Intra-uterine 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. The men all showed a positive mixed antiglobulin reaction to immunoglobulin G in their semen; 31 men were also tested for sperm-bound IgA immunoglobulins by flow cytometry. Serum antisperm antibodies were checked in a tray agglutination test. The women showed normal reproductive endocrinology 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 occurred in the first stage. Timing of ovulation was based on urinary luteinizing hormone assay and transvaginal ultrasonographic measurements. In all, 40 couples either completed the study or the female partner conceived. IUI was significantly better (P = 0.04) with nine pregnancies than timed intercourse with prednisolone (one pregnancy). There were no significant associations between antibody levels, sperm count or motility versus the incidence of pregnancy. In male immunological infertility, well-timed IUI is an effective treatment method: results are obtained rapidly and steroidal side-effects can be avoided.