INTRAUTERINE INSEMINATION VERSUS CYCLIC, LOW-DOSE PREDNISOLONE IN COUPLES WITH MALE ANTISPERM ANTIBODIES

A total of 46 couples with male immunological infertility entered the trial at the infertility clinic of the Family Federation of Finland. T he men all showed a positive mixed antiglobulin reaction to immunoglob ulin G in their semen; 31 men were also tested for sperm-bound IgA imm unoglobulins by flow cytometry. Serum antisperm antibodies were checke d in a tray agglutination test, The women showed normal reproductive e ndocrinology 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 occurre d in the first stage. Timing of ovulation was based on urinary luteini zing hormone assay and transvaginal ultrasonographic measurements. In all, 40 couples either completed the study or the female partner conce ived. IUI was significantly better (P = 0.04) with nine pregnancies th an timed intercourse with prednisolone (one pregnancy). There were no significant associations between antibody levels, sperm count or motil ity versus the incidence of pregnancy. In male immunological infertili ty, well-timed IUI is an effective treatment method: results are obtai ned rapidly and steroidal side-effects can be avoided.