FERTILIZATION EFFICIENCY OF MORPHOLOGICALLY ABNORMAL SPERMATOZOA IN ASSISTED REPRODUCTION IS FURTHER IMPAIRED BY ANTISPERM ANTIBODIES ON THE MALE PARTNERS SPERM

Objective: To investigate the influence of antisperm antibodies on the sperm surface on the outcome of IVF and GIFT. Design: Matched control led retrospective review of two large series. Setting: Reproductive en docrine divisions of two level-three academic centers.Patients: Twenty -nine male factor patients (38 IVF cycles) showing positive antisperm antibodies on the sperm by immunobead test treated by IVF at the Norfo lk program and 56 similar patients (57 cycles) treated by GIFT at the Tygerberg program. Twenty-nine male factor patients (29 IVF cycles) wi th negative antisperm antibodies screening matched by wife's stimulati on protocol and baseline semen analysis characteristics were used as c ontrols in Norfolk; 56 GIFT patients (56 GIFT cycles) matched similarl y were the Tygerberg controls. Study and control groups were divided a ccording to sperm morphology pattern in normal, good, and poor prognos is subgroups for comparison. Main Outcome Measures: Fertilization rate of preovulatory oocytes used in IVF in Norfolk and of GIFT supernumer ary preovulatory oocytes in Tygerberg; total and term pregnancy rates (PRs) and abortion rates. Results: Fertilization rate was significantl y lower in the IVF (41.9% +/- 2.8%) as well as in the GIFT (26.8% +/- 3.8%) (mean +/- SE) study groups than in the respective control groups (73.1% +/- 3.9% and 61.8% +/- 3.9%). Total and term PRs in IVF per cy cle (21.1% +/- 6.6%; 13.2% +/- 5.5%) and per transfer (23.5% +/- 7.4%; 14.7% +/- 6.1%), and in GIFT (25.0% +/- 5.8%; 19.6% +/- 5.3%) in the study groups were also lower when compared with their control counterp arts (IVF per cycle: 62.1% +/- 6.2% and 41.4% +/- 6.0%; IVF per transf er: 41.9% +/- 2.0% and 27.9% +/- 1.9%; GIFT: 31.6% +/- 6.2% and 28.1% +/- 6.0%), but the difference did not reach statistical significance. Abortion rates were similar in the IVF study group (37.5% +/- 17.1%) a nd its control groups (39.9% +/- 11.5%). The abortion rate in the GIFT study group was 14.3% +/- 9.4%, and no abortions were recorded in the control group (not significant). Conclusions: The presence of antispe rm antibodies on the sperm surface per se impairs the outcome of assis ted reproduction, mainly in terms of fertilization rate of preovulator y oocytes, and possibly in terms of total and term PRs. This holds tru e regardless of the impact of other semen parameters, particularly the morphology of the sperm within the semen sample.