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Anti-sperm antibodies in semen have been associated with a decrease in fertility potential. The question arises as to whether intra-uterine insemination (IUI) can improve pregnancy rates by merely allowing earlier capacitation and close timing to ovulation, or whether certain treatments of the spermatozoa add extra benefit. The study presented herein was designed to compare IUI using Percoll density separation with an albumin treatment versus chymotrypsin/galactose treatment. Sixteen patients were evaluated where IUI was randomized between both sperm treatments. Pregnancy rates/cycle were 25% (eight of 32) with chymotrypsin/galactose-treated spermatozoa compared to only 3% (one of 33) cycles with albumin-treated spermatozoa (P < 0.01). Since it has been reported that the proportions of spermatozoa showing immunobead binding for specific antibodies after chymotrypsin/galactose treatment remain unchanged, the exact mechanism for improvement is unknown; possibly chymotrypsin/galactose interferes with the function of the antibodies.

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A previously published study reporting the use of a modified swim-up technique for sperm preparation prior to insemination which resulted in a high percentage of male births has been criticized for its lack of controls. The present prospective study was initiated to investigate further the efficacy of modified swim-up preparation for male sex-selection when applied in a properly defined control group. Our results showed that the proportion of males born in singleton pregnancies was approximately 50% in the group inseminated following sperm preparation with Percoll and in the control group with no sperm preparation compared with 88.5% in the group treated with the modified method of swim-up sperm preparation prior to insemination. This high rate of males in the group treated with modified swim-up was also observed in singleton pregnancies of women taking ovulation inducing drugs (primarily clomiphene citrate). This contrasts with previous publications in which a higher rate of females was found in clomiphene citrate patients using the albumin separation technique. How the mechanism of the swim-up procedure may result in a high male birth rate remains unclear. A high percentage of y enriched semen was found using fluorochrome quinacrine mustard staining but this procedure may falsely stain autosomal chromosomes. If analysis using sensitive DNA probes fails to confirm the y enrichment of the spermatozoa, one must hypothesize that the modified swim-up procedure damages the x-spermatozoa.