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Improvement in pregnancy outcomes in couples with immunologically male infertility undergoing prednisolone treatment and conventional in vitro fertilization preceded by sperm penetration assay: a randomized controlled trial

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Abstract

Purpose

Anti-sperm antibodies (ASA) in men impair not only sperm motility but also fertilization and conception. However, utilization of corticosteroids to suppress ASA has shown variable pregnancy outcomes. This controversy is also extended to include the usefulness of conventional in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) in treatments of men with ASA. This study was therefore designed to define factors contributing to these inconsistent results.

Methods

Infertile men having ASA (n = 241) were randomly assigned for treatment with or without prednisolone for three cycles each of 21 days of their partner’s menstrual cycles. Control and treated men underwent then human sperm penetration assay (SPA), of hamster oocytes, to diagnose men with impaired sperm fusogenic capacity. Men with positive or negative SPA results were admitted to conventional IVF or ICSI programs, respectively.

Results

Treated patients had improved sperm motility and progressive motility when compared to control patients (P < 0.001). Fertilization (P = 0.04), embryo cleavage (P = 0.01), and chemical (P = 0.02) and clinical (P = 0.04) pregnancy rates were higher in treated patients than in control patients undergoing conventional IVF but not ICSI cycles.

Conclusions

Men with ASA may also have compromised sperm fusogenic capacity, which can mask the clinical significance of corticosteroids. Corticosteroid administration in men with ASA, but without compromised sperm fusogenic capacity, improves conventional IVF but not ICSI outcomes; the reason being that ICSI bypasses issues of compromised fusogenic capacity. Inclusion of SPA in infertility clinics that offer both conventional IVF and ICSI services may be useful to identify which patients with ASA benefit from corticosteroid treatments.

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Abbreviations

ASA:

Anti-sperm antibodies

ART:

assisted reproductive technology

BWW:

Biggers, Whitten, Whittingham

hCG:

human chorionic gonadotropin

IVF:

in vitro fertilization

ICSI:

intracytoplasmic sperm injection

SPA:

sperm penetration assay

SCI:

sperm capacitation index

TAT:

tray agglutination test

References

  1. T.S. Li, Sperm immunology, infertility, and fertility control. Obstet. Gynecol. 44, 607–623 (1974)

    CAS  PubMed  Google Scholar 

  2. M.J. Baskin, Temporary sterilization by the injection of human spermatozoa. A preliminary report. Am. J. Obstet. Gynecol. 24, 892–897 (1932)

    Article  Google Scholar 

  3. A.C. Menge, O. Beitner, Interrelationships among semen characteristics, antisperm antibodies, and cervical mucus penetration assays in infertile human couples. Fertil. Steril. 51, 486–492 (1989)

    Article  CAS  PubMed  Google Scholar 

  4. A.E. Omu, F. al-Qattan, B. Abdul Hamada, Effect of low dose continuous corticosteroid therapy in men with antisperm antibodies on spermatozoal quality and conception rate. Eur. J. Obstet. Gynecol. Reprod. Biol. 69, 129–134 (1996)

    Article  CAS  PubMed  Google Scholar 

  5. C. Wang, A. Leung, W.L. Tsoi, J. Leung, V. Ng, K.F. Lee, S.Y. Chan, Evaluation of human sperm hyperactivated motility and its relationship with the zona-free hamster oocyte sperm penetration assay. J. Androl. 12, 253–257 (1991)

    CAS  PubMed  Google Scholar 

  6. R.A. Bronson, G.W. Cooper, D.L. Rosenfeld, Autoimmunity to spermatozoa: Effect on sperm penetration of cervical mucus as reflected by postcoital testing. Fertil. Steril. 41, 609–614 (1984)

    Article  CAS  PubMed  Google Scholar 

  7. R.A. Bronson, G.W. Cooper, D.L. Rosenfeld, Sperm-specific isoantibodies and autoantibodies inhibit the binding of human sperm to the human zona pellucida. Fertil. Steril. 38, 724–729 (1982)

    Article  CAS  PubMed  Google Scholar 

  8. C. Bohring, W. Krause, Characterization of spermatozoa surface antigens by antisperm antibodies and its influence on acrosomal exocytosis. Am. J. Reprod. Immunol. 50, 411–419 (2003)

    Article  PubMed  Google Scholar 

  9. B. Ayvaliotis, R. Bronson, D. Rosenfeld, G. Cooper, Conception rates in couples where autoimmunity to sperm is detected. Fertil. Steril. 43, 739–742 (1985)

    Article  CAS  PubMed  Google Scholar 

  10. M.H. Vazquez-Levin, J.A. Notrica, E. Polak de Fried, Male immunologic infertility: sperm performance on in vitro fertilization. Fertil. Steril. 68, 675–681 (1997)

    Article  CAS  PubMed  Google Scholar 

  11. W.R. Yeh, A.A. Acosta, H.J. Seltman, G. Doncel, Impact of immunoglobulin isotype and sperm surface location of antisperm antibodies on fertilization in vitro in the human. Fertil. Steril. 63, 1287–1292 (1995)

