Try this at home

For couples where the woman has HIV and the man does not, self-insemination is a safe way to get pregnant. Selina Corkery and Roger Pebody explain.

For many women with HIV in the UK, effective treatment means that the desire to have a child without passing on HIV can become a reality. For women on combination therapy and with a viral load of less than 50 copies/ml the rate of transmission from mother to baby is 1 in 1000.¹

Of course, how to get pregnant is an issue. For HIV-positive women, unprotected sex is not always the best way. As for any other woman, a sexually transmitted infection (STI) could be passed on, which could pose a risk for your own health and, if left untreated, could have serious consequences for your baby. If both you and your partner have HIV, there may be a risk of superinfection.

If your partner is HIV-negative, you might pass HIV on to him. For couples where the woman is positive and the man negative, a good option is self-insemination.

“Lots of people don’t realise what a simple option this is,” says Julie Fowler, clinical nurse specialist at St Mary’s Hospital’s Jefferiss Wing. “There’s no reason why it should be any less successful than the standard way of conceiving. The worst thing people report is a bit of awkwardness – it’s best approached with a sense of humour.”

Self-insemination works best in younger women – those in their 20s and 30s. That’s because fertility declines with age in all women.

Julie emphasises the benefits of talking to staff at your HIV clinic if you’re thinking of trying to become pregnant. There’s some useful preparation women can do before conceiving, such as taking folic acid, a vitamin needed to make new cells in the body. You should check that any anti-HIV drugs you are taking are safe in pregnancy. It’s also recommended that both partners have a sexual health check in case of STIs.

Staff can also provide advice about insemination and the equipment you need (see the step-by-step guide below), including determining your fertile period – an important part of maximising your chances of conceiving.

Self-insemination works best in younger women – those in their 20s and 30s. That’s because fertility declines with age in all women. And HIV-positive women may have more difficulty conceiving than their HIV-negative peers. According to Julie Fowler, “It can take a while for any woman to become pregnant. But we might start investigating a bit sooner if someone hasn’t conceived, say, in six months. And perhaps a bit earlier with older women.”

Self-insemination might not be the best option for couples where both are HIV-positive. It’s definitely not suitable when the man is HIV-positive and the woman not. But there are other options such as sperm-washing. Julie Fowler encourages anyone thinking about starting a family to talk to their clinic staff. “There are still things you can do,” she says. “The important thing is to talk to your doctor.”

A step-by-step guide to self-insemination

This technique is suitable if you are a woman with HIV, and your male partner is HIV-negative. You need to make sure that neither you nor your partner has any sexually transmitted infections before using it.

1. Make sure this is one of your fertile days. It’s best to try the technique several times during your fertile period.
2. Ask your partner to masturbate and ejaculate into a container. The container doesn’t need to be sterile, but it should be clean and dry.
3. Next you’ll need a plastic syringe. Your HIV clinic can provide them, or you can buy the kind used to give medicine to babies at a chemist.
4. Wait up to 30 minutes for the semen to become more liquid.
5. Draw back on the syringe once with nothing but air, then push the air out again. Now point the syringe into the liquid and slowly draw it back to suck in the semen. 
6. Get into a comfortable position lying on the bed with your bottom raised on a cushion.
7. Either you or your partner can now slowly insert the syringe as far into the vagina as possible.
8. The area to aim for is high up in the vagina, towards the cervix.
9. Slowly squirt out the contents of the syringe. Gently remove the syringe.
10. Try to remain lying down for the next 30 minutes while the sperm makes its way through the cervix. Some semen may leak out but this is normal, and doesn’t mean it won’t have worked.

An alternative method is for you and your partner to have sex together, using a male condom. After sex, withdraw the penis from the vagina with the condom still on. Then take it off, and use a syringe to transfer the semen to your vagina. If you use this technique, make sure that the condom doesn’t contain a spermicide.

Knowing when you are fertile

If you’re going to use self-insemination techniques, you’ll want to try them on the days when you have the best chances of success. Pregnancy can only occur during a few days each month, and is most likely to happen at the time of ovulation (when an egg is released from one of the ovaries).

“There’s a range of ways of telling when you’re ovulating,” Julie Fowler explains. “Counting the days [see the method explained below], cervical secretions, ovulation pain or body temperature can all be signs. But not all women will have a physical sign. Ovulation kits are available from chemists and are a reliable way of knowing when you’re ovulating, but they can be expensive.”

Julie emphasises there’s no hard-and-fast rule about how often you should try insemination during each cycle. “What’s possible will be determined by people’s lifestyles and schedules. Every two days should be fine. We’d say, no more than once a day, but the most important thing is not to get too hung up on it.”

Counting the days

Noting down the dates of the beginning of each period will show you how long your menstrual cycle is. The average is 28 days, but many women have a shorter or longer cycle.

To get a rough idea of your fertile time

1. Work out the date you are expecting your next period to begin
2. Count back 16 days before this date
3. Your fertile time begins around now and lasts five or six days.

Secretions

Changes in your vaginal secretions are another sign. At the beginning and end of your cycle, cervical mucus is creamy, sticky and thick. As your body prepares for ovulation, it becomes wetter, thinner, clearer and stretchy like raw egg white.

References

1. Townsend C et al. Low rates of mother-to-child transmission of HIV following effective pregnancy interventions in the United Kingdom and Ireland, 2000-2006. AIDS 22: 973-981, 2008.