Couples in which the man is HIV-1 positive and the women is HIV-1 negative have limited options if they wish to reproduce safely. Timed unprotected intercourse carries a 0.1–4% risk of transmitting the virus through semen to the female partner. Sperm washing is a risk-reduction treatment option in which semen is centrifuged to separate live sperm, which does not carry HIV, from seminal plasma and non-germinal cells which may carry the virus, irrespective of the man's viral load, CD4 count or antiretroviral therapy. Absence of detectable HIV should be verified using a polymerase chain reaction nucleic-acid-based sequence amplification assay before the washed sperm is used in treatment. In couples with no fertility issues, the processed semen is inseminated into the female partner at the time of ovulation during a natural cycle. If a couple have additional fertility issues, sperm washing can be combined with ovulation induction, in-vitro fertilization or intracytoplasmic sperm injection. Pregnancy rate per insemination is 12% based on published reports of over 2000 inseminations. To date, there have been no seroconversions in either mother or child following use of correctly processed sperm.
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