The clinical significance of antisperm antibodies in male subfertility

Inflammatory networks in the control of spermatogenesis : chronic inflammation in an immunologically privileged tissue?

Spermatogenesis is a complex, organized process involving intimate interactions between the developing germ cells and supporting Sertoli cells. The process is also highly regulated. Studies suggest that regulation in the seminiferous epithelium involves molecules normally associated with either immune or inflammatory processes; in particular, interleukin 1a (IL1a), IL6, tumor necrosis factor (TNFa), activin A and nitric oxide (NO). While there is considerable evidence that these inflammatory mediators have effects on spermatogonial and spermatocyte development as well as critical supportive functions of the Sertoli cells, which are undoubtedly of considerable importance during testicular inflammation, there remains some skepticism regarding the significance of these molecules with respect to normal testicular function. Nonetheless, it is evident that expression of these regulators varies across the cycle of the seminiferous epithelium in a consistent manner, with major changes in production coinciding with key events within the cycle. This review summarizes the evidence supporting the hypothesis that inflammatory cytokines play a role in normal testicular spermatogenesis, as well as in the etiology of inflammation induced sub-fertility. The balance of data leads to the striking conclusion that the cycle of the seminiferous epithelium resembles a chronic inflammatory event. This appears to be a somewhat paradoxical assertion, since the testis is an immunologically privileged tissue based on its well-established ability to support grafts with minimal rejection responses. However, it may be argued that local immunoregulatory mechanisms, which confer protection from immunity on both transplanted tissues and the developing spermatogenic cells, are equally necessary to prevent local inflammation responses associated with the spermatogenic process from activating the adaptive immune response.

Validity and cost-effectiveness of antisperm antibody testing before in vitro fertilization

OBJECTIVE

To determine the usefulness of and cost-effectiveness of antisperm antibody testing in the prediction of poor fertilization rates in couples undergoing IVF.

DESIGN

Retrospective cohort study.

SETTING

A hospital-based reproductive endocrinology and infertility practice.

PATIENT(S)

Male partners of 251 couples undergoing IVF between 1992 and 1997.

MAIN OUTCOME MEASURE(S)

Fertilization rates in couples undergoing conventional IVF.

RESULT(S)

One hundred nineteen couples were evaluated for antisperm antibodies; fertilization rates were similar in those couples whose husbands were and were not tested (64% versus 68%). Antisperm antibodies were detected in 16 men. Four (25%) of the 16 couples whose husbands had antisperm antibodies fertilized < or = 50% of oocytes, compared with 31 (30%) of the 103 couples whose husbands did not have these antibodies. Overall, 21 couples (8.4%) experienced complete fertilization failure. In a program that included antisperm antibody testing for selected couples and intracytoplasmic sperm injection (ICSI) for those who tested positive, it would cost $11,735 to prevent a fertilization failure (assuming ICSI were 100% effective), whereas it would cost $9,250 to perform ICSI in a second IVF cycle for those who initially failed.

CONCLUSION(S)

In this practice setting, antisperm antibody testing has low sensitivity in predicting low or no fertilization and does not appear to be cost-effective when selectively ordered as part of an IVF workup.

A new method for isolation of human antisperm antibodies

A study was undertaken to isolate pure human antisperm antibodies from the sera of infertile couples. One hundred infertile couples attending the Infertility and IVF Unit (Beilinson Medical Center) because of unexplained infertility were tested (both partners) for antisperm antibodies. Sixty-eight experiments were performed with positive sera containing antisperm antibodies and normal donor sperm. These experiments were followed by experiments in order to elute pure human antisperm antibodies from the sperm surface. Three experiments were performed with human sperm which were found to be coated by antisperm antibodies, in order to directly elute these antibodies from the sperm surface. In all experiments we eluted antisperm antibodies of the IgG and IgA isotypes from the sperm surface. These antibodies were demonstrated in the eluate, in each case by either the indirect immunobead test, the radial immune diffusion assay, or the electrophoresis method. Control experiments were performed as follows: (i) normal donor sperm incubated with normal serum; (ii) normal donor sperm without serum incubation; (iii) normal donor lymphocytes incubated with serum containing antisperm antibodies; (iv) normal donor lymphocytes without serum incubation. No antisperm antibodies were obtained in any of these control experiments. Absorption and elution experiments can be used for the isolation of pure human antisperm antibodies, which may then be used for the production of anti-idiotypic antibodies to antisperm antibodies. The anti-idiotypic antibodies could be further utilized as antigen substitutes for the production of a contraceptive vaccine and/or for application in the treatment of spontaneous abortion and infertility.

