The Fertility Race
HIV and Infertility

High-Tech May Lower Odds

THE POTENTIAL RISK in the Boston program is simply unknown. Experts say sperm washing can dramatically reduce the viral load in semen, but cannot guarantee that absolutely all the virus gets washed away. To further reduce the danger to mother and child, the Assisted Reproduction Foundation will encourage couples to use in vitro fertilization - the process of creating a human embryo in a laboratory dish. That way, the woman never comes in contact with sperm or semen, just the embryo. It may be possible to test the embryo for HIV before it is transferred into the woman's body, but that test is still experimental.

To create the experimental fertility program, Ann Kiessling teamed up with several Harvard infertility specialists who will conduct the medical procedures. She's already built a clinic - in a distinctly unorthodox location. In the parking lot of a suburban Boston medical center, Kiessling unlocks the door to a conventional-looking recreational vehicle with a connected trailer. Inside is nearly all the gear needed for in vitro fertilization. Why a clinic on wheels? Over the years, Kiessling tried to convince a number of infertility programs to offer help for HIV-infected couples. She says some were interested but then backed out for fear of unwanted publicity.

"I decided that since I had so many hospitals decide it was a bad idea, we needed to pick up and move if we needed to, so that's how we got into the concept of a mobile clinic," Kiessling says.

Kiessling and the mobile infertility clinic of the Assisted Reproduction Foundation.

The mobile lab has yet to produce its first human embryo but is already generating scientific controversy. Kiessling's Harvard colleague, Deborah Anderson, runs a completely separate HIV research program and is trying to get the CDC and other medical authorities to endorse sperm washing as a safe technique. Anderson fears that Kiessling is moving too quickly with the clinical trial. Anderson recalls a 1990 Virginia case where a doctor provided sperm washing to a serodiscordant couple. The woman contracted HIV but did not get pregnant. The CDC investigated but could not determine whether the woman got HIV because of the sperm washing procedure. "It set the field back ten years," Anderson says. "And that could happen again without the proper protocols in place."

Kiessling replies she is taking all the proper steps to establish a scientifically and ethically valid program. She asked the research oversight committees of three separate Harvard teaching hospitals to approve her study, figuring that at least one of them will take on the politically-delicate project. One hospital has granted initial approval but wants assurances that the research subjects fully recognize the risks involved.

Some critics grumble privately that Kiessling is too much a maverick. People who know her say the 54-year-old biochemist is used to scientific conflict. Her supporters include retired California orthopedic surgeon Leonard Simpson, a trustee of the Assisted Reproduction Foundation, who says Kiessling's independent nature impels her to serve the patients that other fertility specialists neglect.

"I think she's probably dealt with controversy throughout her whole professional career," Simpson says. "Being a maverick, or one who thrives on standing up to controversy when she believes it's right, is probably a driving force for her."

If the clinical trials with heterosexual couples succeed, the Assisted Reproduction Foundation will attempt to expand its work to serve a diverse group of patients. The clinic will probably be the only one in the nation to accept applications from women who wish to carry the child of a gay man with HIV disease. Foundation trustee Leonard Simpson, an activist on gay and HIV issues and the father of a girl conceived before he contracted HIV, says gay men have as much right to assisted reproduction as heterosexuals - even men with HIV disease.

The exam room for the Assisted Reproduction Foundation's mobile fertility clinic in a converted motor-home.

"With HIV disease, there is [social] prejudice, discrimination, ignorance," Simpson says. "If a woman had breast cancer, most of us would be very sympathetic if a woman wanted to conceive and have a child in the face of an illness."

The Assisted Reproduction Foundation has raised more than $350,000 from private benefactors to create the clinical program for people with HIV. A key goal is to offer infertility services at low cost. At many infertility clinics, the bill for in vitro fertilization can easily top $10,000. Most patients pay out of their own pockets. Ann Kiessling wants to start working with patients this summer, but it is unclear whether she can raise enough money and get the final scientific approval she needs to proceed.

Next: Difficult Decisions

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