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and has been performed in HIV-1-infected couples since the early 1990s without any reported
seroconversion.[956]
In an HIV-infected man, the goal of semen processing is to separate the spermatozoa from
all other semen components to obtain an HIV-1-free spermatozoal fraction that contains
sufficient morphologically normal and motile spermatozoa. The spermatozoal fraction can be
tested for the presence of HIV-1 by PCR-based methods. In one study, HIV-1 could not be
detected by PCR in the spermatozoal frac- tion in 98% of samples of men using ART and in 82%
of men without antiretroviral therapy after semen processing. Though semen processing appears
more effective in men using ART, even in men with full suppression of HIV-1 RNA in blood,
HIV-1 RNA can rarely be found in the spermatozoal fraction after semen processing. In an HIV-
infected woman, there is a theoretical risk that an assisted reproductive procedure itself could
cause vertical transmission. Although receptors for HIV-1 have not been demonstrated on the
surface of the oocyte itself, HIV-1 has been detected in ovarian follicles. Theoretically, a viral
particle could be introduced into a human oocyte during intracytoplasmic sperm injection.[956]