Characterisation of a sperm coating auto-antigen reacting with antisperm antibodies of infertile males using monoclonal antibodies

OBJECTIVE

In a previous study a number of sperm-specific antigens were identified which reacted with antisperm antibodies from both infertile and vasovasostomised males. To investigate the localisation and distribution of these antigens and their role in male fertility, monoclonal antibodies were raised against them; immunoblotting techniques were used to select only those antibodies which competed with human antisperm antibodies for these human auto-antigens.

DESIGN

One antibody, NW21, reacted with an 18 kDa auto-antigen present on epididymal sperm but absent from testicular sperm. Immunohistochemical studies showed that the antigen is produced in small basal cells between the columnar epithelium of the corpus epididymis, passes up into the tubule and then coats sperm passing along the epididymis. Sperm stored in the cauda epididymis and ductus deferens stain strongly for this sperm coating glycoprotein.

CONCLUSIONS

The localisation of this antigen supports the suggestion that auto-immune infertility may represent a response to epididymal rather than testicular sperm. Monoclonal antibodies raised to unique and immunologically accessible sperm coating proteins, produced in the epididymis rather than in the testis, would seem to present an excellent theoretical solution to male contraception.

The effect of intermittent steroid therapy on anti-sperm antibody levels

Sperm-bound antisperm antibody levels were measured in 10 males in subfertile partnerships who were treated with high dose intermittent prednisolone therapy over a period up to 9 months. Antibody levels fell in all patients during therapy, although a transient rise occurred after 2-4 months. There were low treatment complication rates. Four pregnancies occurred during the treatment of the 10 patients. There was no correlation between pregnancy and change in antibody.

Immunological infertility among Nigerian men: incidence of circulating antisperm auto-antibodies and some clinical observations: a preliminary report

OBJECTIVES

To (i) establish the incidence of circulating antisperm auto-antibodies among infertile men; (ii) relate this incidence to the high prevalence of sexually-transmitted diseases (STDs) in sub-Saharan Africa and; (iii) elucidate the effect of steroid and other therapy on semen quality and subsequent fertility of the patients.

PATIENTS AND METHODS

Serum samples from 50 infertile men and 50 age-matched controls were assayed by two agglutination techniques for anti-sperm antibodies. Mean sperm concentrations were determined before and after steroid treatment of patients having antibody titres of 1:64 or above. Serum levels of follicle-stimulating hormone, luteinizing hormone, testosterone and prolactin were also determined by radioimmunoassay in 38 patients. Seminal fluid analysis and culture were performed in 35 patients and testicular histology determined in 21.

RESULTS

Agglutination was demonstrated in 22 of 50 sera (44%), whilst non-agglutinating cytotoxic antibodies were detected in two. Only two of the 50 control sera (4%) were positive. After steroid therapy, antibody titres were significantly decreased and there was a sixfold improvement in mean sperm concentration and a threefold improvement in motility and morphological characteristics. Bacterial (46%) and non-bacterial (17%) infection were recorded in 22 of 35 patients, 13 of whom showed the presence of antisperm antibodies in their sera. Staphylococcus aureus was the commonest single bacterial isolate. Overall, 13 of 29 patients (45%) improved, nine accounting for 12 pregnancies. Pregnancies and/or improvements in semen quality were observed only among patients with mild histological changes. Low testosterone and prolactinaemia occurred in 29% and 21% of the patients, respectively. Among these, anti-sperm antibodies were also recorded in 18% and 13%, respectively.

CONCLUSION

The incidence of antisperm antibodies among infertile men is high in Nigeria and may be related to high prevalence of STDs. Immunologically infertile men can be treated successfully with steroids. Concomitant antibiotic and hormone therapy may also be essential in appropriate cases. Clinicians are advised to adopt a multimodal approach to the treatment of male infertility in sub-Saharan Africa. The presence of non-agglutinating cytotoxic antibodies calls for further investigation of the role of complement in the pathogenesis of immunological infertility.

Immuno-competent cells in the murine epididymis following infection with Escherichia coli

