Treatment of severe male immunological infertility by intracytoplasmic sperm injection

Abstract

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.

Unexplained Male infertility: diagnosis and Management

“…The most successful method of treatment for male patients with ASA is intracytoplasmic sperm injec- tion (ICSI) as it bypasses the otherwise necessary fertilization mechanisms that can potentially be affected by ASA. One study showed that couples who had a poor fertilization rate during IVF (6%) showed a dramatic increase in fertilization rate with ICSI treatment (79%) which was comparable to an ASA negative group (68%) (113). In another study, Esteves et al reported that the outcome of ICSI in men with autoimmune infertility was not influenced by the percentage of ASA-bound spermatozoa (114).…”

Male factor infertility and ART

“…In addition, some authors believe that the presence of significant levels of antisperm antibodies is an indication to always perform ICSI, 42,43 despite a recent meta-analysis concluding that there is no benefit of ICSI over IVF in cases of antisperm antibody-mediated male factor infertility. 44 For cryopreserved sperm from cancer patients, no prospective comparative studies pitting the use of IVF versus ICSI are available in the literature.…”

Effect of Treating Antibody-Coated Sperm With Chymotrypsin on Pregnancy Rates Following Iui as Compared to Outcome of Ivf/Icsi

“…A previous prospective study found that treating naturally antibody-coated sperm with the protein digestive enzyme chymotrypsin prior to IUI significantly improved the pregnancy rates compared to sperm ejaculated into Earle's balanced salt solution medium containing 5% albumin [1]. Other studies have shown improved pregnancy results in the female partner of men with ASA following IVF with ICSI [3,5,7]. One of these studies showed that men with ASA > 70% suffered no adverse effect on outcome when ICSI was used [3].…”