Abstract Cows that require greater than two inseminations to conceive are diagnosed with repeat breeding syndrome (RBS). Anti-sperm antibodies (ASA) in serum are in greater abundance among individuals exhibiting fertility challenges. In humans, treatment with glucocorticoids has been shown to decrease the prevalence of ASA and improve fertility. Therefore, the purpose of this study was to determine the impact of dexamethasone on ASA and pregnancy outcomes in RBS cattle. Holstein multiparous cows (n = 18) diagnosed as having RBS were randomly allotted to one of three treatment groups: Control (C; n = 6), low dexamethasone (LD; n = 6) and high dexamethasone (HD; n = 6). Intramuscular injections of saline (C), 0.05 mg/kg of BW of dexamethasone (LD), or 0.10 mg/kg of BW of dexamethasone (HD) were administered daily starting 4 d prior to insemination (d 0) through insemination (d 4). All treatment volumes were standardized with saline to achieve the same treatment level. Blood was collected on d 0, 4, 8 and 18, with serum extracted on d 0 through 8. Additionally, milk weights were recorded until d 34. For breeding, cows were synchronized using the Double Ovsynch protocol and only one insemination was conducted at the time of breeding. The MIXED procedure in SAS was used to determine the relationship of treatment with the repeated measures of ASA abundance and milk yield. Additionally, a non-parametric chi-square analysis was conducted in SAS using PROC GENMOD to determine the relationship of treatment with immune cell count and pregnancy outcomes. Day, Treatment and Treatment × Day were designated as fixed effects, and a protected post hoc analysis was conducted to account for multiple comparisons. Anti-sperm antibodies tended to decrease (P ≤ 0.082) as dexamethasone increased compared with C, however, there was no Treatment × Day interaction. Daily milk yields for both LD and HD decreased (P < 0.002) compared with C cows, but there was no interaction with day. Though there was an effect for Treatment × Day (P ≤ 0.002) for white blood cell count, percentage lymphocytes, eosinophils, and neutrophils, there was no effect of treatment (P ≥ 0.181). Therefore, interaction differences were largely driven by day (P < 0.001). Surprisingly, there was a trend (P = 0.069) for an increase in pregnancy rates for C cows compared with LD and HD cows. In fact, one-half of the C cows achieved pregnancy compared with just one cow for LD and HD treatments. Overall, dosage of dexamethasone did not differ for ASA or pregnancy outcomes. However, dexamethasone did decrease ASA but did not increase pregnancy rates. Based on these results, we suggest that alternative treatment measures should be explored to improve pregnancy rates in RBS cows.