For the first time in Israel, couples who carry the AIDS virus will be able to attempt pregnancy without the mother being infected by the sperm or the baby getting HIV during delivery. Such specialized services, believed to be sought by dozens of couples around the country, became available on Tuesday at Rambam Medical Center’s in-vitro fertilization (IVF) unit. Now that HIV and AIDS are considered more of a chronic illness whose effects can usually be kept at bay with a drug “cocktail” of protease inhibitors, rather than one that automatically means death, carriers can think about the future.
Until now, the nearly two dozen IVF units around the country rejected such couples, some of whom went abroad for IVF using sperm that had been “rinsed” by chemicals to remove the virus. The virus can be passed on by the sperm of an infected male to the mother or baby or transferred to the fetus during pregnancy, delivery or breastfeeding by an infected female.
Until now, if the male was a carrier, it was impossible for IVF to be performed, because the sperm could infect the woman if they had unprotected sex, while any fetus could infect the mother during pregnancy.
A couple in which one is infected and the other not is called a “discordant” one. If both members of a couple are carriers, there is no problem in having normal conception, or artificial insemination, but the mother would have to be treated with the drug “cocktail” of protease inhibitors during pregnancy and the baby after delivery.
As a result of a plea to the High Court of Justice by the Israel AIDS Task Force, the Health Ministry was forced to find an alternative for them. Hadassah University Medical Center in Jerusalem’s Ein Kerem was designated by the ministry for rinsing the infected sperm, and this service opened in January. Now Rambam has opened its IVF unit to HIV carriers to complete the process.
Rambam director-general Prof. Rafael Beyar said at the opening that the unique service in Israel was launched by bringing together a variety of forces. “This is the beginning of a long road whose high point will be the birth of the first healthy baby to HIV carriers, thanks to our unit,” he said.
Each healthy egg is injected under a microscope with one healthy sperm in a process called intra-cytoplasmic sperm injection.
The ministry gave its permission to open the service only four months ago. Implementation required the establishment of a special lab and subclinics that serve it. Rambam’s immunology institute receives the applicants, while the liver disease institute, the virological lab and the IVF unit cooperate. The unit was built by Rambam’s construction branch at a very high standard.
Prof. Shimon Reisner, the hospital’s deputy director, added that Rambam was one of the pioneers in IVF and has much experience in immune system and liver disease.
Dr. Chezy Levy, chief of the ministry’s medical administration, was present at the ceremony, along with Prof. Joseph Itskovitz, who heads the gynecology department and is a world leader in IVF. Also present were Prof. Shimon Pollack, head of the immunology institute, and Yonatan Karni, head of the Israel AIDS Task Force.
Karni said that his organization fought a “social struggle that today is expressed in medicine. The establishment of this service is a point of light.”
Pollack told The Jerusalem Post that, in the future, producing pregnancies for HIV carriers will become routine. The process of sperm rinsing was developed about two decades ago in the US. Hadassah staffers went abroad to study it. Nothing new had to be learned by Rambam actually to perform IVF or treat the mother and baby to prevent them from being infected with HIV, but new facilities had to be built and procedures set down.
Transmission of the virus by an infected, unrinsed sperm can happen after conception and from an infected mother to the fetus during pregnancy, but the most likely time is during delivery. Women with HIV are told not to breastfeed their babies. If there is a danger of the fetus getting infected, it is in the second half of gestation. A baby born from unrinsed sperm or to a carrier mother is given four weeks of the drug cocktail after birth to prevent the infection from breaking out in its body.
The Rambam service was set up in a building constructed by the hospital technical staff and located in a discreet location in the hospital to ensure privacy of those who use it. Some NIS 2 million were invested in it, and a high level of quality control was established to ensure the safety of the patients and the staff.
Due to the queue of couples waiting for years for the service, said Pollack, there could be dozens who will soon register for treatment. When these people are taken care of, he expects around 15 Israeli couples a year and possibly more from abroad.
While IVF with rinsed sperm is allowed in some European countries, it is barred by the US Food and Drug Administration, as there was one case in which a woman got infected without the man receiving anti-retroviral therapy to reduce his “viral load.”
As a result of that tragic case, the US Centers for Disease Control did not approve the practice there. Pollack said he regarded the procedure as very safe, as there have been 5,000 or 6,000 cases in Europe in which nothing untoward occurred.
The rinsing of sperm at Hadassah will be provided as part of the basket
of health services, just as IVF to produce two healthy babies per woman
(up to a maximum age) is free. The IVF is also included in the basket
paid for by the couple’s health fund. The technology is available in a
few dozen medical centers abroad, but at none in this region; thus
Hadassah AIDS Center director Prof. Shlomo Ma’ayan expects medical
tourists from Turkey, Greece, Cyprus and other countries.
The chemical rinse used today has been utilized for other types of
procedures and found to keep the HIV virus from multiplying. However,
it does make it slightly more difficult to produce a pregnancy. The
success rate for the first attempt is about 30%, according to Ma’ayan.
The rinsed semen is examined for HIV just to be sure and then frozen at
-180 degrees Celsius before being used. Insemination is performed at
Hadassah, while IVF is done in Haifa.