Treatment of sperm autoimmunity in men.

Positive sperm immobilization tests were found in the sera of 6.3% of 491 infertile men. There was a higher frequency of family histories of autoimmune diseases than for other subfertile men. Prognosis for fertility was related to results of sperm-mucus penetration tests: progressively motile sperm indicated a fair outlook--8 of 15 couples conceived within 7 months either spontaneously or with artificial insemination with husband's semen. Absence of progressively motile sperm indicated severe infertility - only 6 of 72 couples produced pregnancies. Treatment of the latter group by temporary suppression of spermatogenesis with testosterone or with Artificial Insemination by Husband (AIH) appeared to be ineffective. However, sperm immobilization titres fell and sperm concentrations, motility and mucus penetration increased during treatment of 14 of the men with prednisolone (0.5-0.75 mg/kg per day) for 4-7 months and there were three pregnancies. It is concluded that sperm autoimmunity in men causing failure of sperm to penetrate cervical mucus produces severe but not absolute infertility. Immunosuppression with continuous high dose glucocorticoid reduces antibody levels and improves semen quality. A controlled trial is needed to determine if this treatment is a practical method for improving fertility in men with sperm autoimmunity.