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If you’re an intended parent living with HIV, you may wonder how surrogacy can be pursued safely. Thanks to modern medical advances like sperm washing, HIV-positive men can father healthy, HIV-negative children via IVF and surrogacy.
Below I answered common questions about sperm washing for HIV+ intended parents that are starting with the surrogacy process, focusing on safety, success rates, procedures, and what to expect.
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The Sperm Washing Process & Requirements
What exactly is “sperm washing” and how does it work?
Sperm washing is a laboratory technique used to obtain a virus-free sperm sample from an HIV-positive male. The HIV virus cannot attach to the sperm cells themselves, so the goal is to separate the sperm from the semen fluid (where any virus would be. By doing so, embryologists can ensure that only clean sperm without any HIV virus is used to create embryos.
In practice, the process involves several steps:
1. Preliminary testing: The intended father undergoes blood tests (e.g. HIV viral load and CD4 count) and is evaluated by his doctor to confirm the virus is well-controlled. Typically, you must be on HIV treatment and have an undetectable viral load for a number of months before proceeding. You’ll also be screened for other sexually transmitted infections, since clinics require you to be generally healthy before providing a sample.
2. Semen collection: You provide a semen sample at the specialized laboratory. This sample is handled under strict protocols for safety. If you need to provide multiple samples, they are collected over the course of a few days.
3. Laboratory processing (“washing”): The lab technicians process the semen using methods like gradient centrifugation and filtration. This spinning process separates the motile sperm from the surrounding seminal fluid and other cells. Essentially, they “wash” away everything except the sperm. The healthy sperm are then placed in a fresh solution. At this point, the sample contains sperm cells but no semen plasma, which dramatically reduces any risk, since HIV resides in the semen fluid, not in the sperm.
4. HIV testing of the sample: The washed sperm sample is then tested with very sensitive molecular techniques (such as a PCR assay) to detect any traces of HIV. Only if no HIV is detected will the sample be cleared for use. If by chance the test finds viral genetic material, that sample is discarded and not used for fertility. In most cases, especially when the father’s viral load is well-managed, the washed sample comes back completely HIV-negative. This extra testing step ensures the sample is as safe as possible.
5. Fertilization and IVF: Once the sperm sample is confirmed to be HIV-free, it is used in the assisted reproduction process. The sperm can fertilize eggs via IVF (in vitro fertilization in a lab dish) or via ICSI (intracytoplasmic sperm injection, where a single sperm is injected into an egg), which are the techniques generally used in standard fertility treatments. The resulting embryos are cultured for a few days and then one (or more) is transferred into the surrogate’s uterus. From this point onward, the surrogacy pregnancy proceeds no differently than any other IVF pregnancy, since the embryo is not exposed to HIV from the start. Laboratories also take care to store any specimens from HIV-positive clients separately from other samples to prevent any risk of cross-contamination.
The process of sperm washing has been used for decades and is very effective. One medical study from 2007 reports that the calculated probability of contamination was equal to zero (95% confidence interval, 0-0.09%).
What requirements does an HIV+ intended parent need to meet to use his sperm in surrogacy?
Fertility clinics will require that an HIV-positive intended father meets certain health criteria before undergoing sperm washing and IVF. Generally, you’ll need to show that your HIV is well-controlled and that you’re otherwise healthy. Common requirements include:
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On antiretroviral therapy: You should be under the care of a doctor and actively taking HIV medication as prescribed.
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Undetectable viral load: You must have an undetectable HIV viral load for a sustained period, typically at least 6 months of suppression (this duration can vary by clinic, but six months is a common minimum). This demonstrates that the virus is effectively managed in your body.
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General health and STI screening: You’ll undergo testing for other sexually transmitted infections (such as hepatitis B/C, syphilis, etc.) and provide a recent physical or health clearance. The clinic wants to ensure there are no other infections in the semen and that you’re in good health for the procedures.
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Specialist consultation: Some programs require a letter from your infectious disease specialist or HIV doctor, confirming your treatment adherence and health status. Your fertility doctor and HIV doctor may coordinate on your care plan.
These requirements are in place to maximize safety. Essentially, if you have been responsibly managing your HIV (taking ART and keeping the virus suppressed) and have no other health issues, you will likely qualify to proceed with sperm washing. The fertility clinic will guide you through the exact tests and paperwork needed. There is no need to be intimidated by the process - this is mostly about documenting that you’re doing well and making sure the timing is right. Many HIV-positive intended fathers find that once they have 6+ months of excellent lab results, they get the green light to move forward.
