Use of condoms to avoid contact between sperm and the female with antibodies has been abandoned because of lack of efficacy. The current office treatments for sperm antibodies in the male are the use of steroids or ejaculation into media containing protein combined with intrauterine inseminations.

The latter may decrease adherence of seminal plasma antibodies to the sperm but will not remove antibodies bound to the sperm prior to ejaculation. In an alternative treatment the sperm are separated on Percoll gradients, and then incubated with antibody beads. A population of sperm without antibody can be separated from the mix and utilized for insemination.

Moderate to high doses of corticosteroids have been used to treat sperm antibodies in the male. Reports of efficacy in reducing antibody levels and marginal increases in pregnancy rate have been balanced by sporadic reports of serious side effects such as aseptic necrosis of the femoral head and less severe side effects such as irritability. Hendry and coworkers47 gave males with sperm antibodies prednisolone 20 mg bid from days 1 to 10 of their partners' cycles, follittleed by 5 mg on days 11 and 12. The dosage was increased if the antibody titer did not fall in 3 months. Nine of 29 who received prednisolone achieved pregnancy, whereas only 1 of 20 who received placebo was successful. An important point is that an advantage for prednisolone was not seen until after 5 months of treatment. Prior to that time pregnancy rates in the treated and the placebo groups were similar. Others have not seen success with steroid treatment although dosage may be a critical factor. We have encountered antibody positive men with poor to zero performance on sperm penetration assays who have improved sperm penetration and achieved pregnancy with treatment consisting of prednisone, 5 mg tid for at least 3 months.

Similar corticosteroid treatment in the female has not been aggressively investigated or used.
The most popular therapy involves intrauterine insemination of washed spermatozoa in conjunction with gonadotropin treatment of the female. Determination of the efficacy of this treatment has been hindered by difficulties in deciding what constitutes a positive sperm antibody test in the female and reports that lumped together patients who were antibody positive with others who may not have been afflicted with antibodies but who had poor postcoital tests.
Use of in vitro fertilization, with placement of sperm near the oocyte, is a reasonable final approach to the treatment of sperm antibodies in both the male and the female. If antibody is hampering sperm transport, IVF is a means of overcoming this problem. If the female is positive for antibodies, her serum is not used in the culture medium. If the male is positive for antibodies, he can ejaculate into medium containing protein as a preliminary to utilizing swimup or Percoll separation of the sperm. Even if many of the sperm continue to be hampered by antibody bound to their surface, there are almost always some sperm that are antibody-free. These sperm would gain a competitive advantage by being placed close to the egg in the IVF procedure. Success with in vitro fertilization is reduced in severals with sperm antibodies, but once fertilization occurs, the probability of pregnancy is not affected. Micromanipulation (Chapter 31) should be considered when IVF failures.

Donor insemination is an alternative therapy for antibodies in the male and possibly in the female if she reacts only to her partner's sperm.