    Article  CAS  PubMed  Google Scholar 

  12. W.F. Hendry, K. Treehuba, L. Hughes, J. Stedronska, J.M. Parslow, J.A. Wass, G.M. Besser, Cyclic prednisolone therapy for male infertility associated with autoantibodies to spermatozoa. Fertil. Steril. 45, 249–254 (1986)

    Article  CAS  PubMed  Google Scholar 

  13. W.F. Hendry, L. Hughes, G. Scammell, J.P. Pryor, T.B. Hargreave, Comparison of prednisolone and placebo in subfertile men with antibodies to spermatozoa. Lancet 335, 85–88 (1990)

    Article  CAS  PubMed  Google Scholar 

  14. D. Keane, D.M. Jenkins, T. Higgins, M. O’Neill, M.F. Mulcahy, J.B. Ferriss, The effect of intermittent steroid therapy on anti-sperm antibody levels. Eur. J. Obstet. Gynecol. Reprod. Biol. 63, 75–79 (1995)

    Article  CAS  PubMed  Google Scholar 

  15. M. Bals-Pratsch, M. Doren, B. Karbowski, H.P. Schneider, E. Nieschlag, Cyclic corticosteroid immunosuppression is unsuccessful in the treatment of sperm antibody-related male infertility: a controlled study. Hum. Reprod. 7, 99–104 (1992)

    Article  CAS  PubMed  Google Scholar 

  16. M. De Almeida, D. Feneux, C. Rigaud, P. Jouannet Steroid therapy for male infertility associated with antisperm antibodies. Results of a small randomized clinical trial.Int. J. Androl. 8, 111–117 (1985)

    Article  PubMed  Google Scholar 

  17. G.G. Haas Jr, P. Manganiello, A double-blind, placebo-controlled study of the use of methylprednisolone in infertile men with sperm-associated immunoglobulins. Fertil. Steril. 47, 295–301 (1987)

    Article  PubMed  Google Scholar 

  18. K. Pagidas, R. Hemmings, T. Falcone, P. Miron, The effect of antisperm autoantibodies in male or female partners undergoing in vitro fertilization-embryo transfer. Fertil. Steril. 62, 363–369 (1994)

    Article  CAS  PubMed  Google Scholar 

  19. A. Zini, J. Lefebvre, G. Kornitzer, F. Bissonnette, I.J. Kadoch, N. Dean, S. Phillips, Anti-sperm antibody levels are not related to fertilization or pregnancy rates after IVF or IVF/ICSI. J. Reprod. Immunol. 88, 80–84 (2011)

    Article  CAS  PubMed  Google Scholar 

  20. A. Zini, N. Fahmy, E. Belzile, A. Ciampi, N. Al-Hathal, A. Kotb, Antisperm antibodies are not associated with pregnancy rates after IVF and ICSI: systematic review and meta-analysis. Hum. Reprod. 26, 1288–1295 (2011)

    Article  PubMed  Google Scholar 

  21. A. Lahteenmaki, I. Reima, O. Hovatta, Treatment of severe male immunological infertility by intracytoplasmic sperm injection. Hum. Reprod. 10, 2824–2828 (1995)

    Article  CAS  PubMed  Google Scholar 

  22. J.N. Robinson, R.G. Forman, S.C. Nicholson, L.R. Maciocia, D.H. Barlow, A comparison of intrauterine insemination in superovulated cycles to intercourse in couples where the male is receiving steroids for the treatment of autoimmune infertility. Fertil. Steril. 63, 1260–1266 (1995)

    Article  CAS  PubMed  Google Scholar 

  23. J. Friberg, A simple and sensitive micro-method for demonstration of sperm-agglutinating activity in serum from infertile men and women. Acta. Obstet. Gynecol. Scand. Suppl. 36, 21–29 (1974)

    Article  CAS  PubMed  Google Scholar 

  24. P.J. Chan, D.R. Tredway, B.C. Su, J. Corselli, B.J. Davidson, M. Sakugawa, Sperm hyperactivation as quality control for sperm penetration assay. Urology 39, 63–66 (1992)

    Article  CAS  PubMed  Google Scholar 

  25. W.F. Hendry, J. Stedronska, J. Parslow, L. Hughes, The results of intermittent high dose steroid therapy for male infertility due to antisperm antibodies. Fertil. Steril. 36, 351–355 (1981)

    Article  CAS  PubMed  Google Scholar 

  26. T.B. Hargreave, R.A. Elton, Treatment with intermittent high dose methylprednisolone or intermittent betamethasone for antisperm antibodies: Preliminary communication. Fertil. Steril. 38, 586–590 (1982)

    Article  CAS  PubMed  Google Scholar 

  27. K.K. Sharma, C.L. Barratt, M.J. Pearson, I.D. Cooke, Oral steroid therapy for subfertile males with antisperm antibodies in the semen: prediction of the responders. Hum. Reprod. 10, 103–109 (1995)

