Efficacy and safety of intrauterine insemination and assisted reproductive technology in populations serodiscordant for human immunodeficiency virus: a systematic review and meta-analysis.

OBJECTIVE To assess procreative outcomes for HIV-positive men and women with seronegative partners. DESIGN Systematic review and meta-analysis. SETTING Not applicable. PATIENT(S) Twenty-four studies with extractable data for HIV-serodiscordant couples undergoing intrauterine insemination (IUI) or in vitro fertilization (IVF). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) PRIMARY OUTCOMES HIV transmission to a seronegative partner and per cycle fecundability; secondary outcomes: analysis of multiple gestation rates, miscarriage rates, and cancellation rates. RESULT(S) For serodiscordant couples, HIV-positive men or women undergoing IUI and IVF treatment had a 17%, 30%, 14%, and 16% per cycle fecundability, respectively. Multiple gestation rates were 10%, 33%, 14%, and 29%, respectively. Miscarriage rates were 19%, 25%, 13%, and 20%, respectively. No HIV transmission was observed in 8,212 IUI and 1,254 IVF cycles, resulting in 95% confidence that the true rate is 4.5 transmissions per 10,000 IUI cycles or less. CONCLUSION(S) In serodiscordant couples, IUI and IVF seem effective and safe based on the literature. Evidence-based practice and social justice suggest that our field should increase access to care for HIV-serodiscordant couples.