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Treatment of men with autoimmunity to spermatozoa
47 Blocking experiments, using spermatozoa incubated in spermagglutinatingonly sera from men which were then placed in spermimmobilising-only sera (plus complement) from women, showed that spermimmobilising a c t i v i t y was not reduced. I t is proposed, therefore, that on some occasions men and women respond to d i f f e r e n t spermatozoal antigens, which offers an explanation of the f i n d i n g that men commonly develop higher t i t r e s of spermagglutinating antibody than women and that women commonly have higher t i t r e s of spermimmobilising antibody. TREATMENT OF MEN WITH AUTOIMMUNITYTO SPERMATOZOA
DAVID KAY and BARRY BOETTCHER Department of Biological Sciences, U n i v e r s i t y of Newcastle, New South Wales. 2308 A u s t r a l i a . Antispermatozoal antibodies in seminal plasma are of e i t h e r the IgG or IgA class of immunoglobulins. Evidence indicates that spermatozoa from autoimmune men a r r i v e in the ejaculate already coated with IgG antibodies from t e s t i c u l a r and/or epididymal lesions, and absorb from the ejaculate secretory IgA a n t i bodies o r i g i n a t i n g mainly in the prostate f l u i d . IgA antibodies on seminal spermatozoa are the most e f f e c t i v e in i n h i b i t i n g progression of spermatozoa in the female t r a c t . This information has led to the development of a t r e a t ment protocol where the patient ejaculates d i r e c t l y into Tyrode's s o l u t i o n . The coagulum is extracted before l i q u e f a c t i o n , dispersed, the spermatozoa concentrated and used f o r i n t r a - u t e r i n e A.I.H. The detection of IgG and IgA on spermatozoal surfaces is undertaken by the M.A.R. and IgA Immunobead tests, respectively. To date, semen from 13 men has been treated in t h i s manner. In a l l cases s i g n i f i c a n t reduction and, in 5 patients, complete e l i m i n a t i o n of IgA on the spermatozoal surface was achieved, while IgG was not affected. Four pregnancies have been achieved (one patient twice), one patient elected not to continue, four have withdrawn a f t e r 3 unsuccessful cycles of insemination, one p a t i e n t ' s wife has additional unresolved problems, two have elected to have additional immunosuppressive therapy and the others are continuing treatment. I t is suggested that t h i s procedure is a useful treatment f o r the condition and should be used p r i o r to immunosuppression in men autoimmune to spermatozoa. CERTAIN FACTORS THAT INFLUENCE THE EFFECTIVENESS OF CORTICOSTEROID THERAPY FOR IMMUNOLOGICAL INFERTILITY DUE TO SPERM ANTIBODIES Subbi Mathur, H. Oliver Williamson~ Petrina V. G e n c % Lea C. Perry~ Philip F. Rust and H. Hugh Fudenberg, Medical University of South Carolina, Charleston S.C. 29425, U.S.A. The reasons for the ineffectiveness of corticosteroids in suppression of sperm antibody titers (AB) and achievement of a pregnancy in certain infertile couples, are not clear. Thirty nine of 79 (49%) infertile couples without AB achieved a pregnancy after treatment for other factors. In contrast, only 6 of 105 (6%) infertile couples with AB achieved a pregnancy without corticosteroids (P<0.001). Sixteen of 69 (23%) couples with AB and treated with prednisone achieved a pregnancy by 3 months, contrasted to 15 of 36 (41%) by 5 to 17 months. The percentage of couples achieving a pregnancy was significantly higher in the corticosteroid-treated than in the untreated AB positive group (P
DAVID KAY and BARRY BOETTCHER Department of Biological Sciences, U n i v e r s i t y of Newcastle, New South Wales. 2308 A u s t r a l i a . Antispermatozoal antibodies in seminal plasma are of e i t h e r the IgG or IgA class of immunoglobulins. Evidence indicates that spermatozoa from autoimmune men a r r i v e in the ejaculate already coated with IgG antibodies from t e s t i c u l a r and/or epididymal lesions, and absorb from the ejaculate secretory IgA a n t i bodies o r i g i n a t i n g mainly in the prostate f l u i d . IgA antibodies on seminal spermatozoa are the most e f f e c t i v e in i n h i b i t i n g progression of spermatozoa in the female t r a c t . This information has led to the development of a t r e a t ment protocol where the patient ejaculates d i r e c t l y into Tyrode's s o l u t i o n . The coagulum is extracted before l i q u e f a c t i o n , dispersed, the spermatozoa concentrated and used f o r i n t r a - u t e r i n e A.I.H. The detection of IgG and IgA on spermatozoal surfaces is undertaken by the M.A.R. and IgA Immunobead tests, respectively. To date, semen from 13 men has been treated in t h i s manner. In a l l cases s i g n i f i c a n t reduction and, in 5 patients, complete e l i m i n a t i o n of IgA on the spermatozoal surface was achieved, while IgG was not affected. Four pregnancies have been achieved (one patient twice), one patient elected not to continue, four have withdrawn a f t e r 3 unsuccessful cycles of insemination, one p a t i e n t ' s wife has additional unresolved problems, two have elected to have additional immunosuppressive therapy and the others are continuing treatment. I t is suggested that t h i s procedure is a useful treatment f o r the condition and should be used p r i o r to immunosuppression in men autoimmune to spermatozoa. CERTAIN FACTORS THAT INFLUENCE THE EFFECTIVENESS OF CORTICOSTEROID THERAPY FOR IMMUNOLOGICAL INFERTILITY DUE TO SPERM ANTIBODIES Subbi Mathur, H. Oliver Williamson~ Petrina V. G e n c % Lea C. Perry~ Philip F. Rust and H. Hugh Fudenberg, Medical University of South Carolina, Charleston S.C. 29425, U.S.A. The reasons for the ineffectiveness of corticosteroids in suppression of sperm antibody titers (AB) and achievement of a pregnancy in certain infertile couples, are not clear. Thirty nine of 79 (49%) infertile couples without AB achieved a pregnancy after treatment for other factors. In contrast, only 6 of 105 (6%) infertile couples with AB achieved a pregnancy without corticosteroids (P<0.001). Sixteen of 69 (23%) couples with AB and treated with prednisone achieved a pregnancy by 3 months, contrasted to 15 of 36 (41%) by 5 to 17 months. The percentage of couples achieving a pregnancy was significantly higher in the corticosteroid-treated than in the untreated AB positive group (P