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Mukherjee AG, Gopalakrishnan AV. Anti-sperm Antibodies as an Increasing Threat to Male Fertility: Immunological Insights, Diagnostic and Therapeutic Strategies. Reprod Sci 2024:10.1007/s43032-024-01610-y. [PMID: 38831152 DOI: 10.1007/s43032-024-01610-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 05/29/2024] [Indexed: 06/05/2024]
Abstract
It is a fact that sperm possess antigenic properties. Substantial scientific research suggests that specific antibodies that attach to sperm antigens can induce infertility in both humans and other species. Antisperm antibodies (ASA) represent a significant etiology of infertility in humans, leading to immunoinfertility. The association between ASA and infertility is multifaceted. The observation of sperm agglutination, although not conclusive for the diagnosis of immunological infertility, may suggest the presence of ASA. Nevertheless, ASA may also manifest in the lack of any sperm agglutination. Managing ASA from an andrological perspective depends on the underlying cause and the specific approaches healthcare professionals adopt. The precise etiology of male infertility resulting from ASA remains unclear. Current research has examined the impact of ASA and its prevalence among infertile males to understand the relationship between ASA and changes in semen parameters. However, the findings have been inconclusive. Numerous techniques have been documented for the management of immunoinfertility. This review examines the importance of ASA in the context of infertility, encompassing the postulated mechanisms underlying the development of ASA, the various assays employed for detecting them, and the available treatments.
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Affiliation(s)
- Anirban Goutam Mukherjee
- Department of Biomedical Sciences, School of Bio-Sciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu, 632014, India
| | - Abilash Valsala Gopalakrishnan
- Department of Biomedical Sciences, School of Bio-Sciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu, 632014, India.
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Sanyal D, Arya D, Nishi K, Balasinor N, Singh D. Clinical Utility of Sperm Function Tests in Predicting Male Fertility: A Systematic Review. Reprod Sci 2024; 31:863-882. [PMID: 38012524 DOI: 10.1007/s43032-023-01405-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023]
Abstract
Routine semen analysis provides considerable information regarding sperm parameters; however, it is not solely adequate to predict male fertility potential. In the past two decades, several advance sperm function tests have been developed. The present systematic review intends to assess the clinical utility of available advance sperm function tests in predicting the male fertility potential. A systematic literature search was conducted as per PRISMA guidelines using PubMed, MEDLINE, Google Scholar, and Cochrane Library. Different keywords either singly or in combination were used to retrieve the relevant articles related to sperm function tests, male fertility, and pregnancy outcomes. A total of 5169 articles were obtained, out of which 110 meeting the selection criteria were included in this review. The majorly investigated sperm function tests are hypo-osmotic swelling test, acrosome reaction test, sperm capacitation test, hemizona binding assay, sperm DNA fragmentation test, seminal reactive oxygen species test, mitochondrial dysfunction tests, antisperm antibody test, nuclear chromatin de-condensation (NCD) test, etc. The different advance sperm function tests analyse different aspects of sperm function. Hence, any one test may not be helpful to appropriately predict the male fertility potential. Currently, the unavailability of high-quality clinical data, robust thresholds, complex protocols, high cost, etc., are the limiting factors and prohibiting current sperm function tests to reach the clinics. Further multi-centric research efforts are required to fulfil the existing lacunas and pave the way for these tests to be introduced into the clinics.
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Affiliation(s)
- Debarati Sanyal
- Department of Neuroendocrinology, ICMR-National Institute for Research in Reproductive and Child Health, Parel, Mumbai, 400012, India
| | - Deepshikha Arya
- Department of Neuroendocrinology, ICMR-National Institute for Research in Reproductive and Child Health, Parel, Mumbai, 400012, India
| | - Kumari Nishi
- Department of Neuroendocrinology, ICMR-National Institute for Research in Reproductive and Child Health, Parel, Mumbai, 400012, India
| | - Nafisa Balasinor
- Department of Neuroendocrinology, ICMR-National Institute for Research in Reproductive and Child Health, Parel, Mumbai, 400012, India.
| | - Dipty Singh
- Department of Neuroendocrinology, ICMR-National Institute for Research in Reproductive and Child Health, Parel, Mumbai, 400012, India.