Epididymitis was induced by retrograde injection of Escherichia coli into the vas deferens of 28 mice. A group of 28 saline-injected animals served as controls. On Days 1, 3, 7 and 28, groups of seven animals were killed. Bacterial culture was performed. Leucocyte numbers and distribution were determined in epididymides. In infected mice, E. coli were isolated from all epididymides on Days 1 and 3, but only from five of seven epididymides on Days 7 and 28. One week after infection, the total number of macrophages rose from about 10 to 28%. Significantly increased macrophage percentages were also found in animals killed 28 days after infection. A simultaneous increase in MHC class II positive cells was seen on Day 7. A total of 20% of the cells expressed MHC class II in infected epididymides (normal = 6%). A similar increase was found on Day 28 after infection. Most of the macrophages and MHC class II positive cells were located in the interstitium, fewer in the peritubular layer and nearly none in the epithelium. The main increase in these cells occurred in the interstitium and, to a lesser but significant extent, in the peritubular area. T-helper and T-suppressor/cytotoxic lymphocytes reached peak values on Day 28. The increase in T-lymphocytes and simultaneous appearance of plasma cells followed the increase in numbers of macrophages and MHC class II positive cells. They were located mainly in the interstitium. A sequential increase in leucocyte subsets and negative culture results for E. coli were observed on Days 7 and 28 (2/7 on each day). The inflammatory process was restricted to the interstitium.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of mixed antiglobulin reaction and direct immunobead test for detection of sperm-bound antibodies in subfertile males

OBJECTIVE

To compare two methods of detection of surface bound antibodies on spermatozoa from subfertile males.

DESIGN

Prospective comparison of direct mixed antiglobulin reaction (MAR) for immunoglobulin (Ig)G with direct immunobead test (IgG and IgA) applied to spermatozoa from male partners of infertile couples. Circulating unbound antibody measured by tray agglutination test in serum and seminal plasma in a representative proportion.

SETTING

Seminology laboratory.

PATIENTS

One hundred nine male partners of infertile couples.

RESULTS

Highly significant correlation between direct MAR (IgG) and direct immunobed test (IgG) and between both of these tests and serum unbound antibody measured by tray agglutination test. Highly significant correlation between direct immunobead test (IgA) and seminal plasma unbound antibody measured by tray agglutination test, but no correlation with MAR (IgG).

CONCLUSIONS

Mixed antiglobulin reaction (IgG) is a cheap, quick, and sensitive screening test, but immunobead test (IgA) provides useful additional information on class of antibody on spermatozoa that may be clinically more important.

Immunomagnetic method to select human sperm without sperm surface-bound autoantibodies in male autoimmune infertility

Using supermagnetic polymer microspheres coated with anti-immunoglobulins, spermatozoa without autoantibodies bound on their surface can be isolated from a sperm population showing a variable percentage of cells with autoantibodies bound on their surface. This simple technique seems to induce no modification of semen qualities; therefore, the concentration of sperm after immunomagnetic separation might be useful for in vivo or in vitro insemination in infertile couples with autoimmune male infertility.

Clinical characteristics of subfertile men with antisperm antibodies

This study investigated the clinical features which could serve as markers to identify subfertile men with antisperm antibodies including age, duration of infertility, history of abdominal or perineal surgery and previous genital trauma. Of the 162 men studied, 43 had a positive test for antisperm antibodies. A significantly greater number of these patients had a history of genital trauma and appendicectomy. Whereas the aetiological role of genital trauma in spermatozoal autoimmunity is readily explicable, that of appendicectomy is not. It can only be postulated that inflammation of the appendix may sometimes affect the vas deferens or that there is some inadvertent injury to the vas deferens during appendicectomy.

Influence of antisperm antibodies on human sperm function

Antisperm antibodies have been found in about 8% of men with infertility and in 60 to 80% of patients following vasectomy. In order to investigate the way antibodies influence sperm function we studied serum and seminal plasma from patients with infertility (n = 61) or undergoing vasovasostomy (n = 25). These antisera were characterised to determine their TAT titre, the nature of the target antigens and their capacity to interfere directly with fertilisation. The results indicate that antibodies from both groups of patients exhibit a capacity to stimulate or suppress sperm/oocyte fusion. The proportion of samples showing stimulatory activity was higher (50%) in the vasovasostomised population than in patients with infertility (21%). The remainder of the antisera suppressed sperm/oocyte fusion. There was no correlation between the titre of antisperm antibodies and their capacity to influence sperm function, indicating that it is the nature of the target antigens which is of significance rather than the antibody concentration. Western blot analysis indicated that these antisera targeted a group of sperm surface antigens with molecular weights of 30kD (35,45,66,90 and 115kD). Monoclonal antibodies are now being prepared in order to determine which of these specific components are involved in the suppression of sperm function.

