Acceptance of HIV-infected patients in assisted reproductive technique protocols.

OBJECTIVE: To assess the adequacy of a multidisciplinary approach providing information to couples affected by HIV before ART. DESIGN: Prospective observational study. SETTING: RT centre and infectious disease clinic, public university hospital. PATIENTS: 50 couples with at least one HIV-infected partner. INTERVENTIONS: Multidisciplinary approach towards ART by various intervening physicians (specialist in fertility, infectious diseases, paediatrics, obstetrics, psychiatry). MAIN OUTCOME MEASURED: We analysed specifically the cases in which the staff did not accept and the patient's compliance to the counselling procedures. RESULTS: Among the 150 couples, 30 did not complete the procedure and were lost to follow-up. The remaining 120 couples were evaluated: 89 couples were accepted, 5 were temporarily refused and 26 were refused definitively. The major reasons for refusal were medical reasons (n=13). CONCLUSION: Because of the high refusal rate and the drop of rate, a multidisciplinary approach is mandatory before initiating ART in seropositive couples.

Filiation and secrecy in artificial insemination with donor.

Artificial insemination with donor (AID) forces the gynaecologist to face the problem of filiation with his patients. Here, the authors point out the pathogenic effect, both on the parents and the child, which may result from rigidly kept secret about 'AID filiation', and they discuss some conditions which could help to avoid this pathogenic effect, possibly allowing a non-traumatic revelation of his/her filiation to the child, in the future.

[AIDS: is it an indication for artificial insemination with anonymous donor sperm?]. / Le SIDA: indication d'insémination artificielle avec sperme de donneur anonyme?

Such demands raise difficulties, as the physician has to consider (and has to be the defender of) the coming child. A thorough psychological investigation must be conducted, as the couple's motives and those of each partner considered separately are not necessarily in agreement. Most important for the couple are the persistence of common projects and the strengthening of the bonds. The husband wants to survive through a child, to give an ultimate present and to increase the chance of keeping his partner. The wife shows her faithfulness and diminishes her partner's guilt feelings. She is, anyway, in a difficult situation if trying not to become pregnant, especially if she had already expressed a wish for maternity in normal circumstances. Unconscious mechanisms can intervene, such as fantasmatic adultery (through IAD) which reequilibrates the couple: the husband who brought the HIV has to be forgiven, or punished. Also, and most importantly, one has to analyze the prospects for the child, who is at risk of loosing his father, and also his mother: a later transmission of the virus to her cannot be excluded. The child will be confronted by illness and death of his father, and by heavy family secrets. The attitude of the medical team remains problematic: no clearcut attitude prevails.