Fatherhood with HIV or Hepatitis

Twenty years ago, a diagnosis of HIV or viral hepatitis effectively closed the door on biological parenthood. Today, the picture is different: reproductive medicine has developed protocols that make it possible to use the genetic material of an infected person while eliminating the risk of transmission to the child or to a partner.

Why This Is Possible at All: The Biology of the Question

HIV, hepatitis B, and hepatitis C are viral infections, not genetic conditions. That distinction matters. The virus is not integrated into the DNA of the reproductive cell and is not inherited the way genetic conditions are. It circulates in bodily fluids — blood, semen, vaginal secretions. That means one thing: remove the virus from the carrier fluid, and the risk of transmission disappears at a technical level, not just a theoretical one.

This principle is what makes reproductive treatment for infected patients possible at all — and why men with these infections have a genuine choice of conception method.

Sperm Washing: How It Works in the Lab

The method is called sperm washing — separating sperm cells from seminal plasma, the main reservoir of the virus. In the lab, the sample is spun through a density gradient to separate motile sperm from plasma, then further rinsed in culture medium that removes lymphocytes, the cells where most of the viral load concentrates.

Studies show that after this process, 92–99% of samples have no detectable viral load. But that is not the end of the procedure. Every washed sample is retested by PCR for residual virus — and around 1.3–7.7% of samples still test positive even after washing. Those samples are discarded and never used. It is the combination of washing plus retesting — not washing alone — that provides the safety guarantee.

Large cohort studies covering thousands of fertilisation cycles using washed sperm have recorded zero cases of HIV transmission to a partner or child.

Where Washed Sperm Is Actually Used

This is worth understanding clearly: sperm washing is not a technique developed specifically for surrogacy. It is a general assisted reproductive technology (ART) method, originally used to concentrate healthy, motile sperm in cases of male infertility. In 1989–1992, Italian reproductive specialists adapted the same technique for serodiscordant couples — where one partner has HIV and the other does not — and it has been the standard protocol for that purpose ever since. Surrogacy uses this same, decades-proven method, simply as one of several possible applications, alongside:

Intrauterine insemination of a partner (IUI). Washed sperm is introduced directly into the uterus of a woman without the infection — the most common use of the method, and the one behind the largest safety studies.

IVF with a partner's own eggs. Where additional infertility factors are present, washed sperm is used to fertilise in the lab, and the embryo is transferred to the partner.

Surrogacy. Where a woman cannot carry a pregnancy herself for medical reasons, or where the intended parents are a same-sex male couple or a single father, the same washed and tested material is used to create an embryo with a donor egg, carried by a surrogate mother.

The medical risk to the child, and to anyone involved in the process, is the same across all three scenarios because it is determined by the sperm-washing and testing step itself, not by who carries the pregnancy. For a single man, the pathway follows the same structure described in our guide to surrogacy for single men. For a male couple, the same principle applies within a gay surrogacy programme.

Why the Egg Is a Different Story

The method does not work for the female reproductive cell, and the reason is purely physical. A sperm cell is small and easily separated from the surrounding fluid. An oocyte is a large cell, surrounded by several layers of follicular cells and fluid that form part of its natural micro-environment. Isolating an oocyte from that environment in a way that reliably removes the virus while keeping the cell viable is not currently possible — no validated protocol for washing eggs exists.

This is a genuine biological limitation, not a gap due to lack of research attention. When the infection is in the man, a solution exists, and it is routine, backed by decades of data. When the infection is in the woman, and her own eggs are needed, no such solution exists yet, and a donor egg is used instead.

Laboratory Protocol: Isolation, Not Just Washing

Working with infected material requires a separate line within the embryology lab, physically isolated from the flow of samples from uninfected patients. This is a biosafety standard: cross-contact between samples is not acceptable in any accredited IVF laboratory.

The specific protocol — centrifugation time, number of washing cycles, cryopreservation conditions — is set individually, depending on the patient's serological status, viral load, and type of infection. HIV, hepatitis B, and hepatitis C behave differently even at the level of laboratory fluid handling, so there is no single "one protocol for all infections."

What Doctors Check Before You Begin

Before admission to any of the three scenarios above, the patient undergoes a full assessment: current viral load, details of antiretroviral or antiviral therapy, and immune status indicators. This is clinical data that directly affects the washing protocol and the expected quality of the material.

Active therapy with a controlled, undetectable viral load is the best-case scenario. But even with less ideal indicators, decisions are made individually rather than automatically declined.

The First Step

Everything begins with a consultation, where the patient's medical picture is assessed in detail — not just the fact of the diagnosis, but the specific indicators that determine the protocol, and which conception pathway fits the situation.