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How many sperm samples are required, and why?
Practically speaking, clinics often ask HIV-positive intended fathers to provide multiple semen samples, commonly 3 to 4 samples, for processing. The main reason is to ensure there is enough HIV-free sperm for the IVF process in case one of the samples shows any virus or has a low sperm count. Remember that even men with undetectable blood can occasionally have a bit of virus in their semen, so by collecting more than one sample, the odds are very high that at least two of them will test completely clear of HIV. In fact, data from the Bedford Research Foundation (which runs the SPAR program) shows that about 15% of semen specimens from men on therapy still test positive for HIV, meaning ~1 in 6 samples might be unusable. To account for this, their protocol is that at least two clean samples are required for a fertility attempt, and they recommend providing three samples to be safe.
All the samples must be collected within a short window (for the US - the FDA requires your blood tests to be done within 7 days of your sperm collection). This usually means you’ll do your sample collections over the course of a few days at the lab. For example, you might provide one sample each on Monday, Wednesday, and Friday of the same week, all tied to one recent set of blood tests. If one of those samples were to show a trace of virus, it would simply be discarded, and the lab would still have others to work with (so you don’t have to start over from scratch). It’s a bit more effort upfront, but it’s done to avoid any delays and ensure success. And encouragingly, the SPAR program reports that every man in their study eventually produced at least two HIV-undetectable semen samples, even if an early sample had a blip, subsequent ones came back clean.
Where is sperm washing done?
Not all fertility clinics are equipped to work with HIV-positive samples, so you will likely use a specialized program for the sperm washing and testing.
Some large fertility centers (and a few international clinics) have in-house capabilities or partner labs to handle HIV-positive specimens.
But, sometimes, you might be required to travel. The good news is that the sperm collection trip is usually brief.
Working out the brief plan for the logistics from the very beginning is important and something your independent surrogacy consultancy can help with.
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How long does the sperm washing process take?
The lab procedure itself is usually completed very quickly.
For example, if you’re going directly to a clinic that will perform sperm washing, you’ll typically provide your semen sample in the morning, and the lab will immediately begin processing it. The centrifugation and initial testing can be done in a matter of hours.
In many cases, you’ll get preliminary results very quickly, confirming whether the sample was cleared for use.
That said, if you’re traveling or living near the clinic that will perform sperm washing, plan on being available for perhaps a couple of days, especially if multiple collections are needed. For example, if you’re giving three samples over three days, you’ll obviously be at the facility for that span.
Afterward, once the lab has your clean, frozen sperm, you’re done with this part. The timeline then shifts to the normal IVF cycle schedule (which depends on syncing with an egg donor or your partner’s egg retrieval and the surrogate’s uterus preparation).
What happens if a semen sample tests positive for HIV?
If any of your provided semen samples shows even a low level of virus, that specimen will not be used for fertilization. The lab will discard that sample and not risk it in any way. This is exactly why multiple samples are taken, so that one “positive” result doesn’t derail the process. Assuming you gave more samples in the same batch, the lab will simply focus on the sample(s) that tested HIV-undetectable. The process can move forward as long as at least two samples come back completely clear (per FDA guidelines for using gametes).
If, for example, you only provided two samples and one of them had a detectable result, the clinic would likely ask you to provide additional samples at a later date (after re-confirming your bloodwork) to ensure they have enough clean sperm for a safe IVF attempt. They might adjust timing or have you double-check adherence to medication, but often it’s just an unpredictable blip
Please remember this: a positive test result on one semen specimen doesn’t mean failure. It just means that particular vial can’t be used, and you’ll rely on your other vials (or do a re-collection) for the actual IVF.
The important point is that any sample with detectable HIV is simply not used, period. The clinic will only proceed with embryo creation once they have confirmed, through PCR testing, that the sperm sample being used has no virus in it. This ensures that no unexpected risk is introduced at any stage.
Safety & HIV Transmission Risks
Can my surrogate contract HIV during the surrogacy process?
