IVF and HIV: A viable option for parenthood

Historically, HIV and fertility treatments like IVF were seen as incompatible due to life expectancy concerns. However, modern medical advancements have made assisted reproduction a realistic and safe option for seropositive individuals wishing to have children.

Today, HIV-positive adults live active and productive lives despite their disease, largely due to highly effective treatments. Many of them are of reproductive age and wish to have children. Thus, what once sounded prohibitive—specifically, childbearing for people living with AIDS—today constitutes a "human right" according to the American Fertility Society (AFS).

Techniques for Safe Reproduction

Assisted reproduction techniques (ART) appear to minimize the risks of infection transmission in couples where one of the two partners is HIV-positive. Both intrauterine insemination (preceded by sperm washing/cleansing) and intracytoplasmic sperm injection (ICSI) have been tested in couples where the male was HIV-positive, and the risk of transmitting the virus to the female partner proved to be zero.

• For HIV-Positive Men: The preferred method is typically Intracytoplasmic Sperm Injection (ICSI). This process uses processed semen to ensure safety and effectiveness, preventing infection of both the mother and the baby.
• For HIV-Positive Women: Intrauterine Insemination (IUI) is generally the first method of choice. Recently, ICSI appears to be the treatment of choice for achieving pregnancy in these couples, surpassing insemination.

Many assisted reproduction centers in both Europe and America offer these treatments (intrauterine insemination and IVF/ICSI) to couples where the male is HIV-positive and the female is negative.
Over 5,000 such procedures have been conducted in the United States and Europe among HIV-serodiscordant couples, resulting in the birth of more than 500 children without a single instance of HIV transmission.

Safety standards
Particular attention is required regarding adherence to safety standards in the operation of these centers to ensure that neither the staff nor other HIV-negative couples are exposed to the risk of virus transmission. This involves rigorous standards during all stages of treatment, including egg retrieval, fertilisation, embryo culture. Transmission risks also concern the process of freezing gametes or embryos originating from HIV-positive couples.

The legislative framework in Greece (Current & recent updates)
In Greece, according to Law 3305/2005, Article 4, testing for HIV is mandatory before undergoing Assisted Reproduction. If the persons are HIV-positive, a special licence is required from the National Authority of Medically Assisted Reproduction (Article 19). Greek law strictly regulates IVF for seropositive individuals to ensure safety. The legal landscape was significantly updated with Law 4958/2022, known as the "Reforms in Medically Assisted Reproduction."

Key provisions:

• Mandatory testing: Under Law 3305/2005, HIV testing remains mandatory before starting any IVF treatment.
• Special permission: Patients testing positive generally require permission from the National Authority of Assisted Reproduction to proceed.
• New age limits (2022 Reform): Law 4958/2022 raised the age limit for women undergoing IVF from 50 to 54 years. (Note: Women aged 50–54 require specific permission from the National Authority.)
• Donor anonymity (2022 Reform): The new law abolished strict donor anonymity. Donors and recipients can now choose between anonymous and non-anonymous (open) donation, allowing children to access donor information upon turning 18.

Medical prerequisites (Law 170/B/06-02-2008):

To qualify for treatment, specific medical criteria must be met:

• The patient is in a stable condition.
• The patient must be on an antiretroviral therapy (HAART) for at least one year.
• T4 lymphocyte counts must be >300/mm³, and viral load must be <50 copies/ml.
• No co-infections (Hepatitis A, B, C, Syphilis)
• No opportunistic infections or serious complications related to the HIV infection are detected.
• There is a certificate from the attending physician stating that the patient is monitored regularly and has complied with the indicated therapy for at least 1 year.
• The application of ART takes place in a special laboratory with the equipment provided for by Article 5.

Informed consent: Couples must sign a consent form acknowledging transmission risks and potential medication effects on the embryo.

The license from the National Authority of Medically Assisted Reproduction for performing IVF with genetic material from HIV-positive individuals is also valid abroad.
Postal Address: 3 Zacharof Str. Postal Code: 115 21, Athens Telephone: 213 2010457

The reality in Greece: Accessibility vs. Legislation
While the legal framework is progressive, the practical availability of treatment remains limited for HIV-positive patients.

1. The "Specialised Unit" Bottleneck

Greek law requires that IVF for seropositive individuals take place in a "specially equipped laboratory" to prevent cross-contamination.

• Private sector limitations: Due to the high cost of maintaining separate, secure laboratories, most private IVF clinics in Greece cannot accept HIV-positive patients, even if legally permitted.
• The public sector solution: To address this gap, Law 4958/2022 explicitly provided for the establishment of a dedicated Medically Assisted Reproduction Unit at the "Attikon" University General Hospital in Athens. This unit is designed exclusively to serve HIV-seropositive individuals, acting as the primary hub for patients who cannot find care in the private sector.

This specialised Unit is still under construction, and we have no information as to when it will officially start offering treatments. So, for the time being, the HIV-positive patients must contact the National Authority of Medically Assisted Reproduction to enrol in a list and wait for their turn.

2. Unequal access
   Because the specialised public unit is located in Athens, patients living in other regions or on the islands may face significant logistical hurdles and travel costs that seronegative couples do not. Patients should be prepared to navigate a two-tier system in which the legal right to treatment exists, but its delivery is highly centralised.

In short, while Greece offers a legal pathway, it does not guarantee universal access. The "reality" is that seropositive couples often face a much smaller pool of providers and higher logistical hurdles than seronegative couples.