Anti-sperm antibodies and vasovasostomy

We have to know at least two things about this couple: Sperm continue to be present; and the wife has been thoroughly evaluated and is without any evident gynecologic problem. Anti-sperm antibodies are present in >80% of men who have had vasectomy and the current success rate of vasovasotomy >90% speaks against anti-sperm antibodies being a problem in most men. My recommendations if the sperm count is < 20 million/cc: 1) continue to pray to the "mother's saint" Gerard Majella, for wisdom, guidance, and intervention; 2) have the urologist check for prostatitis (are their inflammatory cells in the prostate fluid, so-called "leukospermia"? If so treat with Bactrim for an appropriate length of time); 3) take the nutritional aid ProXeed Plus (the amino acid L-carnitine, available at proxeed.com) indefinitely; 4) if no pregnancy occurs within 6 months and a repeat sperm count remains low check the luteinizing hormone (LH), follicle-stimulating hormone (FSH) and testosterone levels. If these are low daily oral clomiphene citrate has a decent chance of increasing those levels and stimulating sperm production. If even this medication is ineffective then the powerful hormone human chorionic gonadotropin (hCG) may be used under the direction of an endocrinologist. Lastly if in a rare case laboratory studies show that anti-sperm antibodies actually are interfering with conception (typically the sperm count is normal but the sperm clump together and are unable to move properly due to the "glue" of the antibiodies) the oral steroid prednisone has been shown to free up the sperm and improve the chance of pregnancy, but beware that the 40-80 mg/day dose causes significant side effects. Dr. Gregory Polito