The risk of a surrogate acquiring HIV from an HIV-positive intended father is extremely low. In fact, with proper precautions (like sperm washing), there has not been a single documented case of a gestational surrogate becoming HIV-positive from carrying a baby for HIV-positive parents. In other words, while transmission is theoretically possible, it hasn’t happened in practice under modern protocols. Thousands of babies have been born via surrogacy to HIV-positive fathers without any transmission to the women who carried them. Clinics still treat this as a serious consideration, but the established safety measures have essentially eliminated the risk to surrogates.
Will our baby be HIV-negative?
Yes! With the appropriate medical techniques, the baby will be born HIV-negative. The sperm washing process ensures that only sperm (which cannot carry HIV) are used, and all HIV-containing seminal fluid is removed. HIV does not attach to the sperm cells themselves; it’s present in the semen fluid, not in the DNA or genes you pass to your child. By isolating the sperm from that fluid and using it for IVF, the resulting embryo is protected from HIV. In over 4,000 assisted reproduction cases involving HIV-positive fathers, not one baby has contracted HIV from their parents. Many healthy babies have been born through this method with zero transmissions to infants. In summary, your child will not inherit HIV from you as long as the recommended protocols are followed.
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Is it safe for an HIV-positive man to use his own sperm in IVF?
Absolutely. HIV-positive intended fathers can safely use their sperm for IVF and surrogacy when proper precautions are in place. Fertility clinics regularly work with HIV-positive patients now, thanks to advances in assisted reproductive technology. The key is that the semen sample is processed and tested (via sperm washing and PCR analysis) to ensure no virus is present before it’s used to fertilize an egg. These measures protect the surrogate and baby. In practice, the chance of HIV transmission in an IVF procedure is extraordinarily low as long as these guidelines are followed. Many clinics, and even entire programs like the Bedford SPAR program, have decades of experience helping HIV-positive men have biological children safely. Being HIV-positive does not prevent you from using your own sperm in IVF, provided you work with a clinic that follows the established safety protocols.
What precautions protect the surrogate from HIV? Does she need special medication or testing?
The primary safeguard is the sperm washing itself, which removes any HIV-containing fluid from the sample before an embryo is created. This means the surrogate is never exposed to the virus during the embryo transfer. As an extra layer of protection, some clinics also may have the surrogate take a preventive antiviral medication (often PrEP, a pre-exposure prophylaxis) around the time of embryo transfer. This medication further reduces the already minimal risk and has been shown to be safe for both the surrogate and the baby. In addition, surrogates typically undergo routine HIV testing during and after the pregnancy to confirm they remain HIV-negative. For example, the standard SPAR protocol is to test the surrogate at ~3 weeks, 3 months, and 6 months after the embryo transfer. The SPAR program even provides at-home test kits to make this monitoring easy. All of these steps - sperm washing, optional PrEP medication, and follow-up testing, are designed to ensure the journey is safe for the surrogate and to reassure everyone involved. It’s worth noting that surrogates in these programs are fully informed about these precautions and agree to them before moving forward, so they are comfortable with the plan. Quite often you will find though that the surrogate will request additional compensation for this.
Fertility & Success Rates
Does sperm washing affect fertility or IVF success?
No, using “washed” sperm does not harm your chances of a successful IVF pregnancy. The sperm washing process itself simply separates sperm cells from the semen. It does not damage the sperm or reduce their ability to fertilize an egg. Clinics report that IVF or ICSI outcomes with washed sperm are comparable to regular IVF success rates, assuming the sperm and eggs are otherwise healthy. So, separating out the sperm and testing them for HIV does not inherently reduce fertilization capability or embryo quality. You can have peace of mind that these safety steps won’t compromise your likelihood of achieving a pregnancy.
What are the success rates of having a baby with washed sperm?
The success rates for having a baby using washed sperm depend mostly on the normal factors (egg quality, embryo health, the surrogate’s uterine receptivity, etc.), rather than on the sperm washing step. In practice, once the sperm is confirmed HIV-free, the IVF process proceeds just like it would for any other couple. Studies and clinical experience show that performing sperm washing and viral screening does not measurably lower the success rates. Pregnancy rates are essentially equivalent to standard IVF outcomes for the same age group and medical conditions. If an HIV-positive father has well-managed health and good-quality sperm, his chances of a successful pregnancy via IVF/surrogacy are as high as any other intended father’s under similar circumstances. Many clinics emphasize that surrogacy for HIV-positive parents is just as safe and successful as any other surrogacy journey with today’s medical advances.
