Prevalence of Sperm Bound Antibodies in Infertile Men with Varicocele: The Effect of Varicocele Ligation on Antibody Levels and Semen Response

Abstract

An increased level of antisperm antibodies has been demonstrated in infertile men with varicocele compared with normal fertile men, suggesting a possible cause and effect relationship. To evaluate the possible etiological role of antisperm antibodies in varicocele patients, we performed a prospective study of 32 infertile men undergoing varicocele ligation. Semen analyses and antisperm antibodies as measured by the immunobead test were performed preoperatively and postoperatively at 3 and 6 months. Of the infertile men with varicocele 28% had a positive immunobead test compared with 0% of normal fertile men. The average total motile sperm count was significantly different (p < 0.05, 2-tailed t test) for 9 varicocele patients with sperm-bound antibody (3.2 x 10(6)) compared with 23 without antibody (8.4 x 10(6)). Postoperatively, 68% of all patients exhibited improved semen parameters, with no change in antibody status in either group. Among the antibody positive group 71% showed an increase in motile sperm per ml. of 2.8 x 10(6) to 17.2 x 10(6) (525% increase, p < 0.05), while in the antibody negative group 67% showed an increase of 3.8 x 10(6) to 24.9 x 10(6) (553% increase, p < 0.05). Our study suggests that there is an increased incidence of sperm-bound immunoglobulin in infertile varicocele patients and an apparent adverse effect on semen parameters in these patients. However, the presence of sperm-bound immunoglobulin did not affect the percentage response to surgical correction, nor can we postulate an immunological mechanism as a major etiological factor in varicocele induced infertility.

The role of the antisperm antibodies in male infertility assessment after microsurgical varicocelectomy

“…Therefore, Djaladat et al (2006) concluded that varicocelectomy could reduce ASA concentration. Knudson et al (1994) were not able to show any significant difference between pre-and post-varicocelectomy ASA concentrations. Bonyadi et al (2013) showed that varicocelectomy had no effect on semen ASA.…”

“…Knudson et al (1994) reported ASA levels in 32 infertile patients with varicocele. In this study, 28% had positive immunobead test results, among which IgG was found to be bound to the surface of the spermatozoa in 100% and IgA in 86% of the cases.…”

“…Our data may explain the existing contradictions. Djaladat et al (2006) recruited the patients with MAR 10-40%, Knudson et al (1994) included patients with the expressed autoimmune process, Sizyakin (1996) evaluated ASA in the blood serum. Bonyadi et al (2013) defined ASA-positive patients as any patient with ASA level above the threshold (>15%) regardless of absolute values.…”

“…There is no general consensus on the efficacy of varicocele surgical treatment for male fertility recovery. There are multiple reports of varicocelectomy resulting in spermiogram improvement (Knudson et al, 1994) and lower ASA titers (Mehrsai et al, 2005;Djaladat et al, 2006;Kendirci & Hellstrom, 2006), while several researchers challenge this (Sizyakin, 1996;Gubin et al, 1998;Bonyadi et al, 2013). The recent meta-analyses of Baazeem et al (2011), Kroese et al (2012), Kim et al (2013) on the surgical treatment of patients with the male infertility factor did not consider ASA as a relevant factor in varicocelectomy.…”

Comparison of diffusion-weighed MRI findings of the testis in patients with the advanced stage unilateral testicular varicocele

“…We believe that the reduced ADC values observed in patients with varicocele may be related to these histopathological alterations. Unilateral varicocele has been known to cause an increase in both testicular temperature secondary to autoimmune and hormonal effects, according to the literature [19][20][21]. The reduced contralateral ADC values observed in our study may possibly be appearing as a result of these effects.…”