Human Reproduction, Vol. 10, No. 1, pp. 103-109, 1995
© 1995 European Society of Human Reproduction and Embryology
Oral steroid therapy for subfertile males with antisperm antibodies in the semen: prediction of the responders
University Department of Obstetrics and Gynaecology, Jessop Hospital for Women Leavygreave Road, Sheffield S3 7RE, UK
Correspondence: 1To whom correspondence should be addressed
This study was performed to examine the effectiveness of steroid therapy in subfertile men with antisperm antibodies and infertility lasting > 1 year, to predict those who would respond positively, and to evaluate the effect of the therapy on semen parameters and antisperm antibodies. The patients included 48 subfertile couples in whom the male partner had 
20% motile spermatozoa with bound antibodies of immunoglobulin (Ig)G, IgA or a combination of both, and were treated with prednisolone, 40 mg a day, for the first 10 days, then 5 mg on days 11 and 12 of the partner's cycle for 9 months. Twelve couples became pregnant; a cumulative conception rate of 30.2% was achieved at 9 months. The pregnant group started with significantly higher concentrations of IgG (tail) and grade I motility (P = 0.03 and P = 0.02 respectively). Multi-covariate discrete logistic regression analysis on the initial screening semen samples predicted a higher chance of conception for those with high levels of IgG (tail) (P = 0.006, sensitivity = 33%, specificity = 93%, correct = 75%, false positive = 33% and false negative = 24%). In the pregnant group, prednisolone caused a significant increase in grade I motility (P = 0.03). In the non-pregnant group, there was a significant increase in grade I motility (P = 0.0002), amplitude of lateral head displacement (P = 0.03), curvilinear velocity (P = 0.02) and decrease in grade IV motility (P = 0.03) following prednisolone treatment. In both groups there was suppression of the total antisperm antibody concentrations. Comparison of semen parameters in the last semen samples between the two groups showed that the pregnant group had significantly higher progressive motility (P = 0.008) and lower grade IV motility (P = 0.02). It was concluded that steroid treatment is effective in treating subfertile men with antisperm antibodies; it suppresses certain isotypes on different locations and improves motility. The isotype IgG against the tails of spermatozoa is a specific predictor for pregnancy for men to be treated with prednisolone.
Key words: antisperm antibodies/male subfertility/steroid therapy
Submitted on February 7, 1994; accepted on August 1, 1994.
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