Motion characteristics of spermatozoa from men with cytotoxic sperm antibodies

Semen samples from 55 fertile nonautoimmune and 44 infertile sperm autoimmune men were evaluated by computerized sperm cell motion analysis. Sperm counts (mean +/- SEM, 59.6 +/- 10.3 X 10(6) per ml), motility (39.0 +/- 4.6%), mean swimming speed (micron/sec, 26.5 +/- 0.9), mean linearity (straight line distance of the cell track divided by the actual track length and multiplied by 10, 6.5 +/- 0.2), and motility index (% motility X mean speed, 10.7 +/- 1.4) in 23 men with significant titers of cytotoxic sperm antibodies in their serum and seminal plasma were less (p less than 0.0001) than those in the fertile controls. However, these parameters were comparable in 18 men with sperm antibodies in their seminal plasma but not in their serum, and the control group. Infertile men with serum cytotoxic sperm antibodies had more sperm cells swimming at 11-30 micron/sec, and fewer moving at 31 micron or higher; this was in contrast to results obtained from fertile men (p less than 0.05). The percentages of sperm cells moving at 21-30 micron/sec were increased, while those moving at 51-60 microns/sec were decreased in men with seminal plasma sperm antibodies, versus controls. Spermatozoa with low linearities (less than or equal to 6) were higher (p less than 0.05) in men with serum and seminal plasma cytotoxic sperm antibodies than in the fertile group.(ABSTRACT TRUNCATED AT 250 WORDS)

Antispermatozoal antibodies in men with urethritis

Antispermatozoal antibodies have been measured by the tray agglutination test (TAT) in three groups of patients with urethritis attending a clinic for sexually transmitted diseases and in one control group of men without urethritis. In 3 of 17 (17.6%) patients with acute nongonococcal urethritis (NGU) the serum TAT was positive at titers of 1:16 or more; and in 1 of these patients in whom Chlamydia was grown, the TAT titer rose from 1:4 before treatment, to 1:8 at 2 weeks, and 1:16 at 4 weeks, indicating probable immunization against sperm antigens at the time of infection. A rise in titer from 0 to 1:8 occurred in a second patient with NGU. Six (15.6%) of 39 patients with recurrent NGU and 2 (16.6%) of 12 patients with gonorrhea followed by postgonococcal urethritis also had positive antisperm antibody titers of 1:16 or more. None of 27 control subjects had positive antisperm antibody titers. These observations indicate that development of antisperm antibodies can be stimulated in some individuals by NGU.

Effect of cyclosporin A in male autoimmune infertility

Nine infertile men (mean duration of infertility, 8.3 years) with antisperm antibodies were treated with the immunosuppressive drug cyclosporin A for 6 months with a dose of 5 to 10 mg/kg/day. Seminal plasma and serum antisperm antibodies fell in three subjects on treatment, and sperm count and motility increased substantially in one. Three successful pregnancies occurred in the study group: one on treatment, one in the first cycle of artificial insemination with the husband's sperm after treatment (twin infants), and one 3 months after cessation of treatment (twin infants). Successful conceptions with cyclosporin were unrelated to falls in antisperm antibody titer.

Cyclic prednisolone therapy for male infertility associated with autoantibodies to spermatozoa

Seventy-six subfertile men with significant titers of antisperm antibodies were treated with a new corticosteroid regimen, consisting of prednisolone, 40 mg daily, rising to 80 mg daily if antibody titers did not fall, given from days 1 to 10 of the partner's menstrual cycle, for up to nine cycles. Twenty-five (33%) of the partners became pregnant during a treatment cycle, more than twice the expected incidence without treatment. No serious complications occurred, although one half of the patients had transient minor side effects. This regimen appears to be encouraging and suitable for further assessment in a prospective controlled trial.

Correlation between the direct IgG MAR test (mixed antiglobulin reaction test) and seminal analysis in men from infertile couples

The direct IgG mixed antiglobulin reaction (IgG MAR) test was carried out in 395 male subjects from infertile couples, selected on the basis of their seminal characteristics (sperm concentration greater than 10 X 10(6)/ml, sperm motility greater than 10%); attempts were made to correlate results with the seminologic aspects of the ejaculate. A significant correlation was observed between a positive MAR test and spontaneous sperm autogglutination. No correlation was observed, however, between test positivity and concentration, motility and sperm morphologic features, the macroscopic aspects studied (viscosity, fluidification), or increased concentration of leukocytes.

Rehabilitation of the disabled adolescent: experience with a local authority assessment centre

School leavers and young adults who are severely physically disabled pose particular problems for habilitation and rehabilitation. A local authority unit, the Fourways Assessment Centre, has been providing a comprehensive service to this group of people for the past 10 years. Rather than operating as an independent self contained unit it has been closely integrated with the local authority social services and educational services.

