A comparison of intrauterine insemination in superovulated cycles to intercourse in couples where the male is receiving steroids for the treatment of autoimmune infertility

Abstract

Objective: To compare IUI with timed intercourse in men receiving oral steroid therapy for the treatment of infertility associated with antisperm 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 > or = 50% [using the indirect immunobead test with isotypes immunoglobulin (Ig) G, IgA, and IgM (GAM) beads] in either seminal plasma or serum on routine testing were recruited with their partners into the study.

Main outcome measures: Antisperm antibody levels in seminal plasma and serum, sperm parameters, conception rates, and pregnancy outcome.

Results: There was a statistically significant reduction in seminal plasma antisperm antibody levels associated with steroid therapy. There was a significant improvement in certain spermatozoan parameters during steroid therapy. The cumulative pregnancy rate over four cycles 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 insemination significantly improves the chance of achieving a conception when used as an adjuvant therapy to cyclical intermediate dose steroid therapy. Antisperm antibody levels in seminal plasma are significantly reduced during treatment with cyclical intermediate dose steroid therapy, although levels in serum appear to be unaffected. Cyclical intermediate dose steroid therapy significantly improves certain sperm parameters but, when used in isolation, is associated with a low pregnancy rate.