Outcomes from the first assisted reproduction program for HIV-serodiscordant couples in Australia.

OBJECTIVE: To describe the clinical outcomes for all HIV-serodiscordant couples attending an assisted reproduction program. DESIGN, SETTING AND PARTICIPANTS: Retrospective review of demographic, clinical and outcome data for all HIV-serodiscordant couples who attended an assisted reproduction program at a tertiary hospital in Melbourne, between its commencement in 2003 and June 2010. MAIN OUTCOME MEASURES: Pregnancies, miscarriages, births, HIV transmission to the HIV-negative partner, semen quality and detection of HIV (HIV RNA and HIV DNA) in semen. RESULTS: As of June 2010, 39 HIV-positive clients had proceeded to assisted reproduction after the initial consultation in the program. There were 162 completed cycles, with 26 pregnancies (clinical pregnancy rate per cycle, 16.2% for HIV-positive men with an HIV-negative partner, and 15.4% for HIV-positive women). Of all 222 tested semen samples, 18 (8%) had HIV RNA detected despite these men receiving antiretroviral therapy and having an undetectable HIV viral load in plasma. Sperm velocity was significantly lower in HIV-positive clients receiving combination antiretroviral therapy than in a control group of recipient-recruited sperm donors (P = 0.01); there were no other significant differences in sperm quality between the two groups. No HIV transmission to babies or HIV-negative partners occurred. CONCLUSION: Our findings show detectable HIV in 8% of semen samples from men with an undetectable HIV viral load in plasma, but confirm the safety of assisted reproduction for HIV-serodiscordant couples within a program with strict protocols for HIV treatment and testing of all semen before use.

Are alterations in plasma protease concentrations during labor associated with poor obstetric outcomes?

OBJECTIVE: The purpose of this study was to assess the association between abnormal connective tissue remodeling during labor as reflected by plasma concentrations of extracellular matrix remodeling proteolytic enzymes and adverse obstetric outcomes. STUDY DESIGN: A prospective observational study of 176 nulliparous women who attended the antenatal clinics at the Mercy Hospital for Women (Melbourne, Australia) from 1999 to 2000. RESULTS: Patients with a prolonged second stage (>120 minutes) had a significantly increased plasma concentration of matrix metalloproteinase 9 after delivery compared with control subjects (P<.001); patients in labor who underwent an emergency caesarean delivery had a significantly lower concentration (P<.001). Patients with a prolonged duration of labor (>11 hours) had a significantly lower urokinase plasminogen activator plasma concentration compared with control subjects (P<.01). CONCLUSION: Altered plasma concentrations of extracellular matrix remodeling proteolytic enzymes, matrix metalloproteinase 9, and urokinase plasminogen activator were found to be associated with abnormal labor and delivery outcomes. This finding may provide a useful predictor of abnormal obstetric outcomes.