Do I really need sperm washing if my viral load is undetectable?
Yes – it is strongly recommended (and often required) even if your blood viral load is undetectable. The principle of “U=U” (undetectable = untransmittable) is encouraging for natural conception, but when it comes to IVF and tissue samples, embryologists adhere to the highest safety standard. Fertility clinics and regulators still insist on sperm testing/washing to absolutely eliminate any chance of the virus being present.
In fact, research has shown that a portion of men with undetectable HIV in their blood can still have low levels of HIV in their semen.
Estimates vary, but roughly 20% of semen samples from men on effective treatment still test positive for HIV genetic material. Because of this, sperm washing and PCR testing of semen are required to ensure the sample used for IVF truly contains no virus.
In practice, even clinics in regions that embrace U=U will require you to go through the sperm testing process regardless of your undetectable status. This may involve an extra step, but it gives everyone total peace of mind.
The bottom line is that even with an undetectable viral load, you will need to undergo sperm washing and verification procedures before using your sperm in surrogacy, to meet medical and legal guidelines and protect all parties. Think of it as an added insurance policy that ensures zero risk.
Can both my partner and I be HIV-positive and still pursue surrogacy?
Yes. Both intended parents can be HIV-positive and still have a biological child via surrogacy, as long as certain precautions are in place.
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If you are a same sex male couple where both of you have HIV, the key requirement is that the partner providing the sperm has a consistently undetectable viral load (and goes through the sperm washing process). Both of you will undergo the normal health screenings, and each will need medical clearance, but HIV itself does not prevent you from proceeding. Often, one partner’s sperm is used to create the embryos (just as in any couple, you’ll decide whose biomaterial to use or even fertilize eggs with each partner’s sperm and choose the best embryos). The medical team will ensure that any sperm sample used is fully cleared of the virus before IVF. Many seroconcordant couples (where both partners are HIV-positive) have successfully built families this way. Aside from the additional medical coordination for managing both parents’ health, the process is very much like any other surrogacy journey. Agencies and clinics experienced in HIV-positive family-building have worked with many couples in which both dads are HIV-positive. With careful planning, and both partners on antiretroviral therapy, an HIV-positive couple can absolutely grow their family via IVF and surrogacy.
If you are a HIV positive heterosexual couple, the same principles apply: what matters most is that both partners are in good health, on consistent antiretroviral therapy, and have undetectable viral loads.
For the male partner, the sperm washing is performed before IVF or ICSI to ensure the sample is free of any virus before it fertilizes the eggs.
For the female partner, the focus shifts to managing her viral load and overall health before any egg retrieval. As long as she is on effective treatment and her viral load is undetectable, she can safely provide her eggs for IVF. The embryos created from her eggs and washed sperm can then be transferred either to her own uterus (if she plans to carry) or to a surrogate if carrying a pregnancy is not medically recommended.
In both scenarios, the fertility team will coordinate closely with the couple’s infectious disease specialist to verify viral suppression, complete all necessary screening, and ensure that all lab and clinical protocols meet regulatory standards.
Surrogates, Disclosure & Emotional Concerns
Will my surrogate know that I’m HIV-positive?
Yes. Transparency is a fundamental part of the surrogacy process. Your surrogate should be informed of your HIV status from the very start. When agencies match surrogates and intended parents, all relevant medical information is disclosed, including HIV, so that the surrogate can give fully informed consent. In practice, surrogacy contracts explicitly state that the intended parent is HIV-positive and outline the medical precautions that will be in place. A surrogate needs to understand and agree to these aspects before moving forward.
Some intended parents worry that disclosing HIV might scare off potential surrogates. In reality, many surrogates are open to working with HIV-positive parents once they learn about the safeguards in place. But they do have the choice: if a particular woman is not comfortable, she can decline the match early on. This open discussion is important for building trust. By the time you’re officially matched, your surrogate will have knowingly and willingly accepted to carry for an HIV-positive family, confident in the safety measures. You can also expect confidentiality outside of the necessary parties, typically only the agency, clinic, surrogate (and her OB/GYN) need to know your status. Your privacy is respected, but within the team, openness is critical. Rest assured that surrogates who proceed are usually very educated on the matter and often quite passionate about helping you become parents regardless of HIV. The honesty from both sides helps create a positive, collaborative relationship.
