Julian N. Robinson

A comparison of intrauterine insemination in superovulated cycles to intercourse in couples where the male is receiving steroids for the treatment of autoimmune infertility

OBJECTIVE To compare IUI with timed intercourse in men receiving oral steroid therapy for the treatment of infertility associated with antisperm antibodies. DESIGN A prospective, randomized, cross-over trial. SETTING All patients were managed and treated at the Andrology Unit, Churchill Hospital, Oxford, United Kingdom. PATIENTS AND PARTICIPANTS Thirty males who were found to have antisperm levels of > or = 50% [using the indirect immunobead test with isotypes immunoglobulin (Ig) G, IgA, and IgM (GAM) beads] in either seminal plasma or serum on routine testing were recruited with their partners into the study. MAIN OUTCOME MEASURES Antisperm antibody levels in seminal plasma and serum, sperm parameters, conception rates, and pregnancy outcome. RESULTS There was a statistically significant reduction in seminal plasma antisperm antibody levels associated with steroid therapy. There was a significant improvement in certain spermatozoan parameters during steroid therapy. The cumulative pregnancy rate over four cycles of IUI was 39.4%. The cumulative pregnancy rate over four cycles of natural intercourse was 4.8%. There was a significantly higher chance of achieving a pregnancy with IUI. CONCLUSION Intrauterine insemination significantly improves the chance of achieving a conception when used as an adjuvant therapy to cyclical intermediate dose steroid therapy. Antisperm antibody levels in seminal plasma are significantly reduced during treatment with cyclical intermediate dose steroid therapy, although levels in serum appear to be unaffected. Cyclical intermediate dose steroid therapy significantly improves certain sperm parameters but, when used in isolation, is associated with a low pregnancy rate.

Detection of antisperm antibodies in seminal plasma by flow cytometry: comparison with the indirect immunobead binding test.

OBJECTIVE To compare flow cytometry with the established indirect immunobead binding test (IBT) for the detection of antisperm antibodies in seminal plasma. DESIGN A prospective, comparative study. SETTING University-based andrology unit. PATIENT(S) One hundred and fifty-eight men with suspected male factor subfertility. INTERVENTION(S) Seminal plasma samples were incubated with antisperm antibody-negative donor sperm. Surface-bound antibody was detected with fluorescence-labeled antihuman antibody in the flow cytometry assay or with immunobead-labeled antihuman antibody in the IBT. MAIN OUTCOME MEASURE(S) The percentage of sperm that tested positive for surface-bound antibody was determined in the two assays. Seminal plasma was antisperm antibody-positive when > or = 20% of the sperm were antibody-bound, and clinically significant levels were present when > or = 50% of the sperm were antibody-bound. RESULT(S) Of 71 samples that were negative by the IMT, 66 (93%) also were negative by flow cytometry. Of 63 samples that had > or = 50% immunobead binding, 55 had equivalent results by flow cytometry. Overall statistical analysis showed a good correlation between the two assays. CONCLUSION(S) There is a good correlation between the indirect IBT and indirect flow cytometry for the detection of antisperm antibodies in seminal plasma.

Ectopic pregnancy after luteal phase initiation of gonadotropin-releasing hormone analog before in vitro fertilization

Three patients had an undetected pregnancy when they commenced a GnRH-a on the 21st day of their cycle before ovulation stimulation for IVF. Two of the three pregnancies were later diagnosed as ectopic gestations. Based on this and previous case reports in the literature, it is suggested that luteal phase administration of GnRH-a may predispose to EPs, particularly in patients with damaged tubes, by reducing tubal motility secondary to a transient increase in circulating P concentrations.

Does large loop excision of the transformation zone of the cervix predispose to the development of antisperm antibodies in women

OBJECTIVE To determine whether large loop excision of the transformation zone of the uterine cervix for cervical intraepithelial neoplasia predisposes to the development of female isoimmunity to human spermatozoa. DESIGN A prospective, controlled study. SETTING Colposcopy and Andrology units at the John Radclife and Churchill Hospitals, Oxford, United Kingdom. INTERVENTIONS Serum samples were collected from 33 women before large loop excision of the transformation zone of the cervix and repeated at a minimum time interval of 4 months after the procedure. Women were questioned regarding the procedure and subsequent reproductive function. A control population of 30 women not undergoing cervical surgery also underwent serial serum screening for antisperm antibodies. MAIN OUTCOME MEASURE(S) The detection of serum antisperm antibodies by flow cytometry. RESULTS None of the serum samples before large loop excision of the cervical transformation zone had clinically significant levels of antisperm antibodies. There was, however, a significant rise in antisperm antibody levels in women following large loop excision of the transformation zone. Apparent risk factors for the development of antisperm antibodies included a short duration of sexual abstinence and the use of nonbarrier contraception after surgery. There was no rise in antisperm antibody levels in the control population. CONCLUSION Large loop excision of the transformation zone of the cervix is a risk factor for the development of antisperm antibodies in women. Women should be advised to use barrier contraception or avoid sexual intercourse until complete healing of the cervix has occurred.

A comparative analysis of two preparations of human chorionic gonadotrophin

A biophysical analysis of two pharmaceutical preparations of human chorionic gonadotrophin (Endo and Profasi) demonstrated that both contained high hCG specific activity. HCG protein analysis by occlusion HPLC and SDS gel electrophoresis showed similar profiles for both products. Although the purified protein components of both preparations were similar their were differences in the contents of the unpurified preparations. The Endo preparation exhibited greater inter-vial variability and contained an unidentified aromatic substance which interacted with the desalting column.