A COMPARISON OF INTRAUTERINE INSEMINATION IN SUPEROVULATED CYCLES TO INTERCOURSE IN COUPLES WHERE THE MALE IS RECEIVING STEROIDS FOR THE TREATMENT OF AUTOIMMUNE INFERTILITY

Objective: To compare TUT with timed intercourse in men receiving oral steroid therapy for the treatment of infertility associated with anti sperm antibodies. Design: A prospective, randomized, cross-over trial. Setting: All patients were managed and treated at the Andrology Unit, Churchill Hospital, Oxford, United Kingdom. Patients and Participants : Thirty males who were found to have antisperm levels of greater than or equal to 50% [using the indirect immunobead test with isotypes imm unoglobulin (Ig) G, IgA, and IgM (GAM) beads] in either seminal plasma or serum on routine testing were recruited with their partners into t he study. Main Outcome Measures: Antisperm antibody levels in seminal plasma and serum, sperm parameters, conception rates, and pregnancy ou tcome. Results: There was a statistically significant reduction in sem inal plasma antisperm antibody levels associated with steroid therapy. There was a significant improvement in certain spermatozoan parameter s during steroid therapy. The cumulative pregnancy rate over four cycl es of IUI was 39.4%. The cumulative pregnancy rate over four cycles of natural intercourse was 4.8%. There was a significantly higher chance of achieving a pregnancy with IUI. Conclusion: Intrauterine inseminat ion significantly improves the chance of achieving a conception when u sed as an adjuvant therapy to cyclical intermediate dose steroid thera py. Antisperm antibody levels in seminal plasma are significantly redu ced during treatment with cyclical intermediate dose steroid therapy, although levels in serum appear to be unaffected. Cyclical intermediat e dose steroid therapy significantly improves certain sperm parameters but, when used in isolation, is associated with a low pregnancy rate.