Our approach to the management of patients with antisperm antibodies is to identify and treat the underlying problem, ie, repair the obstruction or varicocele. If this is not successful, we initiate treatment with 20 mg of prednisone twice daily days 1-10 of the wives' cycle and 5 mg on days 11 and 12 for 3 months. Following this treatment course we reevaluate -for the presence of antibodies. Aseptic necrosis of the femoral head is the most devastating complication of steroid therapy (1 % incidence), although this is uncommon with short term (< 6 months), intermittent (12 days/month) therapy. We now recommend IVF with ICSI which is very successful for severe antibody problems.
