Indications for corticosteroids prior to epididymal sperm retrieval.
OBJECTIVE
To evaluate the effectiveness of low-dose intermittent prednisone treatment designed to reduce antisperm antibodies for men prior to epididymal sperm retrieval and in vitro fertilization.


METHODS
This was a retrospective review of 75 subfertile men with reproductive obstruction due to congenital absence of the vas deferens, or other reproductive tract obstruction, who underwent a total of 98 episodes of microsurgical epididymal sperm aspiration (MESA) with in vitro fertilization.


RESULTS
For couples in whom the man was pretreated with prednisone, better fertilization rates (39% vs. 21%, P < .0001) and pregnancy rates (48% vs. 26%, p = 0.06) were obtained than in couples in whom the man was not pretreated. The benefit of prednisone treatment was most noticeable for men with preoperatively detectable antisperm antibodies. Prednisone-treated men with preoperative antisperm antibodies showed improved fertilization rates (40% vs. 9%, p = 0.005). Men without antibodies who were treated with prednisone showed a decrement in fertilization rate, from 73% to 24% (fertilizations per oocyte, P < .0005). Success of prednisone treatment could not be correlated with specific assisted-reproduction technique (IVF, PZD, SuZI, or ICSI).


CONCLUSIONS
Preoperative evaluation of antisperm antibody status and treatment of antibody-positive men prior to epididymal sperm retrieval may play a role in improvement of the fertilization and pregnancy results achieved by centers that provide MESA with assisted reproduction. These results are most important when MESA is performed without the assistance of intracytoplasmic sperm injection. Empiric treatment with prednisone may be detrimental to the fertility of men who have no antisperm antibodies.
James Buchanan Brady Foundation, Department of Urology, New York, New York, USA.
D
D
Shin
G D
GD
Palermo
M
M
Goldstein
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Z
Rosenwaks
P N
PN
Schlegel
D000328:Adult; D000906:Antibodies / Q000187:drug effects; D016009:Chi-Square Distribution; D004822:Epididymis / Q000166:cytology / Q000187:drug effects* / Q000473:pathology; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage* / Q000009:adverse effects; D011247:Pregnancy / Q000706:statistics & numerical data*; D012099:Reproductive Techniques; D013094:Spermatozoa / Q000166:cytology / Q000187:drug effects* / Q000276:immunology; D013396:Suction
D000906:Antibodies; D005938:Glucocorticoids; D011241:Prednisone