Will being HIV-positive make it harder to find a surrogate?
Not usually, especially if you work with an agency experienced in HIV-inclusive journeys. While it’s true that not every surrogate will be comfortable with the idea at first, there are many surrogates who are willing to carry for HIV-positive intended parents once they understand the medical facts. Reputable surrogacy agencies provide education to their applicants about sperm washing and the excellent safety record so far. As a result, they often have a pool of surrogates who have already agreed to be considered for HIV-positive matches.
It’s important to go through an agency who has this experience. Their knowledge and expertise in such particular cases can reassure potential surrogates and address concerns knowledgeably.
You may be limited to working with certain clinics or programs (since, as mentioned, not all clinics handle HIV cases and some countries don’t offer surrogacy programs for HIV+ intended parents), which could slightly narrow the field.
The matching timeline might in some cases be a bit longer only because of the added medical coordination, but in general, yes, you can find a wonderful surrogate. Women who step forward for this are often particularly compassionate and will be proud to help you overcome the stigma and build your family.
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Will my HIV status affect our surrogacy contract or legal process?
Your surrogacy contract will include provisions related to your HIV status, but these are straightforward and meant to protect everyone’s understanding. Typically, there will be a clause acknowledging that the intended parent is HIV-positive and outlining the agreed-upon medical protocol (e.g., that you will undergo sperm washing and testing, that the surrogate consents to take preventive medication if advised, and that she’ll undergo the post-transfer HIV tests). The contract may also have confidentiality clauses regarding your health information. Other than these additions, the contract is much like any other surrogacy agreement, covering responsibilities, financial terms, what happens in various contingencies, etc.
Legally, there is no prohibition on HIV-positive individuals becoming parents via surrogacy in most countries. There may be a few countries or regions with outdated regulations (so it’s wise to choose a surrogacy-friendly location).
One practical legal consideration: some clinics require additional consent forms. For instance, an acknowledgment from the surrogate that she’s aware of the intended parent’s HIV and the use of washed sperm. These forms go into the medical file. And some countries might require an extra physician sign-off, but these are formalities your lawyer/clinic will manage. Overall, being HIV-positive doesn’t change your ability to become a legal parent. It only introduces a few extra steps to confirm everyone is on the same page. As long as you work with an attorney and agency familiar with HIV-related cases (which many are now), the legal process will feel no more complicated than that of any other intended parent.
Costs & Accessibility
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Does surrogacy cost more if I’m HIV-positive?
The general cost of surrogacy (agency fees, egg donor, IVF cycle costs, legal, etc.) remains the same whether or not you have HIV. However, in certain circumstances, a surrogate may request additional compensation in connection with an HIV-positive Intended Parent.
Reputable agencies do not charge higher agency fees for HIV-positive clients. You’re paying for the same core services. However, you should budget for some additional medical expenses related specifically to sperm washing and associated testing. The specialized lab procedures, like semen analysis, multiple PCR tests of your samples and the actual sperm washing procedure will be an out-of-pocket cost that a typical IVF patient might not have.
Insurance rarely covers the sperm washing step since it’s considered elective, so most intended parents plan to pay this out-of-pocket.
Your surrogacy budget should have a line for the “HIV-related” medical services, but it’s not an astronomical addition. Many find it’s a manageable fraction compared to the overall surrogacy cost. It’s wise to discuss these expected costs upfront with your clinic or agency so you know what to expect. But rest assured, aside from the lab/testing fees (and possible additional surrogate compensation), all the standard surrogacy expenses remain standard. There are no surprise mark-ups just because you’re HIV-positive. Agencies should treat you like any other intended parent, with just a special medical plan in place.
Pursuing surrogacy as an HIV-positive intended parent may involve a few extra hurdles, but with the right information and support, it is entirely achievable. The medical advancements of the past few decades have opened the door for you to build a family safely and responsibly.
If you have more questions or need guidance tailored to your situation, I’m here to help. Every journey is unique – and yours, like so many others, can end in the joyous arrival of a healthy baby.
Don’t hesitate to reach out for specialized advice or support as you embark on this path. Your dream of parenthood is possible, and you don’t have to walk the path alone.
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Together, we’ll create a roadmap that fits your goals and values. Let’s turn the dream of parenthood into reality — on your terms, with independent guidance you can trust.
