Sperm antibodies are present in 6% of infertile men. They have sperm coated with antibodies to the extent that sperm function is impaired, particularly sperm-mucus penetration and sperm-zona pellucida binding, resulting in severe infertility.
Natural pregnancy rates without treatment are very low, and fertilization rates with standard IVF are low or zero. Other men have positive Antibodies test, sometimes with tail tip-only binding and normal or only marginally impaired mucus penetration. These low-level sperm antibodies are probably irrelevant to the infertility, and other causes of the couple’s infertility should be sought. Sperm antibodies can be treated by steroids in immunosuppressive doses. Antibody levels fall, and semen quality improves in about 50% of patients; about 25% produce natural conceptions during a 4- to 6-month course of treatment. There are significant risks of severe side effects, particularly aseptic necrosis of bone. The superior results of ICSI make this treatment obsolete and only useful in exceptional circumstances.