- The Washington Times - Thursday, February 14, 2002

Fertility doctors should not deny treatment to couples infected with the AIDS virus, according to new ethics guidelines released yesterday by the American Society for Reproductive Medicine.
"With the development of new techniques and treatment protocols, we're able now to help HIV-positive patients have children while miminizing the risks they face. I encourage clinics to develop the expertise needed to bring the hope of parenthood to these patients," Dr. William Keye Jr., ASRM president, said in a statement.
HIV patients should not be denied fertility treatment unless doctors lack the skills and facilities to manage such patients or the patients are uncooperative, the guidelines say.
"This was not an issue a decade ago," Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, said of the quesetion of whether HIV-infected persons should have babies. "Then HIV was a death sentence."
Likewise, the risk of perinatal transmission of HIV also has plunged. "Between 1994 and 2000, perinatal AIDS cases fell by 80 percent," largely as a result of giving HIV-positive mothers the drug ziduvudine (AZT) before the second and third trimesters of pregnancy, said Dr. Robert Janssen, director of the division of HIV/AIDS prevention at the federal Centers for Disease Control and Prevention.
"Today, the average rate of perinatal [mother to child] HIV transmission is 1 [percent] to 3 percent," down from 20 percent to 30 percent less than a decade ago, Dr. Janssen said.
Eight years ago, ASRM, which sets standards for fertility clinics to follow, discouraged doctors from treating infertility patients who were HIV positive. But in its first update of those guidelines, published yesterday in the journal Fertility and Sterility, ASRM's ethics committee went far beyond saying HIV-infected patients should not be automatically dismissed.
"According to the Ethics Committee, doctors practicing reproductive medicine ought not to deny treatment to individuals infected with HIV. Ethically, as well as legally, they have the same obligation to treat HIV-positive patients as patients suffering from any other chronic disease," ASRM said in a news release.
"Taking into account the best interests of the children who might result, treatment should only be denied if the clinic lacks the skills and facilities to manage HIV-positive patients, or if the patient refuses reasonable testing and treatment. When a clinic lacks the skills and facilities to manage HIV positive patients, the patients should be referred to a clinic that has these resources," the organization said.


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