Assisted reproductive technologies may obviate apparent immunologic infertility

Spermatozoal autoantibodies have been associated with reduced fertilization by natural coital methods. Nine subfertile men were evaluated who repeatedly tested positive for spermatozoal autoantibodies as characterized by direct immunobead test. Using the hemizona assay, we determined whether tight binding of spermatozoa to the zona pellucida was reduced in these test males as compared to a fertile male whose semen had been cryopreserved and thawed immediately prior to testing. The average number of spermatozoa tightly bound to the zona pellucida from the subfertile male was significantly reduced compared to the fertile male (mean +/- SD, P less than or equal to 0.01) 19.5 +/- 8 versus 77.1 +/- 49. Seven of the nine couples eventually had successful fertilization using intrauterine insemination or gamete intrafallopian tube transfer and one couple conceived with natural coital insemination. Our findings, albeit limited, suggest that greater caution should be used in implicating associations of spermatozoal autoantibodies with absolute infertility, because novel assisted reproductive technologies often may obviate conventional encumbrances on opportunities for pregnancy.