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Shibahara H, Chen Y, Honda H, Wakimoto Y, Fukui A, Hasegawa A. Sex difference in anti-sperm antibodies. Reprod Med Biol 2022; 21:e12477. [PMID: 35814191 PMCID: PMC9255895 DOI: 10.1002/rmb2.12477] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/23/2022] [Accepted: 05/30/2022] [Indexed: 12/04/2022] Open
Abstract
Background Some diseases have sex differences. There have been no reports on the relationship between anti-sperm antibodies (ASA) and sex differences. Methods ASA are detected by sperm-immobilization test using patients' sera in women. In men, the ASA testing is generally performed by direct-immunobead test. Main findings Sperm-immobilizing antibodies in women inhibit sperm migration in their genital tract and exert inhibitory effects on fertilization. ASA bound to sperm surface in men also show inhibitory effect on sperm passage through cervical mucus. The fertilization rate of IVF significantly decreased when sperm were coated with higher numbers of ASA. For women with the antibodies, it is important to assess individual patients' SI50 titers. In patients with continuously high SI50 titers, pregnancy can be obtained only by IVF. For men with abnormal fertilizing ability by ASA, it is necessary to select intracytoplasmic sperm injection. Production of sperm-immobilizing antibodies is likely to occur in women with particular HLA after exposure to sperm. The risk factors for ASA production in men are still controversial. Conclusion Attention to sex differences in specimens, test methods and the diagnosis of ASA should be paid. For patients with ASA, treatment strategies have been established by considering sex difference for each.
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Affiliation(s)
- Hiroaki Shibahara
- Department of Obstetrics and GynecologySchool of Medicine, Hyogo Medical UniversityNishinomiyaJapan
| | - Yuekun Chen
- Department of Obstetrics and GynecologySchool of Medicine, Hyogo Medical UniversityNishinomiyaJapan
| | - Haruka Honda
- Department of Obstetrics and GynecologySchool of Medicine, Hyogo Medical UniversityNishinomiyaJapan
| | - Yu Wakimoto
- Department of Obstetrics and GynecologySchool of Medicine, Hyogo Medical UniversityNishinomiyaJapan
| | - Atsushi Fukui
- Department of Obstetrics and GynecologySchool of Medicine, Hyogo Medical UniversityNishinomiyaJapan
| | - Akiko Hasegawa
- Department of Obstetrics and GynecologySchool of Medicine, Hyogo Medical UniversityNishinomiyaJapan
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Gatimel N, Moreau J, Isus F, Moinard N, Parinaud J, Leandri RD. Anti-sperm antibodies detection by a modified MAR test: Towards a better definition of its indications. Reprod Biomed Online 2018; 37:717-723. [PMID: 30409465 DOI: 10.1016/j.rbmo.2018.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 09/10/2018] [Accepted: 09/19/2018] [Indexed: 11/28/2022]
Abstract
RESEARCH QUESTION Anti-sperm antibodies (ASA) have been shown to reduce male fertility but consensus about the precise situations in which tests should be carried out are lacking. In infertility investigations, should the mixed antiglobulin reaction (MAR) test be a first-line test? Should it be carried out systematically before assisted reproductive technology (ART)? What are the risk factors for ASA? DESIGN All infertile patients (n = 1364) were tested with SpermMar (modified MAR test) between July 2013 and June 2017. Intra-patient variability of the MAR test was also assesed by comparing two tests within the same year in selected patients (n = 101). RESULTS The main factor that influenced the percentage of ASA was the presence or absence of sperm agglutination. In the presence of agglutinations, 27 out of 72 (37.5%) patients were positive for ASA compared with 33 out of 1292 (2.6%) in the absence of agglutinations (P < 0.0001). When one risk factor was present (spontaneous sperm agglutination, history of scrotal trauma or inguinal surgery), 33 out of 179 (18.44%) tests were positive for ASA (≥50% coated spermatozoa), whereas only 27 out of 1242 (2.2%) were positive when no risk factor was present (P < 0.0001). CONCLUSIONS ASA detection should not be systematically recommended in investigations of fertility status and before ART but reserved for when sperm agglutination is found during conventional sperm examination, or if the patient has a history of scrotal trauma or has undergone inguinal surgery.
