Natasha Davies Wits Reproductive Health and HIV Institute A Safer Conception Clinic Fertility Assessment Tool and Case Discussion Natasha Davies Wits Reproductive Health and HIV Institute

Background Low cost, low technology safer conception service Infertility suspected in many clients No male or female fertility investigations A history-based fertility assessment was needed to help identify couples with possible infertility

Fertility Assessment Tool Overview

Cases

Palesa and Abel* 30 years Living with HIV 2nd visit initiated ART * Names changed for confidentiality 30 years Living with HIV 2nd visit initiated ART Enrolment CD4 = 314 Viral Load 141 after 3/12 on ART 34 years Living with HIV On first line ART already Enrolment CD4=146 VL undetectable

Fertility Assessment Concerns Palesa no previous pregnancies Irregular cycles > 35 days Variability > 5 days Couple trying to conceive for 9 years Condomless sex at least twice weekly

Outcome Paused conception attempts for 3 months Cycle variability = wide fertile window Frequent attempts from Day 7 – Day 21 of cycle No pregnancy achieved in 6 months Referred for fertility assessment at local hospital

Mercy and Phillip* 39 years 50 years Tested HIV negative * Names changed for confidentiality Mercy and Phillip* 39 years Tested HIV negative 50 years Living with HIV On first line ART (2008) Enrollment CD4 = 552 Viral Load undetectable No living children

Fertility Assessment Minor concerns Mercy’s age (39 years) BMI (28.6 kg/m2) Mercy had two previous pregnancies Regular intercourse 1-2 times per week Always with condoms

Outcome 4 visits over 4 months Advise = condomless sex from Day 13 – Day 16 Conceived on first attempted cycle Condomless sex for 7 days (11 rounds) Pregnancy confirmed at 7 weeks

Conclusion Usefully alerts clinicians to potential issues Encourages realistic discussion with couples Validation process would be worthwhile

Acknowledgements Those who supported development of the tool, especially Dr Okeoma Mmeje, Dr Ian Cooke and Dr Yossi Unterslak Department of Health and RHI staff who support the safer conception clinic All the safer conception clinic clients