Surrogacy for HIV Positive Couples and Single Gay Men

HIV Positive Gay Men

Can HIV positive gay couples and men become biological dads? Thanks to a procedure known as sperm washing, the answer is yes! Read through our comprehensive guide to becoming a dad though surrogacy and IVF as an HIV positive gay man below. 

Surrogacy for HIV Positive Couples and Single Gay Men

Through a procedure called "sperm washing" gay, bi and trans men living with HIV can safely become biological dads through surrogacy and IVF — without transmitting the HIV virus on to their surrogate or baby. Read our guides below for more information. 

Sperm Washing for HIV Positive Gay Men

For many years, an HIV diagnosis also ruled out the ability of those living with the virus to become parents — for fear of passing the HIV virus on to one's partner or the resulting baby. But thanks to advancements in reproductive technologies, and in the treatment of HIV, this is no longer the case.

Thanks to advancements in antiretroviral treatments, many people living with HIV now have what's called an "undetectable" viral load — meaning that the virus has been reduced to such a small amount in the body that it can no longer be detected by standard blood tests. Research has shown that people living with HIV who have undetectable viral loads are unable to pass the virus on to their partners or a child conceived through sex.

However, for extra precautions, gay men interested in having their own biological babies will need to conduct something known as "sperm washing" as part of their surrogacy and IVF journey — which has also been shown to reduce the risk of transmission to negligible levels.  

Sperm Washing FAQs for HIV Positive Gay Men

How does sperm washing work?

First, semen is collected from the HIV positive partner. Through a separation process known as centrifugation, the sperm is removed from the seminal fluid. Since the HIV virus is carried in the seminal fluid, and not the sperm, this allows for a vastly decreased risk of HIV transmission to either the gestational carrier in a surrogacy arrangement, or the resulting child.

When was sperm washing created? 

Sperm washing has been around for many years; in fact, the first time a child was born via sperm washing in the United States was in 1999. Read more about this breakthrough in this American Public Media article, Conceiving Ryan.

Are there different types of sperm washing? 

Yes, there are several different types of sperm washing. The most basic wash involves repeated centrifugation to eliminate the seminal fluid from the sample. Some men may choose to undergo more advanced forms of sperm washing that allows for the isolation of sperm with high motility rates. But the most basic procedure is all that is required for HIV positive men to prevent transmission of the virus.

How expensive is sperm washing?  

There are downsides to sperm washing; it's expensive, not often covered by insurance, and unavailable in many fertility clinics — meaning you may need to partner with an additional clinic to get the procedure done. If you are considering surrogacy as your path to parenthood, this can add a substantial amount to the overall cost of surrogacy. According to Ryan Kiessling, MPM, of the Special Program of Assisted Reproduction at the Bedford Research Foundation Clinical Laboratory, HIV-positive men interested in surrogacy should budget from $8,000 to $10,000 for this procedure. 

How effective is sperm washing? 

In practice, sperm washing has been found to practically eliminate the risk of HIV transmission to either the gestational surrogate or the child. Though there will be no way to fully eliminate the transmission risk, research in this area is very encouraging. In fact, one study of 914 sero-discordant couples – couples in which one partner is HIV positive and one partner HIV negative – found no instances of HIV infection among the women, or the resulting children conceived following the sperm washing procedure.

The Special Program of Assisted Reproduction (SPAR)

Most fertility clinics don't conduct sperm washing in-house, but instead work with specialized labs to conduct the procedure. One of the longest-established and most reputable programs is called the Special Program of Assisted Reproduction (SPAR) — a project of the Bedford Research Foundation Clinical Laboratory.

Through SPAR, the Bedford Clinic has helped hundreds of HIV+ men, both gay and straight, build their families through surrogacy and IVF. Many of our Partners to Fatherhood have worked with SPAR for years, helping HIV+ men achieve their dreams of becoming a biological dad.

The medical process involves the semen from the Intended Parent being collected and screened. Any samples containing the HIV virus or any other significant pathogens are discarded. It’s important to note, on average only 15% of semen samples from an infected male on anti-retroviral therapy actually carry the HIV virus. The healthy sperm is “washed” for added protection; washed sperm is free of semen. The specimen is then frozen for transportation and preservation at a participating clinic where the IVF process takes place.

