Pregnancies after ultrasound-guided fallopian insemination with cryostored donor semen.

Twenty-nine patients, previously treated unsuccessfully with a median 9.5 cycles of conventional intracervical donor insemination, were offered fallopian catheterization on the side of the dominant follicle and direct insemination at the presumed site of fertilization, the ampullary-isthmic junction. Forty-five of 50 cycles were associated with successful tubal catheterization and 6 of these cycles were conceptional. Five viable intrauterine pregnancies resulted. We conclude: (1) that direct sperm transfer to the fallopian tubes is possible without the need for anesthesia or operation; and (2) that at the time of ovulation, the fallopian tube isthmus can be catheterized without later interfering with ovum or embryo transport to the uterus. Optimum timing for fallopian catheterization in relation to ovulation and the risk of side effects both remain to be established.

Prevalence, testicular function and seminal parameters in men with sperm antibodies.

A prospective survey of 289 unselected men, attending a male infertility clinic (200 subjects) or as donors presenting for an artificial insemination programme (89 subjects) was performed. High titres of sperm agglutinating antibodies (greater than 1/32) were present only in a group of (6.5%) of infertile men but not in volunteer donors. Low titres occurred with similar frequencies (12%) in both groups. The sperm immobilizing antibody test was less sensitive and more specific but of no additional diagnostic benefit. Patients with high titres of sperm antibodies had evidence of testicular damage with decreased testicular volumes, elevated serum FSH and LH levels and reduced sperm density and motility whereas low titres were not associated with any testicular or seminal pathology. These data suggest a sub-group of infertile men have evidence of spermatogenic damage and impaired sperm function associated with high titres of sperm antibodies. Immunologic infertility in these men may reflect either an underlying autoimmune orchitis or a secondary immune reaction following testicular damage of various causes.

Successful pregnancy after occlusion therapy for high-titre sperm antibodies.

A 32-year-old woman presented with a five-year history of primary infertility. In addition to anovulation associated with hyperprolactinaemia, she was found to have high titres of anti-sperm antibodies of agllutinating and immobilizing types. These were present in both serum and cervical mucus. After the regular use of condoms for nine months, all antibody titres fell dramatically and immobilizing antibodies became undetectable. Successful pregnancy quickly ensued. This report documents in thorough detail for the first time the sequential antibody changes associated with successful occlusion therapy.

Local production of antisperm antibodies in infertile women.

The presence and significance of locally produced antisperm antibody in 20 well-documented infertile patients has been investigated. Sera and vaginal washings both from patients and from fertile controls were examined for antisperm antibody by means of four methods. Antisperm antibody was detected in 25% of the washings taken from infertile patients, but in none of those from fertile women. Detection of antibody by the microimmobilization technique discriminated best between infertile and fertile women both in serum (P=0.0166) and in washings (P=0.0166). The results of this study support the concept that locally produced antisperm antibody contributes to conception failure in a subgroup of infertile women, and that the routine study both of sera and of vaginal washings of infertile patients has practical value.

PIP: 20 women (mean age, 32 years) with infertility of at least 12 months duration (mean duration of infertility, 4.2 years) were studied to determine antisperm antibody in local secretions of infertile women. 33 fertile women who had just delivered 6-8 weeks before comprised the controls (mean age, 24.2 years). Antisperm antibody was detected using 4 techniques: 1) microagglutination tray test by Frieberg; 2) tube-slide microagglutination test by Franklin and Dukes; 3) microimmobilization test of Isojima as modified by Boettcher; and, 4) indirect immunofluorescent test of Hjort and Hansen. Cervical and vaginal washings were obtained from the subjects using the method of Waldman. Sperm samples of good quality (sperm count of about 6 x 10 to the seventh/ml; good motility of at least 70%; abnormal forms of less than 30%) were used. Antisperm antibody was found in the cervical-vaginal washings of 25% of the infertile patients and none in the fertile group. The sperm microimmobilization testwas the most discriminating test, giving positive results in the sera/washings of 20% of the infertile patients, and negative results in both the serum/washings of all controls (P=0.0166). The findings confirm the role of antisperm antibody in the conception failure of a subgroup of infertile women.