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Positive sperm immobilization tests were found in the sera of 6.3% of 491 infertile men. There was a higher frequency of family histories of autoimmune diseases than for other subfertile men. Prognosis for fertility was related to results of sperm-mucus penetration tests: progressively motile sperm indicated a fair outlook--8 of 15 couples conceived within 7 months either spontaneously or with artificial insemination with husband's semen. Absence of progressively motile sperm indicated severe infertility - only 6 of 72 couples produced pregnancies. Treatment of the latter group by temporary suppression of spermatogenesis with testosterone or with Artificial Insemination by Husband (AIH) appeared to be ineffective. However, sperm immobilization titres fell and sperm concentrations, motility and mucus penetration increased during treatment of 14 of the men with prednisolone (0.5-0.75 mg/kg per day) for 4-7 months and there were three pregnancies. It is concluded that sperm autoimmunity in men causing failure of sperm to penetrate cervical mucus produces severe but not absolute infertility. Immunosuppression with continuous high dose glucocorticoid reduces antibody levels and improves semen quality. A controlled trial is needed to determine if this treatment is a practical method for improving fertility in men with sperm autoimmunity.

The immunobead test (IBT) is a new method of detecting antisperm antibodies with the advantages of enabling determination of the presence of antisperm antibodies during routine semen analysis, immunoglobulin isotypes and antibody specificity for binding to sperm structures such as head or tail. The IBT is compared with the conventional methods of detecting antisperm antibodies in serum; the tray agglutination test (TAT) and the sperm immobilization test (SIT). Positive IBT (50% or more of washed motile sperm binding to anti-IgG and/or anti-IgA immunobeads) were found in 6.8% of 689 men being investigated for infertility. Both IgG and IgA were found to be present in all cases. The IBT correlated closely with the serum antisperm antibody tests; of the 202 men tested by all three methods, 200 (99%) were either positive for circulating antibodies and IBT or negative for both. No men with serum antisperm antibodies lacked local antisperm antibodies as detected by IBT, and only two men (1%) were IBT positive in the absence of either one or both types of circulating antibodies. Individually, the TAT and the SIT correlated equally well with the IBT; 97% and 98% of men tested by TAT and IBT, and SIT and IBT respectively, were either positive by both or negative by both. It is concluded that the IBT is an excellent procedure for the detection of sperm antibodies.