    Article  CAS  PubMed  Google Scholar 

  28. P. Curtis, S. Preutthipan, K. Gleeson, R.W. Shaw, Effect of low-dose prednisolone on sperm fertilizing capacity in subfertile men with circulating antisperm antibodies. Arch. Androl. 33, 111–118 (1994)

    Article  CAS  PubMed  Google Scholar 

  29. O. Grigoriou, S. Konidaris, V. Antonaki, C. Papadias, G. Antoniou, A. Gargaropoulos, Corticosteroid treatment does not improve the results of intrauterine insemination in male subfertility caused by antisperm antibodies. Eur. J. Obstet. Gynecol. Reprod. Biol. 65, 227–230 (1996)

    Article  CAS  PubMed  Google Scholar 

  30. H. Shibahara, M. Mitsuo, M. Inoue, A. Hasegawa, M. Shigeta, K. Koyama, Relationship between human in-vitro fertilization and intracytoplasmic sperm injection and the zona-free hamster egg penetration test. Hum. Reprod. 13, 1928–1932 (1998)

    Article  CAS  PubMed  Google Scholar 

  31. B. Zausner-Guelman, L. Blasco, D.P. Wolf, Zona-free hamster eggs and human sperm penetration capacity: a comparative study of proven fertile donors and infertility patients. Fertil. Steril. 36, 771–777 (1981)

    Article  CAS  PubMed  Google Scholar 

  32. E.Y. Ko, E.S. Sabanegh Jr, A. Agarwal, Male infertility testing: reactive oxygen species and antioxidant capacity. Fertil. Steril. 102, 1518–1527 (2014)

    Article  CAS  PubMed  Google Scholar 

  33. Z.P. Nagy, G. Verheyen, J. Liu et al., Results of 55 intracytoplasmic sperm injection cycles in the treatment of male-immunological infertility. Hum. Reprod. 10, 1775–1780 (1995)

    Article  CAS  PubMed  Google Scholar 

  34. P.J. Chan, J.U. Corselli, W.C. Patton, J.D. Jacobson, S.R. Chan, A. King, A simple comet assay for archived sperm correlates DNA fragmentation to reduced hyperactivation and penetration of zona-free hamster oocytes. Fertil. Steril. 75, 186–192 (2001)

    Article  CAS  PubMed  Google Scholar 

  35. R.J. Aitken, D.S. Irvine, F.C. Wu, Prospective analysis of sperm-oocyte fusion and reactive oxygen species generation as criteria for the diagnosis of infertility. Am. J. Obstet. Gynecol. 164, 542–551 (1991)

    Article  CAS  PubMed  Google Scholar 

  36. S. Grunewald, T.M. Said, U. Paasch, H.J. Glander, A. Agarwal, Relationship between sperm apoptosis signalling and oocyte penetration capacity. Int. J. Androl. 31, 325–330 (2008)

    Article  CAS  PubMed  Google Scholar 

  37. R. Sanchez, W.B. Schill, Influence of incubation time/temperature on acrosome reaction/sperm penetration assay. Arch. Androl. 27, 35–42 (1991)

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

This study was funded by the Barz IVF Center for Embryo Research and Infertility Treatment (Barz2014) and University of Baghdad (March 9th, 2014). The authors thank Iraqi Ministry of Health for making this study possible.

Author contributions

S.A.M., A.M.T., and M.T.R. participated in research design. A.M.T., M.T.R., S.K.A., S.M.T., Z.A.K., and S.A.M. conducted the experiments. S.A.M., A.M.T., and M.E.K. performed data analysis and interpretations. A.M.T. wrote the manuscript, and all authors critically reviewed the manuscript and approved it.

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Authors and Affiliations

  1. Barz IVF Center for Embryo Research and Infertility Treatment, Koya Street, Brayate, Erbil 44001, Kurdistan, Iraq

    Ahmed M. Taiyeb, Mundhir T. Ridha-Albarzanchi, Shereen M. Taiyeb, Zuhair A. Kanan, Shahla K. Alatrakchi, Michael E. Kjelland & Saeeda A. Muhsen-Alanssari

  2. College of Medicine, University of Baghdad, Baghdad 10007, Iraq

    Mundhir T. Ridha-Albarzanchi, Zuhair A. Kanan & Saeeda A. Muhsen-Alanssari

  3. US Army Research and Development Center—USACE, 3909 Halls Ferry Rd., Vicksburg, MS 39180, USA

    Michael E. Kjelland

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  1. Ahmed M. Taiyeb
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Correspondence to Ahmed M. Taiyeb.

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Taiyeb, A.M., Ridha-Albarzanchi, M.T., Taiyeb, S.M. et al. Improvement in pregnancy outcomes in couples with immunologically male infertility undergoing prednisolone treatment and conventional in vitro fertilization preceded by sperm penetration assay: a randomized controlled trial. Endocrine 58, 448–457 (2017). https://doi.org/10.1007/s12020-017-1446-7

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  • DOI: https://doi.org/10.1007/s12020-017-1446-7

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