Access to infertility services in Canada for HIV-positive individuals and couples: a cross-sectional study

A survey was sent to all registered fertility clinics in Canada to assess the availability of services (investigations and treatment) for infertility and/or viral transmission risk reduction in achieving pregnancy. The proportion and location of clinics willing to carry out investigations and treatments were determined. Logistic regression analysis was performed to assess differences in response rates, investigations, and treatments by province and by couple scenario.Completed surveys were received from 23/28 (82%) of clinics across eight Canadian provinces. Seventy-eight per cent (18/23) were willing to accept HIV-positive individuals in consultation, and 52% had actually seen at least one HIV-positive man or woman in the previous year. Clinics in every province were willing to offer infertility investigations, but only clinics located in five provinces were willing to offer fertility treatments. The most commonly available treatment was intrauterine insemination for couples in which the female partner was HIV-positive (52%). Other techniques, such as sperm washing (26%) or in vitro fertilization (17%), were less commonly offered. A smaller number of clinics were willing to offer risk reduction techniques in achieving pregnancy.Access to infertility investigations and treatments in Canada is limited and regionally dependent.Registered with ClinicalTrials.gov at http://www.clinicaltrials.gov webcite, registration number NCT00782132.Since the identification of the human immunodeficiency virus (HIV) and the acquired immunodeficiency syndrome (AIDS) in the 1980s, there have been significant advances made in the management and long-term prognosis for infected individuals. In the early days of the epidemic, most people diagnosed as HIV-positive were not expected to live a long lifespan. Currently, with the advent of combination antiretroviral therapy (cART), and the ability to reconstitute the immune system and keep viral loads to undetectable levels, HIV-positive indivi