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Affiliation(s)
- Nicolas Gatimel
- Service de Médecine de la Reproduction, Hôpital Paule de Viguier, CHU Toulouse, 330 avenue de Grande Bretagne, Toulouse 31059, France; Université Paul Sabatier Toulouse-III, Groupe de Recherche en Fertilité Humaine (EA 31694, Human Fertility Research Group), 330 avenue de Grande Bretagne, Toulouse 31059, France.
| | - Jessika Moreau
- Service de Médecine de la Reproduction, Hôpital Paule de Viguier, CHU Toulouse, 330 avenue de Grande Bretagne, Toulouse 31059, France; Université Paul Sabatier Toulouse-III, Groupe de Recherche en Fertilité Humaine (EA 31694, Human Fertility Research Group), 330 avenue de Grande Bretagne, Toulouse 31059, France
| | - François Isus
- Service de Médecine de la Reproduction, Hôpital Paule de Viguier, CHU Toulouse, 330 avenue de Grande Bretagne, Toulouse 31059, France; Université Paul Sabatier Toulouse-III, Groupe de Recherche en Fertilité Humaine (EA 31694, Human Fertility Research Group), 330 avenue de Grande Bretagne, Toulouse 31059, France
| | - Nathalie Moinard
- Service de Médecine de la Reproduction, Hôpital Paule de Viguier, CHU Toulouse, 330 avenue de Grande Bretagne, Toulouse 31059, France; Université Paul Sabatier Toulouse-III, Groupe de Recherche en Fertilité Humaine (EA 31694, Human Fertility Research Group), 330 avenue de Grande Bretagne, Toulouse 31059, France
| | - Jean Parinaud
- Service de Médecine de la Reproduction, Hôpital Paule de Viguier, CHU Toulouse, 330 avenue de Grande Bretagne, Toulouse 31059, France; Université Paul Sabatier Toulouse-III, Groupe de Recherche en Fertilité Humaine (EA 31694, Human Fertility Research Group), 330 avenue de Grande Bretagne, Toulouse 31059, France
| | - Roger D Leandri
- Service de Médecine de la Reproduction, Hôpital Paule de Viguier, CHU Toulouse, 330 avenue de Grande Bretagne, Toulouse 31059, France; Université Paul Sabatier Toulouse-III, Groupe de Recherche en Fertilité Humaine (EA 31694, Human Fertility Research Group), 330 avenue de Grande Bretagne, Toulouse 31059, France
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Vazquez-Levin MH, Marín-Briggiler CI, Veaute C. Antisperm antibodies: invaluable tools toward the identification of sperm proteins involved in fertilization. Am J Reprod Immunol 2014; 72:206-18. [PMID: 24863647 DOI: 10.1111/aji.12272] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 04/28/2014] [Indexed: 12/18/2022] Open
Abstract
The identification of sperm proteins involved in fertilization has been the subject of numerous investigations. Much interest has been dedicated to naturally occurring antisperm antibodies (ASA) and their impact in fertility. Their presence in men and women has been associated with 2-50% of infertility cases. ASA may impair pre- and post-fertilization steps. Experimental models have been developed using sperm proteins as immunogens to evaluate their involvement in sperm function. Our team has pursued investigations to assess ASA presence in biological fluids from patients consulting for infertility and their effect on fertilization. We found ASA in follicular fluids with ability of inducing the acrosome reaction and blocking sperm-zona pellucida interaction and used them to identify sperm entities involved in these events. We generated and utilized antibodies against proacrosin/acrosin to characterize the sperm protease system. We implemented an ELISA to detect proacrosin/acrosin antibodies in human sera and evaluated their impact upon fertility by developing in vitro assays and a gene immunization model. This review presents a summary of ASA history, etiology, current approaches for detection and effects upon fertility. ASA (naturally occurring, generated by animal immunization and/or of commercial origin) are invaluable tools to understand the molecular basis of fertilization, better diagnose/treat immunoinfertility and develop immunocontraceptive methods.
