Diagnosis and treatment of immunologically infertile males with antisperm antibodies

Abstract

The presence of antisperm antibodies (ASA) can reduce fecundity in both males and females. The present review describes a strategy, established by investigations of the diverse inhibitory effects of ASA on fertility, for the appropriate diagnosis and treatment of infertile males with ASA. For infertile males with ASA, diagnosis using the direct-immunobead test (D-IBT), the postcoital test (PCT) and the hemizona assay (HZA) should be carried out as the basis for decision-making. If the patient with ASA has an abnormal hemizona index, it seems reasonable to advise selecting intracytoplasmic sperm injection-embryo transfer (ICSI-ET) as a primary treatment. However, it has been shown that some immunologically infertile males with normal fertilizing ability established pregnancy by timed intercourse (TI) or intrauterine insemination (IUI). In such patients with ASA having normal hemizona index, TI or IUI can be selected based on the PCT result. Therefore, the treatment strategy for males with ASA is similar to that for infertile males with oligozoospermia or asthenozoospermia. In conclusion, it should be emphasized that a diversity of ASA exists and their effects on fertility in infertile males. Although there is an argument that routine testing for ASA in males is not always necessary, one should be aware that in some cases of failed IUI or IVF, ICSI is selected afterward because of the diagnosis of ASA. (Reprod Med Biol 2005; : 133-141).

Antisperm antibodies in infertile men and their correlation with seminal parameters

“…It can be inferred with certainty that there are specific antibodies that affect reproduction. In this manner, an effective diagnosis of antibody pathology might lead to less invasive treatments at a lower cost and shorter duration, in contrast to the utilization of the new methodologies of assisted reproduction, such as intracytoplasmic sperm injection 33,35,36 . Improved diagnosis and treatment of immunologic infertility, as well as a more complete understanding of the mechanism behind this phenomenon, are dependent on the identification and characterization of relevant sperm antigens 37 …”

“…In this manner, an effective diagnosis of antibody pathology might lead to less invasive treatments at a lower cost and shorter duration, in contrast to the utilization of the new methodologies of assisted reproduction, such as intracytoplasmic sperm injection. 33,35,36 Improved diagnosis and treatment of immunologic infertility, as well as a more complete understanding of the mechanism behind this phenomenon, are dependent on the identification and characterization of relevant sperm antigens. 37 Despite several semen parameters being believed to be affected by ASA, 33 consistent semen analysis abnormalities that can reliably identify infertile men who are at risk of harboring ASA have not been identified.…”

Definitions and Epidemiology of Unexplained Male Infertility

“…Prefertilization effects from ASA include sperm agglutination, sperm cytotoxicity, poor cervical penetration, acrosome reaction, and poor oocyte binding [28,29]. Sperm agglutination can impair motility and cervical penetration and is higher in patients with the presence of ASA [30,31].…”

Autoimmune Orchitis

“…Documented orchitis cases due to autoimmune diseases are illustrated in Table 53 Testis has a privileged immune condition, but it accessible to the immune system (2). It is believed that the underlying pathogenic mechanism involved in the testicular autoimmune disease is a T-cell response to antigens or microorganisms that have permeated the testis barrier (11). This hypothesis is supported by the immune condition demonstrated in the blood-testis barrier injury during inflammation, infection, and trauma (2).…”