How available is sperm washing?

The disadvantages of sperm washing are that:

• The treatment is expensive and patient-funded in over 50% of cases.
• It is currently only provided by a limited number of fertility centres in the UK, Europe and Northern America. In the UK, sperm washing is currently available at the Chelsea and Westminster Hospital in London.

National Institute of Clinical Excellence guidelines published in February 2004 on fertility have recommended sperm washing in serodiscordant couples as a risk-reduction process.¹ This has led to a significant increase in the number of primary care trusts willing to fund up to three cycles of sperm-washing treatment on the basis of risk reduction.² The costs involved depend largely on whether other fertility treatment is needed, with insemination the cheapest and ICSI the most expensive.

A letter of recommendation from the GUM physician to the relevant health authority is usually required.

To be eligible, couples need to be in a heterosexual relationship that has lasted over a year, and HIV serodiscordant or both HIV-positive. They are expected to be on treatment and for their HIV to be stable. They will need a referral letter from a GP or HIV clinician, and current details of CD4 count and viral load.

They will receive counselling individually and together, be screened for sexually transmitted infections and undergo fertility tests. They will also be assessed to check that the welfare of any child conceived is not at risk. (Previous injecting drug use will not necessarily exclude couples if it is felt the behaviour is no longer an issue.) The couple will be asked to sign consent forms stating that they understand the procedure. This initial process can take two to three months.