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Affiliation(s)
- Mónica H Vazquez-Levin
- Instituto de Biología y Medicina Experimental (IBYME), National Research Council of Argentina (CONICET), Buenos Aires, Argentina
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Tomlinson M, Lewis S, Morroll D. Sperm quality and its relationship to natural and assisted conception: British Fertility Society Guidelines for practice. HUM FERTIL 2013; 16:175-93. [DOI: 10.3109/14647273.2013.807522] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Zini A, Fahmy N, Belzile E, Ciampi A, Al-Hathal N, Kotb A. Antisperm antibodies are not associated with pregnancy rates after IVF and ICSI: systematic review and meta-analysis. Hum Reprod 2011; 26:1288-95. [DOI: 10.1093/humrep/der074] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Anti-sperm antibody levels are not related to fertilization or pregnancy rates after IVF or IVF/ICSI. J Reprod Immunol 2011; 88:80-4. [DOI: 10.1016/j.jri.2010.09.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 08/12/2010] [Accepted: 09/22/2010] [Indexed: 11/19/2022]
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Esteves SC, Schneider DT, Verza S. Influence of antisperm antibodies in the semen on intracytoplasmic sperm injection outcome. Int Braz J Urol 2007; 33:795-802. [PMID: 18199347 DOI: 10.1590/s1677-55382007000600007] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2006] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The aim of this study was to analyze the influence of autoantibodies against spermatozoa present in the semen on the outcome of in vitro fertilization with intracytoplasmic sperm injection (ICSI). MATERIALS AND METHODS We performed a retrospective analysis of clinical and laboratorial data from a six year-period ICSI cycles. Screening for the presence of ASA in the semen, by using the direct immunobeads test (IBT), was available for 351 cycles. According to the percentage of antibody-bound spermatozoa in the semen, we divided the cycles in four groups: I (n = 194): 0%-10% ASA; II (n = 107): 11%-20%; III (n = 33): 21%-50% and IV (n = 17): 51%-100% ASA. Additionally, a group of 349 ICSI cycles performed with ejaculated spermatozoa from oligo/asthenozoospermic men who had insufficient number of motile sperm available for ASA screening was included for comparison. ICSI outcomes were compared among groups and included fertilization rate (2 PN), cleavage rate, cleavage velocity, embryo quality, clinical pregnancy and miscarriage rates. Data were examined statistically, with an alpha level of 5% considered significant. RESULTS Fertilization, cleavage rate and velocity, percentage of good quality embryos, as well as clinical pregnancy and miscarriage rates did not differ among different ASA levels groups. ICSI outcomes in men exhibiting different levels of autoimmunity against spermatozoa did not differ from those with severely abnormal seminal parameters. CONCLUSIONS Our data indicate that intracytoplasmic sperm injection (ICSI) outcomes are not influenced by ASA levels on sperm.
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Affiliation(s)
- Sandro C Esteves
- Androfert, Male Reproduction Reference Center, Av. Dr. Heitor Penteado 1464, Campinas, Sao Paulo, Brazil.
