CLINICAL AND BIOLOGICAL ASPECTS OF MALE IMMUNE INFERTILITY - A CASE-CONTROLLED STUDY OF 86 CASES

A case-control study of clinical, endocrine and seminal characteristic s in 86 infertile men and a prospective study of conception rates duri ng 804 follow-up cycles among 75 infertile couples with male immune in fertility were performed. Genito-urethral infections or surgery, and p alpable epididymal abnormalities were more common among the immunologi cal cases than among the non-immunological infertile controls (n=180), but sperm concentration, motility and morphology were similar. The sp ontaneous conception rate in 70 cases was 1.7% per cycle. Treatment by intra-uterine insemination (IUI) resulted in 8.6% pregnancies per cyc le, conventional in vitro fertilization (IVF) had a 18.4% success rate per attempt, and two out of three couples treated by intracytoplasmic sperm injection (ICSI) attained pregnancy. Minimal sperm quality requ ired for successful IUI was not lower than that recorded in couples wi th spontaneous conception.It is concluded that immunological infertili ty, as diagnosed by a positive mixed antiglobulin reaction (MAR) test, is associated with a low spontaneous conception rate. Techniques of a ssisted reproduction are useful in the management of couples with infe rtility resulting from this pathology, but sperm characteristics requi red for successful IUI are much higher than those needed for successfu l IVF. A strategy for the logical management of this pathology is prop osed.