Sperm agglutination: Prevalence and contributory factors

Abstract

Agglutination is a finding noted in semen analyses (SAs) that often causes confusion as to its significance. While some have attributed agglutination to antisperm antibodies (ASAs), there are other causes as well, such as genital tract infection and ascorbic acid deficiency. Additionally, it is known that patients with ASAs often have risk factors such as a history of scrotal trauma or surgery. Therefore, we sought to determine the prevalence of agglutination in our patient population and correlate it with these risk factors, regardless of the presence/absence of ASAs. A retrospective study was conducted on the SAs of men seen at a single academic Reproductive Center. Of the 1,095 SAs identified, 133 (12.1%) patients experienced agglutination (61.7% scant, 21.8% moderate and 16.5% excessive). Of patients who underwent multiple SAs, 24 (12.2%) showed variability. Furthermore, patients who underwent scrotal surgery carried 3.4 times the risk of agglutination (X2 p < 0.01) and 5.5 times the risk of variability (X2 p < 0.01) as compared to those patients without a history significant for scrotal surgery. Agglutination is a relatively common finding in men presenting to a reproductive clinic with little intrapatient variability. Scrotal surgery confers a higher risk of agglutination and variability.

Pathogenesis of Autoimmune Male Infertility: Juxtacrine, Paracrine and Endocrine Deregulation

“…Compared to the tests described above, the IBT test has a number of advantages, such as the ability to determine the isotype of ASAs, their localization, also it has high sensitivity and specificity [24,153,154]. The WHO recommended both MAR and IBT tests as screening methods for ASAs reveal [7,11,35,[120][121][122]155]. The MAR test is considered sufficient because IgA almost never occurs without IgG, and, as it was already mentioned, there is a variant of the Sperm MAR test that can detect IgA associated with sperm [24].…”

“…In general, infectious processes can disrupt local immune regulation, can damage spermatozoa directly or through an inflammatory reaction, leading to the formation of ASAs [122]. It was found that in more than 40% of cases, ASAs to sperm surface antigens were found in infected patients, which is significantly higher rate than among uninfected infertile and fertile men [126].…”

“…Varicocele is traditionally considered a potentially curable cause of male infertility, and varicocelectomy still serves as the gold standard of treatment; however, surgical intervention often fails to restore fertility, improve semen analysis, so the outcome of the operation remains poorly predictable [24,51,76]. Earlier ASAs were not considered as a factor that negatively affects the result of surgical treatment, but nowadays many researchers reported ASAs level increase after surgical intervention [42,43,50,78,80,86,117,[120][121][122].…”

Diagnostic value of advanced semen analysis in evaluation of male infertility

“…The ASA test is recommended to patients with asthenozoospermia, with disrupted blood-testis barrier, or when sperm agglutination can be observed during a routine semen analysis (Snow-Lisy & Sabanegh, 2013). One of the causes for sperm agglutination is the presence of ASA (Berger, Smith-Harrison, & Sandlow, 2019). ASA in the serum and seminal plasma can lead to male infertility by interfering with sperm motility and sperm-oocyte binding (Agarwal & Said, 2009;Chiu & Chamley, 2004) and incapacity of penetrating the cervical mucus (De Almeida, Soumah, & Jouannet, 1986 (Mazumdar & Levine, 1998).…”

Role of Antisperm Antibodies in Infertility, Pregnancy, and Potential for Contraceptive and Antifertility Vaccine Designs: Research Progress and Pioneering Vision

“…Researchers provided evidence that antibody-mediated immune reactions were responsible for spontaneous or missed abortions [152,153]. Missed abortion is a term used for a spontaneous abortion due to fetal demise without any extraneous intervention.…”