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Vujisić S, Lepej SZ, Jerković L, Emedi I, Sokolić B. Antisperm Antibodies in Semen, Sera and Follicular Fluids of Infertile Patients: Relation to Reproductive Outcome afterIn VitroFertilization. Am J Reprod Immunol 2005; 54:13-20. [PMID: 15948768 DOI: 10.1111/j.1600-0897.2005.00274.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
PROBLEM Data given in the literature, regarding the influence of antisperm antibodies (ASA) in the semen and/or sera on in vitro fertilization (IVF) procedure outcome are controversial. The aim of this study was to compare the prevalence of ASA in semen, peripheral blood and follicular fluid as well as to determine total immunoglobulin concentration in the serum and follicular fluid. Selected parameters were analyzed with regard to IVF outcome. METHOD OF STUDY The study enrolled 52 married couples. ASA in the semen was determined by direct immunobead mixed antiglobulin reaction (MAR Screen test), while in the peripheral blood and follicular fluid was determined by indirect immunobead MAR Screen test. Immunoglobulin (IgG, IgM and IgA) concentration in the follicular fluid and serum was determined by a liquid-phase immunoprecipitation assay with nephelometric end-point detection and analyzed with regard to IVF outcome. RESULTS Semen MAR test IgG was < 20% in 38 couples, and > 20% in 14 couples. Fertilization (73.2% versus 71.5%) and pregnancy rates (28.9% versus 28.57%) in both groups of patients were not significantly different. The results of direct and indirect MAR test were not associated with fertilization and pregnancy rates. Total serum IgG, IgM and IgA in infertile women were within normal ranges. Follicular fluid IgG was within normal values for serum samples, while IgA and IgM were decreased. CONCLUSION The presence of ASA on sperm or in the serum and follicular fluid was not associated with IVF outcome in the couples with good quality semen characteristic.
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Affiliation(s)
- Sanja Vujisić
- Department of Obstetrics and Gynecology, Medical School, University of Zagreb, Sveti Duh Hospital, Zagreb.
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Shibahara H, Shiraishi Y, Suzuki M. Diagnosis and treatment of immunologically infertile males with antisperm antibodies. Reprod Med Biol 2005; 4:133-141. [PMID: 29699216 DOI: 10.1111/j.1447-0578.2005.00102.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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; 4: 133-141).
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Affiliation(s)
- Hiroaki Shibahara
- Department of Obstetrics and Gynecology, Jichi Medical School, Tochigi, Japan
| | - Yasuko Shiraishi
- Department of Obstetrics and Gynecology, Jichi Medical School, Tochigi, Japan
| | - Mitsuaki Suzuki
- Department of Obstetrics and Gynecology, Jichi Medical School, Tochigi, Japan
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Immunologically Mediated Male and Female Reproductive Failure. Mucosal Immunol 2005. [DOI: 10.1016/b978-012491543-5/50102-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Chiu WWC, Chamley LW. Clinical associations and mechanisms of action of antisperm antibodies. Fertil Steril 2004; 82:529-35. [PMID: 15374685 DOI: 10.1016/j.fertnstert.2003.09.084] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2003] [Revised: 09/29/2003] [Accepted: 09/29/2003] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To review and critique the current English literature describing the effects of antisperm antibodies (ASA) on mammalian fertility. DESIGN A comprehensive English language literature was searched using Medline and by hand-searching. Emphasis was placed on clinically relevant articles. RESULT(S) Results from the studies were extrapolated and the effects of ASA on fertility described. CONCLUSION(S) Antisperm antibodies may interfere with fertility. Not all ASA cause infertility. Current tests cannot differentiate the infertility-related ASA from those that do not interfere with infertility, because the antigenic specificities of these ASA are not known. The antigens which the infertility-related ASA must be characterized to allow an accurate detection and proper treatment for couples with ASA.
