Decades ago, a heterosexual couple that wanted a baby, but couldn’t conceive, faced limited options. Over the years, however, medical science has advanced to such a degree, that those who could not previously get pregnant, now can have a family, with one of the biggest advancements being the success of the so-called test-tube baby.
In fact, this in-vitro fertilization, which is, in effect, the process of making a test-tube baby, has been a great leap forward.
Still, one group was left out of the equation. HIV-positive men couldn’t use their own sperm to fertilize an egg in a partner or surrogate, since the infection could, and often would, spread to the mother and the fetus.
New technologies along with new government rulings, however, are changing that.
The decision by the United States Supreme Court that stipulated that those living with HIV must be considered disabled, and therefore protected under the Americans with Disabilities Act, states that this population is legally entitled to all medical services. In addition, the American Society for Reproductive Medicine recently stated that reproductive specialists have the responsibility to assist this population with their fertility needs. These services include fertility services by reproduction specialists.
But, how can Chicago-area residents take advantage of these services? Until recently, there was no facility in the Chicago area to assist this population, with the closest being a lab in Boston. In January, however, Andrology Laboratory Services, Inc., opened an office at 223 E. Erie, which is setting out to change the status quo, with a lab devoted specifically to people with HIV.
Dr. R. S. Jeyendran is the director and owner of the lab, and a specialist in andrology, which is defined by Blakiston’s Medical dictionary as the science of diseases of the male sex, especially of those of the male reproductive organs. He has been in this field since 1978, and is the author of three books in this area (A Practical Guide to the Complete Interpretation of Semen Analysis, Protocols for Semen Analysis in Clinical Diagnosis, Sperm Collection and Processing Methods: A Practical Guide).
He has big plans.
First, Jeyendran, or Dr. J to those who know him, has set up both testing and sorting or cleaning of sperm, so that those men who are living with HIV may still find themselves fathers. This washing or cleaning increases sperm concentration, and separates the sperm from the seminal fluid.
Currently, Jeyendran is employing a technique referred to as the Semprini Method, which originated in Italy, and is named for the doctor who put it into practice. With the Semprini Method, gradient centrifugation, a common procedure used in sperm processing, is employed to separate sperm from the seminal fluid. Sperm is also selectively separated based on their size motility, and density. Then, the sperm, which has not itself been conclusively linked to HIV infection, but is still tested for the virus, is introduced to the female in a swim-up procedure.
A study of 513 HIV-negative women impregnated with sperm that was treated using the Semprini Method found that 97.5% of the mothers tested negative for the virus after three months, and 92% tested negative after 1 year. Not bad, but Jeyendran thinks he can do better. He believes existing laboratory methods are insufficient for processing the sperm of HIV-positive men. Jeyendran concludes that both the Semprini Method, and the Duncan Holly Biomedical technique, which is performed at the aforementioned Boston clinic, have drawbacks which his new, proposed technique can overcome. ‘
I don’t like both these methods,’ he says. ‘With Semprini, there are very few (viable) sperm left. And, Duncan’s method freezes (all the sperm).’ Not only that, but the Duncan method also yields a sample that contains seminal fluid and non-sperm cellular elements known to harbor the virus.
Jeyendran proposes that because sperm density is higher than both the medium in which they swim as well as the virus cells, that a new method be used, which employs a swim-through technique, therefore putting the least stress on the sperm. This concept is implemented by layering semen in a very thin layer, over a heavier, more viscous media. Sperm then migrate into and towards a gravitational force, literally swimming down. The sample that is left above will include the seminal fluid, non motile or poorly motile sperm, and any other non-sperm cellular elements. Jeyendran hopes that the new procedure will yield a virus-free sample of fertile, high-quality sperm.
Sounds logical, but there’s one big hitch. $20,000. That’s right, Jeyendran is hoping to raise that amount to fund the proper research and study of this method, but is finding his grantwriting efforts so far unrewarded. ‘We are a profit-motivated corporation,’ he explains. ‘Much of the funding is for not-for-profits. We are trying to find a donor. We have not been able to.’
Still, Jeyendran remains hopeful. ‘If we can prove that our system is better, everyone can use this system.’ In the meantime, the lab, which has its main facility at 680 N. Lake Shore Drive, just across the street from where Jeyendran is a research professor at Northwestern University, will continue to use the Semprini method. ‘Erie handles only these samples,’ says Jeyendran.
Microbiologist and andrologist Mary Damirayakhian, who had worked with Jeyendran 20 years ago, and molecular biologist Laurence Fischel, will handle and conduct the testing. The Erie Street facility will also offer other labs storage and cleaning facilities not otherwise available.
‘Nobody wants to do the sperm testing,’ explains Jeyendran, ‘because of liabilitiies. Many physicians are concerned about contamination between samples. They don’t want to get involved.’ So, Jeyendran’s lab tests, but also stores sperm and eggs from Hepatitis C patients, that other facilities don’t want to work with due to the possible risk. These samples ‘demand a separate tank to freeze them, using liquid nitrogen.’ That takes space and money, that most other labs can’t spend. Not only is this lab-within-a-lab expensive, there is also a potential for negative publicity that some labs may be unwilling to risk.
In the future, Jeyendran hopes ALS will have the facilities to actually perform the fertilization there. As for expected demand, the picture is foggy. Jeyendran says, ‘About five years ago, Dr. Semprini said 60 couples went to Italy (for his procedure).’ Right now, there are about one or two calls a month to clinics (in the area) inquiring about the procedures. ‘There aren’t any current national centers (to track these figures),’ the doctor explains. ‘Now, with the D.C. (Supreme Court) ruling, demand must increase. Mine is a preemptive strike.’
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