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To assess the reproductive performance of men co-infected with hepatitis C virus (HCV) and human immunodeficiency virus (HIV-1) undergoing assisted reproduction.A retrospective analysis. Setting: University-based assisted reproductive technology (ART) center. Patients: We reviewed 217 consecutive ART cycles performed on 106 HIV-1 serodiscordant couples between August 1997 and March 2004, in which 28 men (26%) were seropositive for HCV and HIV-1 (group 1). Main outcome measures: Patient demographics and laboratory testing were compared to reproductive outcomes of men undergoing similar treatment but infected only with HIV-1 (group 2). Results: Co-infected men and their partners were of similar age as men infected only with HIV-1. Comparing group 1 to group 2, like values were noted for HIV-1 viral loads [1,993 ± 1,140 copies/ml (mean ± SE) vs. 1,659 ± 487 copies/ml]; CD4 counts (520 ± 98 vs. 604 ± 38 mm−3); and semen parameters. IVF performance and outcomes were similar, with fertilization rate (0.68 ± 0.03 vs. 0.71 ± 0.02); number of normally cleaving embryos (6.0 ± 0.5 vs. 5.3 ± 0.3); embryo implantation rate (0.27 ± 0.04 vs. 0.2 ± 0.02); and clinical pregnancy rate (40 vs. 29%). Although the male mortality rate was low in both groups, morbidity among co-infected men was significantly higher. Seven of 28 men (25%) had detectable HCV viral loads, and 14 (50%) had elevated liver function tests. Conclusion: Men co-infected with HCV and HIV-1 do reasonably well undergoing ART to prevent transmission of viruses to their partners and children.