Ask the Doctor

Can you tell me about conception for serodiscordant couples?

This preconception period is the time to sit down with your OBGYN and his HIV specialist to discuss your plans. You will likely be referred to a reproductive specialist to discuss your options. For HIV serodiscordant couples (in which one partner is infected with HIV while the other is not), the ultimate conception goal is to conceive while minimizing the risk of HIV transmission, but other important factors such as cost and treatment efficacy also exist. The use of donor sperm is the safest option. In this method, sperm from an HIV-negative man is used either through intrauterine or in vitro fertilization.

If this is not acceptable to you and your partner, and you intend to use his sperm, then it is vital that the risk of transmission be reduced as much as possible. If your partner is not already on antiretroviral therapy (ART), it should be initiated, and his viral load (the amount of virus in the blood) should be monitored closely until it is consistently undetectable before you attempt to conceive. A technique of sperm preparation called “sperm washing” that separates the sperm from the semen can further reduce the risk of transmission. These sperm can then be used for intrauterine or in vitro fertilization. There are added benefits to this sperm analysis. Abnormalities in sperm count, structure and motility have been noted in HIV positive men, which could present an issue regarding his fertility.
If you intend to conceive through intercourse with your partner, consultation with a reproductive specialist can still help. Condomless intercourse should be timed to coincide with ovulation. These specialists will be able to help determine when ovulation is taking place to maximize the likelihood of conception in the lowest number of attempts. They can also identify any potential fertility issues that may exist and cause delay, and provide fertility treatments to assist in overcoming them.
An undetectable viral load is of critical importance. In addition, PrEP (pre-exposure prophylaxis) further reduces the risk of transmission. PrEP is the use of Truvada (a common HIV medication) to prevent infection in HIV negative people. The medication is taken daily and can reduce the risk of transmission by up to 90% when taken consistently. If taken for conception, the CDC advised that daily dosing of Truvada should begin 1 month before attempting conception and should continue for one month after. In PrEP trials for women, the medication was stopped as soon as pregnancy was established, and no problems were associated with its use for mother or baby.

Katherine Liang, FNP
AbsoluteCARE Medical Center & Pharmacy

Why do I wheeze more in the Spring and Fall?

Most of us look forward to Spring after hibernating indoors all Winter. We enjoy getting out and walking, enjoying the blooming flowers and budding trees. But if you have asthma or allergies (or both), spring pollen season can take a toll on your lungs — the same goes for ragweed in the Fall. Seasonal pollens in the Spring and Fall can trigger asthma symptoms by increasing airway inflammation causing someone to wheeze more during these peak seasons.
If seasonal pollen is a trigger for your asthma, it is best to stay indoors when pollen levels are high, particularly during the morning hours. Keep windows closed to prevent pollen from getting into your home or car. When you have been outside, take a shower and wash your clothes to remove residual pollen once you are back indoors. Most importantly, always remember to carry your rescue inhaler with you should it become difficult for you to breath or you start to wheeze while enjoying the outdoors.

Allene Harrison, NP-C
AbsoluteCARE Medical Center & Pharmacy