My husband and I have just completed our first IVF/ICSI treatment. It did not work. Five eggs were retrieved, and only two fertilized. I was told that my lining was good. Our problem is that my husband has a high level of antibodies on his sperm. We were told he is at a significant level in all three categories, but I'm not sure what that means. We are now just starting our second try. The doctor suggested that we do ICSI and assisted hatching. How would this improve our chances? If this does not work for the second time, what other options should we try? Is there anything that can be done about the antibodies? I am 32 years old, and my husband is 35.

Kim

The role and significance of sperm antibodies is not clear. In general, antibodies are immune proteins that attach to a cell they perceive as foreign or dangerous; they then either destroy the cell or signal white blood cells to come and attack. Antibodies that attack sperm can adversely affect both sperm motility (movement) and the ability of the sperm to bind to the egg and fertilize it.

However, the story is not that clear and simple. No two sperm antibodies are alike. In fact, the body can create an antibody to any of the many proteins covering the outside of the sperm.

You mentioned that three types of antibodies were present. That could have two possible meanings. First, the antibodies might be directed at different parts of the sperm -- that is, the head, mid-portion or tail of the sperm. Antibodies directed at the head may adversely affect sperm-egg binding and fertilization, but that is not always the case. In fact, studies have shown that some antibodies may actually enhance the sperm's ability to attach to the egg. So, knowing that antibodies are present on the head does not always mean there will be a problem. Antibodies directed against proteins found on the tail generally result in diminished sperm motility. Those attacking the midpiece can cause both problems.

Antibodies also come in different classes: IgA, IgG and IgM. IgA is predominantly found in the woman's cervical mucus, where it interferes with sperm motility. IgG can be found circulating in the blood in either the male or female; it can be seen after vasectomy reversal or infection in the man, but the basis for these antibodies forming in the woman is less clear. IgM is usually an initial response to invasion by a foreign substance, and the cause and significance of these sperm antibodies is less clear.

As for treatment recommendations, without a review of your entire medical history and the last IVF cycle, I can't really advise you. Normally, however, I would recommend at least two or three cycles of IVF and ICSI before considering alternatives. I do not believe that routine use of assisted hatching offers much benefit for most women.

Moreover, because the IVF laboratory performed ICSI in the previous cycle, it actually avoided the problems caused by antibody-related infertility, so that should not be an issue here. However, I am a bit surprised that only five eggs were retrieved. On average, we retrieve over 12 eggs, and in someone your age, I would expect even more. So I wonder if there is not also an ovarian basis for concern. You and your doctor should consider anti-ovarian antibody testing. A study published in the summer of 1999 in the journal Human Reproduction suggested that supplementation with L-arginine may improve outcome in some cases. You should review these concerns with your physician to see if additional testing or treatment is advisable.