Treatment of male infertility due to sperm surface antibodies: IUI or IVF?
This prospectively designed study was aimed at comparing the results of two different treatment protocols in 29 infertile couples with proven male immunological infertility, i.e. a positive (>50%) mixed antiglobulin reaction (MAR) test (IgG and/or IgA). In the first protocol (group I, n = 14) couples were treated with ovarian stimulation/ intrauterine insemination (IUI), followed by in-vitro fertilization (IVF) if no pregnancy occurred after three IUI cycles. In the second protocol (group II, n = 15), patients were treated with IVF as a first choice procedure. The decision to follow protocol 1 or 2 was made by the couples after information about financial costs and expected success rates (according to the literature) for both treatment options. In group I, nine patients (64.3%) conceived after a maximum of three IUI cycles whereas seven patients (46.6%) of group II became pregnant during the first IVF cycle. The take-home baby rate per started IUI or IVF cycle was 27.3% (9/33) and 44.4% (16/36) respectively with a take-home baby rate of 64.3% after three IUI cycles and 93.3% after three IVF attempts. To conclude, both IUI and IVF yielded unexpectedly high pregnancy rates in this selected group of patients with long-standing infertility due to sperm surface (predominantly IgG) antibodies. Since cost benefit analysis comparing superovulation IUI with IVF may favour a course of four IUI cycles, we advocate superovulation IUI as the first line therapy in male immunological infertility.
Ombelet
W
W
Genk Institute for Fertility Technology, St Jansziekenhuis, Belgium.
Vandeput
H
H
Janssen
M
M
Cox
A
A
Vossen
C
C
Pollet
H
H
Steeno
O
O
Bosmans
E
E
D000328:Adult; D001323:Autoantibodies / Q000378:metabolism*; D002985:Clinical Protocols; D003298:Coombs Test; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D007248:Infertility, Male / Q000175:diagnosis / Q000276:immunology* / Q000628:therapy*; D007317:Insemination, Artificial, Homologous; D008297:Male; D010062:Ovulation Induction; D011247:Pregnancy; D011446:Prospective Studies; D013094:Spermatozoa / Q000276:immunology*
D001323:Autoantibodies