Thanks to advances in medicine, people living with HIV can now lead long, healthy lives. With better treatments, many HIV-positive men are interested in starting families. But even with effective therapy, HIV can still affect male fertility, especially sperm health.
Dr. Bhumesh Tyagi, Consultant in General Medicine at Shardacare Health City in Noida, spoke exclusively with Onlymyhealth. He explained that while much focus is on preventing HIV transmission to partners and children, it is also important to understand how HIV itself affects sperm and male fertility.
HIV is not passed through individual sperm cells. Instead, the virus is mostly found in the fluid around sperm (seminal plasma) and in immune cells present in semen. However, the virus can still harm sperm quality in several ways:
Changes in Semen Quality
Studies show that HIV-positive men often have poorer semen quality than HIV-negative men, even if they are on stable antiretroviral therapy (ART). Common issues include:
Lower sperm motility: Sperm move slower and less effectively.
Reduced sperm count: There are fewer sperm per milliliter of semen.
Abnormal sperm shape: More sperm have unusual forms that may lower fertility.
Less semen volume: The total amount of ejaculate is smaller.
Thicker semen: Increased viscosity makes it harder for sperm to swim.
DNA Damage in Sperm
HIV can increase the damage to sperm DNA, known as DNA fragmentation. This damage reduces sperm quality and may affect fertility. Scientists believe this happens because HIV causes inflammation and oxidative stress in the reproductive system. Some ART drugs might also harm sperm mitochondria, which affects DNA integrity.
Hormonal and Immune Effects
HIV infection can disrupt hormones like testosterone, leading to lower sperm production and reduced sex drive. The weakened immune system may also allow other infections in the genital area, which can further harm sperm and reproductive organs.
The Role of Antiretroviral Therapy (ART)
ART has changed HIV treatment dramatically. It helps reduce viral load and inflammation, which can improve semen quality. But some studies suggest certain ART drugs may still cause sperm DNA damage. Despite this, the health benefits and prevention of HIV transmission from ART far outweigh its minor effects on sperm.
Safe Family Planning for HIV-Positive Men
HIV-positive men who want to have children have several safe options:
Maintain an undetectable viral load: When ART suppresses the virus to undetectable levels (U=U: Undetectable = Untransmittable), HIV cannot be passed to partners through sex. This greatly lowers transmission risks during conception.
Sperm washing: This lab process separates healthy sperm from infected fluid and cells. The cleaned sperm, free from HIV, can be used for assisted reproductive techniques like intrauterine insemination (IUI) or in vitro fertilization (IVF).
Assisted reproductive technologies: IUI and IVF provide safe paths for couples where one or both partners have HIV.
Sperm banking: Men worried about future fertility can store sperm before treatments that may affect sperm production.
Importance of Expert Care and Communication
HIV-positive men should discuss fertility plans openly with their HIV doctors and fertility specialists. Proper testing, including semen analysis, and review of ART can help choose the safest and most effective way to become a parent.
Conclusion
HIV affects male fertility and sperm health in several ways, but modern HIV care has improved prospects greatly. With successful ART and reproductive technologies, HIV-positive men can safely pursue fatherhood while protecting their health and that of their families.
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