A Comparison of Controlled Ovarian Hyperstimulation with Intrauterine Insemination to in vitro Fertilization and Embryo Transfer in the Treatment of Male Infertility Caused by Sperm Surface Antibodies / 대한산부인과학회잡지

ABSTRACT

This prospective study was performed to evaluate the effectiveness of controlled ovarian hyperstimulation(COH) with intrauterine insemination(IUI) versus in vitro fertilization and embryo transfer(IVF-ET) in the treatment of male infertility caused by sperm surface antibodies. From March 1995 to August 1996, 29 couples with male immunologic infertility entered the trial. Only men with >or=40% motile spermatozoa with bound antibodies of immunoglobulin (Ig)G, IgA or a combination of both in direct immunobead test(IBT) were included in this study. There was no evidence of other factors in infertility in any infertile couples. The couples were randomized to undergo either COH with IUI(IUI group), or IVF-ET(IVF group). IUI group and IVF group were similar with respect to female and male age, duration of infertility, and IBT results. There were no significant differences between two groups with regard to the amount of gonadotropins required, days of gonadotropins administration, serum estradiol concentration on the day of human chorionic gonadotropin(hCG) administration, the number of mature (>or=14mm) follicles, or endometrial thickness. A total of 10 clinical pregnancies were obtained in IUI group, and 12 in IVF group. In 2 of 30 IVF cycles, intracytoplasmic sperm injection(ICSI) was performed because of fertilization failure. One patient became pregnant after ICSI. There were no significant differences between two groups in the clinical pregnancy rate per cycle (31.3% vs 40.0%), miscarriage rate(20.0% vs 8.3%), and multiple pregnancy rate(20.0% vs 16.7%). There were also no significant differences in pregnancy outcome between two groups according to the Ig isotype of sperm surface antisperm antibody(ASA)(GA group, IgG ASA >or= 40%, IgA ASA>or=40%; G group, IgG ASA >or=40%, IgA or=40%). This study suggests that it could be reasonable to offer COH with IUI to the patients with infertility caused by sperm surface ASA, prior to their referral for more expensive and invasive procedure, IVF-ET.