Egg donation: HIV risk for recipient?

Dear HIV experts,

in our struggle with secondary infertility we have decided to go for an egg donation and are confused by the many different opinions on the risk of contracting HIV during that process.

All fertility clinics we contacted told us their donors would be tested for HIV shortly before the eggs are retrieved. However, opinions differ when it comes to a second HIV test: One clinic told us they would routinely freeze the resulting embryos to allow for a second test a few weeks/months after the fertilization. Only after this second HIV test comes back negative, embryos will be transferred to the recipient.
A second clinic told us they would forego the second test and transfer fresh embryos because there was no risk of contracting HIV from an egg donation.

We would prefer a fresh embryo transfer, but only if there is no risk associated.

The clinic that does fresh embryo transfers gave us several reasons why a second test is not needed:
1) When the eggs are retrieved all other cell material is mechanically removed and the eggs are then washed. During that process the HI-virus "dies"
2) Eggs are not the typical cells that carry the virus, i.e. the virus targets a different kind of cells in the body
3) The number of cells transferred to the recipient (my understanding: ideally, but not necessarily, just the egg) is too small to be infectious

Hence my question is: Is there really no risk associated with a fresh embryo transfer (i.e. no second HIV test needed), or would we have to wait for the second test to come back negative (i.e. cryo transfer)?

I sincerely appreciate your taking the time to read and answer my question. Please excuse any mistakes, I am not a native speaker.

[H. Hunter Handsfield, M.D.]

Welcome to the forum and thanks for your question.

Unfortunately, neither I nor Dr. Hook has any experience in HIV testing in this setting.  However, I would encourage you not to worry.  I am unaware there has ever been a reported case of HIV acquired by ovum or embryo transfer in treating infertility.  This undoubtedly is because HIV is rare in heterosexual women in the US and other industrialized countries, and I would imageine it's even lower in egg donors than in the general female population.  Combined with the high accuracy of HIV testing, I think this really isn't a serious concern, regardless of which testing strategy is used by the infertility clinic you choose.

In addition, I am inclined to agree that a human egg would be very unlikely to harbor HIV, even in the unlucky (and very unlikely) chance you had an HIV infected donor.  In infected people, HIV is harbored in immune system cells -- not, to my knowledge, in eggs.  In other words, I am inclined to believe that the rationale you were given by the fresh embryo transfer clinic is valid.  But I cannot directly vouch for it from my own scientific knowledge.

Sorry I can't answer all your questions in detail, but I hope this perspective is helpful to you.  Best wishes for successful treatment and a healthy child.

HHH, MD