INDICATIONS FOR CORTICOSTEROIDS PRIOR TO EPIDIDYMAL SPERM RETRIEVAL

Objective-To evaluate the effectiveness of low-dose intermittent predn isone treatment designed to reduce antisperm antibodies for men prior to epididymal sperm retrieval and in vitro fertilization. Study Design -This was a retrospective review of 75 subfertile men with reproductiv e obstruction due to congenital absence of the vas deferens, or other reproductive tract obstruction, who underwent a total of 98 episodes o f microsurgical epididymal sperm aspiration (MESA) with in vitro ferti lization. Results-For couples in whom the man was pretreated with pred nisone, better fertilization rates (39% vs. 21%, P < .0001) and pregna ncy rates (48% vs. 26%, p = 0.06) were obtained than in couples in who m the man was not pretreated. The benefit of prednisone treatment was most noticeable for men with preoperatively detectable antisperm antib odies. Prednisone-treated men with preoperative antisperm antibodies s howed improved fertilization rates (40% vs. 9%, p = 0.005). Men withou t antibodies who were treated with prednisone showed a decrement in fe rtilization rate, from 73% to 24% (fertilizations per oocyte, P < .000 5). Success of prednisone treatment could not be correlated with speci fic assisted-reproduction technique (IVF, PZD, SuZI, or ICSI). Conclus ions-Preoperative evaluation of antisperm antibody status and treatmen t of antibody-positive men prior to epididymal sperm retrieval may pla y a role in improvement of the fertilization and pregnancy results ach ieved by centers that provide MESA with assisted reproduction. These r esults are most important when MESA is performed without the assistanc e of intracytoplasmic sperm injection. Empiric treatment with predniso ne may be detrimental to the fertility of men who have no antisperm an tibodies.