Planning your pregnancy

Pregnancy planning advice:

Pre-conception, planned pregnancy, and your rights to have a baby
What to do when one partner is HIV-positive and the other is HIV-negative

Related pages on conception options:

Pre-conception, planned pregnancy, and your rights to have a baby

House with chirping bird on the roof

Many HIV-positive women become pregnant when they already know their HIV status. Many women are also already taking anti-HIV drugs when they become pregnant.

If you already know that you are HIV-positive, you may have discussed the possibility of becoming pregnant as part of your routine HIV care—whether this pregnancy was planned or not.

If you are planning to get pregnant, your healthcare provider will advise you to:

Consider your general health
Have appropriate check ups
Treat any sexually transmitted infections

You should also make sure you are receiving appropriate care and treatment for your HIV.

It is reassuring to know that over 1000 HIV-positive pregnant women had uninfected babies in the UK in 2006.

Choose a healthcare team and maternity hospital that supports and respects your decision to have a baby.
If you are not supported in this decision, then you should arrange to see a doctor and healthcare team with more experience in dealing with HIV.
You may not be able to travel to a centre with this expertise. In this case, you should contact them for advice, support and to find out your rights.

What to do when one partner is HIV-positive and the other is HIV-negative

There is still controversy over the best advice to give to couples where one partner is HIV-positive and the other HIV-negative (the medical term is sero-discordant).

It is usually unwise for couples where one partner is HIV-positive and the other HIV-negative to have unsafe sex. Even when politely called a conception attempt, there is always a risk to the HIV-negative partner of contracting HIV.
For an HIV-negative woman, the chance of becoming HIV-positive from having unprotected sex will depend on many things, including the viral load in the semen of her male partner. It is important to remember that an undetectable viral load result from a blood test does not mean that viral load is undetectable in seminal fluid.
For an HIV-negative man, transmission risk depends on the level of viral load in the genital fluids of his female partner. Again, an undetectable viral load in blood does not always mean the same as in genital fluid.
Other factors are also important. An uncircumcised man is likely to be more at risk of contracting HIV because cells in the foreskin are more vulnerable to infection. And having sex with an uncircumcised HIV-positive man is of greater risk to an HIV-negative woman than sex with a circumcised man.
Infections of the genital tract also increase the risk of sexual transmission of HIV. Regardless of the method of conception, both members of a sero-different couple should check for such infections. This should include screening and treatment for other sexually transmitted infections. The man should have a semen analysis. This can rule out any infection and also to ensure that his sperm count is fit and healthy.

All these risk factors aside, HIV is actually quite a difficult virus to transmit. Statistically it is much harder to transmit HIV than to get pregnant. Therefore, limited conception attempts made during ovulation (a woman’s fertile period) may carry a low risk if the positive partner has undetectable levels of viral load (we talk about this and how to make it safest below). But there is still a risk involved for both male and female negative partners from any single unprotected exposure. After all, people can conceive from one attempt and also become HIV-positive from one exposure.

In one study of HIV-negative women and HIV-positive men, 4% of women became HIV-positive. But this study took place before the routine use of HAART.

A more recent study in Spain of 40 sero-different couples conceiving when the man was on HAART and had a viral load of less than 50copies/mL for at least 6 months, had no transmissions.

One additional point should be stressed. Although a low number of conception attempts can be relatively safe, some couples do not return to safer sex afterwards. This often results in the negative partner becoming HIV-positive.

HIV is still a disease that can affect the rest of your life. If one of you has stayed HIV-negative until now, you don't want to change this over a decision to have a baby.