A total of 29 infertile couples (group A) with male antisperm antibodies detected by the mixed antiglobulin reaction (MAR) and partly by flow cytometry (n = 21) were treated using an intracytoplasmic sperm injection (ICSI) technique to assist fertilization. In all, 22 of them had shown a poor fertilization rate (6%) in previous in-vitro fertilization (IVF) treatments. The fertilization and cleavage rates in ICSI, 79 and 89% respectively, were similar to those in a MAR-negative group (group B; n = 20) injected because of male infertility (68 and 93% respectively). A third group (group C; n = 37) with male immune infertility was treated by conventional IVF. All these couples had at least one oocyte fertilized, but the overall fertilization rate (44%) in group C was significantly poorer (P < 0.001) than that in the two ICSI groups. However, the embryo quality was lower in group A compared with that in the other groups. A total of 13 pregnancies resulted in group A (46%), of which five ended in miscarriage. None of the six pregnancies (30%) in group B aborted during the first trimester. These results reveal, for the first time, that ICSI offers a good chance of fertilization for couples with male immunological infertility. However, post-fertilization events may compromise these results because of factors not yet clearly understood.
A total of 46 couples with male immunological infertility entered the trial at the infertility clinic of the Family Federation of Finland. The men all showed a positive mixed antiglobulin reaction to immunoglobulin G in their semen; 31 men were also tested for sperm-bound IgA immunoglobulins by flow cytometry. Serum antisperm antibodies were checked in a tray agglutination test. The women showed normal reproductive endocrinology and at least one patent Fallopian tube. The couples were randomized to undergo either up to three intra-uterine inseminations (IUI), or timed intercourse with cyclic, low-dose (20 mg) prednisolone therapy of the men. Cross-over was carried out if no pregnancy occurred in the first stage. Timing of ovulation was based on urinary luteinizing hormone assay and transvaginal ultrasonographic measurements. In all, 40 couples either completed the study or the female partner conceived. IUI was significantly better (P = 0.04) with nine pregnancies than timed intercourse with prednisolone (one pregnancy). There were no significant associations between antibody levels, sperm count or motility versus the incidence of pregnancy. In male immunological infertility, well-timed IUI is an effective treatment method: results are obtained rapidly and steroidal side-effects can be avoided.
Data from 33 couples suffering from male immune infertility, who underwent 47 in-vitro fertilization (IVF) cycles between January 1989 and August 1991, were retrospectively analysed. The serum of all the 33 male partners had elevated tray agglutination test (TAT) titres (> or = 1:16) and positive mixed antiglobulin reaction (IgG MAR) test results in their semen. There was a slight correlation between these tests in semen and serum. Fertilization rates were analysed in three sperm MAR subcategories. Only the strongly positive MAR group (values > or = 90%) revealed a significant reduction in fertilization rate compared to the other MAR groups. However, this was not observed with increasing serum TAT titres. Fertilization rates were decreased in asthenozoospermic (20.1%) compared to normozoospermic (34.0%) male partners. This occurred also with couples not affected by immunological factors, but when antisperm antibodies were present, the fertilization rates were significantly poorer irrespective of whether the sperm motility was normal or decreased. Once fertilization occurred, the pregnancy rate was not affected by the severity of immunological factors. In assisted reproduction the sperm preparation techniques may reduce the inhibiting effects of antibodies bound to the spermatozoa, and when there are several oocytes to be inseminated, the chance of fertilization rises.
Early reports of male immunological infertility suggested a decline in antisperm antibody concentrations in some patients after even short-term (10 day) therapy with low-dose prednisolone. In the present study, 53 men with positive results in spermatozoal mixed antiglobulin reaction (MAR) and serum tray agglutination tests (TAT), were randomized to receive either 20 mg of prednisolone or placebo daily for 2 weeks prior to in-vitro fertilization (IVF) treatment. The antibody levels were also monitored by flow cytometry (FCM). There were no significant differences between these groups as regards fertilization rates (35% with prednisolone; 39% with placebo) and pregnancy rates (29%; 32%). No significant changes occurred in either MAR or FCM results in relation to therapy. Patients with fertilization rates of < 10% had significantly higher immunoglobulin G (IgG) MAR values compared with those with better fertilization, whereas there was no relationship between IgA levels and fertilization results. As regards FCM, the results were similar, but without statistical significance. In conclusion, IVF is a good course of action in severe male immune infertility, but low-dose prednisolone therapy does not lower the sperm-bound antibody numbers and does not improve the IVF outcome.
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