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Affiliation(s)
- Will W-C Chiu
- Department of Obstetrics and Gynecology, University of Auckland, Auckland 3, New Zealand
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Lombardo F, Gandini L, Lenzi A, Dondero F. Antisperm immunity in assisted reproduction. J Reprod Immunol 2004; 62:101-9. [PMID: 15288186 DOI: 10.1016/j.jri.2003.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2003] [Indexed: 10/26/2022]
Abstract
Antisperm antibodies (ASA) can impair the fertilising capacity of human spermatozoa, acting negatively on sperm motility and cervical mucus penetration, and at the level of in vitro gamete interaction. Several methods attempt to improve the potentially deleterious effects of ASA-mediated infertility: by decreasing ASA production, by removing ASA already bound to sperm, artificial insemination (AIH) and fertilisation (IVF, ICSI). Only ICSI seems able to overcome the problem, with fertilisation and pregnancy rates of ASA-positive patients undergoing this technique in the same range as ASA-negative patients. As immunological infertility is relatively rare, literature in the field is quite scarce and more studies need to be conducted to confirm that embryo quality is not impaired.
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Affiliation(s)
- Francesco Lombardo
- The University Laboratory of Seminology and Immunology of Reproduction, Department of Physiopathology, University of Rome La Sapienza, 00161 Rome, Italy.
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Abstract
PURPOSE OF REVIEW Much attention has been paid to the role of immunology in reproductive success or failure. Every step in the establishment of normal pregnancy has been implicated as a possible site of immune-mediated reproductive failure. The widespread testing of antiphospholipid, antinuclear, antithyroid, and antisperm antibodies, as well as generalized immune testing, have thus been employed to diagnose patients with otherwise unexplained infertility or recurrent pregnancy loss. Controversial data surrounding the widespread and variable use of immune testing in current fertility practice is reviewed to determine which tests are warranted based on sound scientific evidence. Because it is postulated that early miscarriage, when occult, could represent a failure of embryo implantation indistinguishable from unexplained infertility, this analysis of immune testing includes a discussion of patients with recurrent pregnancy loss. RECENT FINDINGS Despite the increased prevalence of abnormal immune testing associated with early reproductive failure, the most rigorous studies have not proven a cause and effect between these phenomena. There is wide variation and inconsistency regarding this association, depending upon which test(s) are employed, the study methodology used, and the patient population under study. The significance of selected immunological test abnormalities associated with early reproductive failure is uncertain. SUMMARY Great variability exists in identifying candidates for immune testing, determining which tests to order, interpreting the test results, and offering immunologic treatments. This review argues that the use of widespread immune testing in clinical practice can not be supported by existing data. The resulting therapies are similarly of unconfirmed benefit and may cause harm.
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Affiliation(s)
- Caleb B Kallen
- Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut 06520-8063, USA
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Kutteh WH. Antisperm antibodies. Do antisperm antibodies bound to spermatozoa alter normal reproductive function? Hum Reprod 1999; 14:2426-9. [PMID: 10527961 DOI: 10.1093/humrep/14.10.2426] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- W H Kutteh
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Tennessee, 956 Court Avenue, Room D324, Memphis, Tennessee 38163-2116 USA
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Kamada M, Yamano S, Senuma M, Nakagawa K, Maegawa M, Aono T. Semen analysis and antisperm antibody. ARCHIVES OF ANDROLOGY 1998; 40:117-28. [PMID: 9507744 DOI: 10.3109/01485019808987934] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Evaluation of the fertilizing potential of sperm is an important procedure in in vitro fertilization and embryo transfer (IVF-ET) clinic, in order to avoid performing invalid conventional IVF-ET or unnecessary intracytoplasmic sperm injection (ICSI). However, none of the standard semen parameters are reliable indices in predicting IVF outcome. The test examining sperm-zona interaction is the best present method, though the short supply of the human zona component should be solved. IVF-ET treatment is useful for pregnancy in women having sperm immobilizing antibodies because it avoids exposing sperms to antibodies that block fertilization. ICSI should be used in immunologically infertile men diagnosed by specific method to demonstrate the in vivo exposure of sperms to antisperm autoantibodies that block fertilization.
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Affiliation(s)
- M Kamada
- Department of Obstetrics and Gynecology, School of Medicine, University of Tokushima, Japan
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