The Four Steps in the SPAR Process for HIV-Positive Gay Men

1) Consultations with intended parent(s) and surrogate

Both intended parents and surrogates will have conversations with the surrogacy agency about what the SPAR program is, how the program works, and if there are risks to the surrogate in the SPAR program.

2) Collection of specimens, following FDA protocol

The HIV infected parent will visit the Bedford Clinic and leave a semen sample.

3) Semen testing

Semen will then be tested for presence of the virus using the PCR HIV DNA assay. Depending on the outcome, it is then “washed” using a centrifuge to separate the sperm from the seminal fluid. Washed sperm are suspended in a new solution and cryopreserved.

4) Specimen is ready

The specimen is then shipped to a participating IVF clinic (the intended parents' clinic) for fertilization and embryo transfer.

Common Questions About SPAR 

Your surrogacy team will be on hand to answer any questions you have about SPAR or becoming a biological dad as an HIV-positive gay men — but here are the answers to some common questions about the program. 

Are there requirements to participate?

All intended parents accepted into the SPAR program must be treating their HIV with medication — which often reduces the viral load to undetectable levels. 

Do I need to travel to participate?

Since SPAR's Bedford Labs is located in Massachusetts, you will need to travel there to provide your sperm sample for analysis and treatment. But you will not conduct other aspects of your fertility journey at the lab — your sample will then be shipped back to your fertility clinic, which will handle your IVF transfer. 

How much does SPAR cost?

It is recommended intended parents budget between $8,000 to $10,000 for this procedure.

Does insurance cover any costs of SPAR?

Coverage varies widely by patient, policy, and location — but the SPAR program says that some insurance companies don't treat an infectious disease like HIV as a diagnosis of infertility. Still, some patients manage to get the costs associated with some of the labs, like blood and semen analysis, covered by insurance.  Other patients have had some routine lab costs, such as semen analyses and blood hormone tests, covered by insurance. The test for the virus is not FDA approved and is not eligible for insurance coverage. Bedford Research Foundation does no insurance billing.

Transmission Risks to Surrogates and Babies

Doctors and researchers don't like to speak in absolutes — so they will never say there is absolutely zero risk of transmission to surrogates and babies when working with an HIV-positive intended parent. But the research clearly shows that, as long as certain protections are put in place prior to your surrogacy journey, the risk of transmitted HIV to your surrogate or baby is completely negligible.

FAQs About HIV Transmission to Surrogates and Babies 

What is the risk to your surrogate or baby of contracting HIV?

While professionals will never tell you there is no risk, the research is pretty clear on the subject — there have been no documented cases of transmission when sperm washing has been conducted as a part of an IVF procedure. In fact, in 2016, Fertility and Sterility published a meta-analysis of 40 studies on the subject — and found zero transmissions of HIV following 11,585 sperm washing procedures with 4,000 women.

Additionally, HIV-positive intended fathers will need to have an undetectable viral load, which according to the CDC, likewise prevents transmission of the virus. In 2016, two studies — one in The New England Journal of Medicine and another in The Journal of the American Medical Association (JAMA) Trusted Source — found zero incidences of transmission when an HIV-positive partner was on antiretroviral therapy for at least six months.


What extra precautions are taken to ensure your surrogate and baby's safety? 

Intended dads who are HIV-positive will be thoroughly screened prior to matching with a gestational carrier. You will first need to be cleared by your HIV physician to ensure you are undetectable. You will be cleared if you have been following your HIV regime as prescribed by your doctor, have had an undetectable viral loan for at least six months prior to beginning your surrogacy journey, and have no additional sexually transmitted infections. FDA regulations further require that you  provide three semen samples, all of which will be double washed, prior to proceeding. 

Is there anything the surrogate can do to further reduce transmission risks? 

Having an undetectable viral load, and undergoing sperm washing, will both by themselves offer incredibly high degrees of protection. But as an extra layer of precaution, your surrogate will also likely be encouraged to take medication to reduce transmission risks even further via pre-exposure prophylaxis (better known as PrEP.) A number of studies have shown PrEP to be an incredibly effective way to reduce transmission risks, even if exposed to active levels of the HIV virus,.

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