An in vivo technique for screening immunologic factors in the etiology of the unexplained poor postcoital test.
A study was designed to determine the incidence and etiology of the unexplained poor postcoital test. An in vivo comparison of sperm penetration by husband's versus donor sperm in the wife's estrogen-stimulated mucus was performed. The 8 of 30 women showing improvement of husband's penetration in mucus (group 1) were treated with high-dose estrogen (HDE) and hMG, and 4/8 conceived. Anti-sperm antibodies (ASA) were insignificant in this group. In group 2, in which donor sperm penetrated but husband's sperm did not, 8 men of 17 were found to have an ASA level over 50% on the sperm surface; 6/8 treated with high-dose methylprednisolone (MP) had an improved postcoital test, and 5 achieved a pregnancy. Two patients with levels under 50% were still treated with MP, and one achieved a pregnancy. In five group-3 couples, positive ASA were found in the cervical mucus of two women; and one woman improved on the postcoital test and conceived following MP therapy. The 30 unexplained poor postcoital tests occurred in 5,000 couples evaluated. In general, those patients considered to have significant clinical antibody had levels over 50%. Because side effects of MP may be severe, and positive ASA may be found in normal donors, it is important to use a comparison penetration test to help determine if treatment with corticosteroids seems reasonable.
Check
J H
JH
Department of Obstetrics and Gynecology, UMDNJ, Robert Wood Johnson Medical School, Camden.
Nowroozi
K
K
Adelson
H G
HG
Bollendorf
A
A
Chern
R
R
Press
M
M
D002582:Cervix Mucus / Q000276:immunology; D004967:Estrogens / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007070:Immunoglobulin A / Q000032:analysis / Q000276:immunology; D007074:Immunoglobulin G / Q000032:analysis / Q000276:immunology; D007246:Infertility / Q000188:drug therapy / Q000209:etiology* / Q000276:immunology; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D013084:Sperm-Ovum Interactions / Q000187:drug effects / Q000276:immunology*; D013094:Spermatozoa / Q000276:immunology
D004967:Estrogens; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D008775:Methylprednisolone