-Müllerian hormone concentrations in HIV-infected women were significantly lower than those in HIV-seronegative patients (1.86 and 3.2 ng/ml; p = 0.024). Analysis of the stimulated cycle parameters revealed no significant difference in the starting and total doses of gonadotropins and in the duration of stimulation in both groups. Nevertheless, smaller numbers of oocytes (8.86±1.1 and 12.9±0.8; p = 0.001), mature oocytes (7.45±0.9 and 10.1±0.6;p = 0.003), zygotes (5.88±0.7and 8.4±0.001;p = 0.001), cleavage-stage embryos (5.55±0.6and 8.1±0.4;p = 0.001), as well as blastocysts (2.68±0.5and 4.4±0.4;p = 0.009) were obtained from HIV-infected patients than from control subjects. Selective single embryo transfer was performed on day 3 or 5 of cultivation in both groups. HIV-infected patients were found to have lower incidence rates of biochemical and clinical pregnancy than HIV-seronegative women in both the therapy cycles of ART(17.2and 44.2%, p = 0.015; 13.8% and 40.4%, p = 0,014) and cryo cycles (30 and 55.2%, p = 0.049; 20 and 53.6%; p = 0.008). Conclusion. HIV-infected women receiving an IVF program were noted to have a higher frequency of cycle cancellation, fewer obtained oocytes, and the lowest pregnancy rate. Further investigations are needed to understand the specific effects of HIV and/or ARVT on an ovarian response, oocyte quality, and outcomes of ART programs.