Well, not actually sperm, but Senate Bill 443, state Senator Carole Migden's (D-San Francisco) sperm-washing bill, has passed both houses of the California Legislature with almost no opposition and is on Governor Arnold Schwarzenegger's desk awaiting his signature.
SB443 would reverse the current restriction on the use of semen from HIV-infected men for the purposes of assisted reproduction (more commonly known as artificial insemination). The original law was put into effect in the late 1980s when it was crucial to ensure the safety of the blood supply as well as sperm and organ donations.
Technology exists now, however, to wash semen of HIV such that couples in which the man is HIV-positive and the woman is HIV-negative (also known as discordant couples) can safely get pregnant using assisted reproduction. HIV is not located inside sperm but is found within seminal fluid and white blood cells. It is unlikely that HIV is able to infect spermatozoa, because spermatozoa lack the receptors that HIV typically latches onto. Sperm washing can separate the sperm from the other components in semen that may contain HIV. The washed sperm is then used for either intrauterine insemination or in-vitro fertilization.
Since the early 1990s, there have been numerous published studies reporting over 4,500 assisted reproduction procedures using washed sperm from HIV-positive men. There have been no reports of HIV transmission when using these standardized procedures. California and Delaware are the only two states in the U.S. that have specific prohibitions against the use of semen from men with HIV for designated recipients.
One of the unintended and paradoxical consequences of the law is that discordant couples in California are unable to take advantage of technology that can decrease their risk of HIV transmission as they try to get pregnant. As a result, discordant couples need to either go out of state to access this technology or, more commonly, they risk HIV transmission as they try to conceive naturally.
Between January and March of this year, I, along with colleague Dr. Nena Bonn here at UCSF, conducted a survey of the 67 California fertility clinics to evaluate current practices related to HIV-affected couples. Thirty (45 percent) of the clinics have responded thus far. Half of the clinics have had HIV affected couples requesting care within the past year. In the past year, an estimated 130 couples affected by HIV have requested care at fertility clinics in California. Among the clinics that have responded, 83 percent are willing to provide services to HIV affected couples if the state law were to change.
In 2001, the American College of Obstetricians and Gynecologists stated that assisted reproductive technology should not be denied to patients based solely on their HIV status. In addition, in 2002, the ethics subcommittee of the American Society for Reproductive Medicine stated very explicitly that it is, in fact, unethical to withhold assisted reproduction and infertility care to couples based solely on HIV status.
Truly, the most frustrating part of my job is explaining to discordant couples that they cannot access sperm washing in California. We have the science to ensure safe conception, standards of care supporting the use of this technology, the ethical obligation to ensure the safety of our citizens, and medical providers in California willing to provide this service. Reversing this ban has been long overdue.
I am very grateful to the couples who stepped forward (strong stigma exists, even here, even now) to testify in support of this bill and especially to Senator Migden for her willingness to take up this issue and fight for a fundamental human right for people with HIV/AIDS the right to safely conceive a child.
Dr. Deborah Cohan is an associate professor in the Department of Obstetrics and Gynecology at UCSF, medical director of the Bay Area Perinatal AIDS Center, and assistant director of the National Perinatal HIV Hotline.