The clinical relevance of classes of immunoglobulins on spermatozoa from infertile and vasovasostomized males

Following reversal of vasectomy, conceptions occur even when antisperm antibodies are present in the seminal plasma, but this is most unusual in men with similar titers of such antibodies who are spontaneously infertile. To clarify the differences between antisperm antibodies occurring in infertile men and those associated with vasectomy reversal, we have studied 23 spontaneously infertile men and 22 men who underwent vasectomy reversal, all of whom had antisperm antibodies detected in seminal plasma by the same tray agglutination test. The class of antibody on spermatozoa was defined by a double-antibody technique using diluted rabbit anti-human IgG, IgM, or IgA or secretory component, followed, after washing, by 125I-labeled donkey anti-rabbit Ig. The results have shown that similar amounts of IgG and IgM were present on the spermatozoa, but infertile men had significantly more IgA and especially more secretory component than men who underwent vasectomy reversal. This was associated with significantly greater impairment of penetration of cervical mucus in the former group. It appears that the type of antibody on the spermatozoa may vary according to the stimulus for its production.

Varicocele and antisperm antibodies

Semen analysis and immunofluorescent antisperm antibodies were tested in 65 patients with varicocele. The mean sperm count and motility values in our study were 36.8 +/- 2.9 million per ml and 38.4 +/- 2.5 per cent, respectively. Both parameters were found not to differ significantly in three grades of varicocele. Immunofluorescent antisperm antibodies were detected in 24.6 per cent of the cases. A significant correlation was demonstrated between the presence of the antibodies and genital infection.

Immunological screening of a male population with infertile marriages

Four hundred not preselected male partners of infertile marriages were screened for the presence of anti-sperm antibodies. Serum and seminal plasma specimens from each patient were tested by the modified slide agglutination test (MSAT) and by the sperm-immobilization test. In addition, the IgG MAR test was performed on fresh ejaculates. Thirteen per cent of patients showed sperm agglutinating activity in serum and 5.7% also in seminal plasma. Sperm-immobilizing activity was found in 4.7% of serum and 1% of seminal plasma specimens, always associated with a high titre of sperm agglutinating activity. A highly significant linear correlation was found between the results of the MAR test and serum sperm-agglutinating activity; the presence of sperm-agglutinating activity in seminal plasma was always associated with MAR test positivity greater than 50%. The incidence of anti-sperm antibodies was not significantly different in patients with normo-, oligo- and azoospermia. The effectiveness and the easiness of both the MAR test and the MSAT do not justify, in our opinion, the utilization of more complex and expensive techniques for the detection of anti-sperm antibodies.

The prognosis of male subfertility: a survey of 1025 men referred to a fertility clinic

A retrospective survey of 1025 consecutive men referred to a male fertility clinic was carried out: 180 (18%) produced a pregnancy while attending the clinic. There was an overall inverse relationship between age and the production of pregnancy, although the majority of pregnancies were in the partners of men aged 25 to 39 at referral. The proportion of pregnancies rose from 4% for men presenting with azoospermia to 27% for those with initial sperm counts of 11 to 20 million/ml. The relationship between production of pregnancy and sperm density was inconsistent for men with sperm densities above 20 million/ml. There was no significant difference in the sperm motility at referral between those who did or did not produce a pregnancy. Success was highest for men whose duration of infertility at referral was between 2 and 3 years. The importance of these findings to the investigation of infertile men is discussed.

Modification of the slide agglutination test for the detection of sperm-agglutinins

We have modified the slide agglutination test (SAT) in order to make it available for the routine detection and titration of sperm agglutinins. Serum and seminal plasma samples of 156 subfertile patients were tested by the modified slide agglutination test (MSAT) in two trials. Fifteen per cent of serum and 7.5% of siminal plasma samples gave positive results and MSAT showed excellent reproducibility: a highly significant statistical correlation between the positive titres in the two determinations was observed. One hundred and ten samples were tested simultaneously by the MSAT and the tray agglutination test (TAT). The two tests showed a similar sensitivity with a significant statistical correlation between the positive titres. Using the MSAT the reading of results was easier and more precise. Therefore we propose the MSAT for the routine detection and titration of sperm-agglutinins.

Methylprednisolone treatment of immunologic infertility in male

Over a 5-year period, 98 men (101 "cases") with immunologic infertility, as diagnosed by Kibrick and F-D sperm agglutination testing, were treated with one or more regimens of methylprednisolone (96 mg/day for 7 days). Among the 71 patients for whom complete follow-up data were obtained, 31 (44%) succeeded in achieving pregnancy in their partners within 12 months of the start of treatment. The pregnancy-achievers and nonachievers were compared with respect to their semen quality, Kibrick titers, and F-D agglutination before and after therapy. No single, clear-cut factor could be identified to explain, or predict, a successful outcome. However, some men did have improved semen quality; of these, 69% achieved a pregnancy in the partner. Furthermore, pregnancy was somewhat more likely to occur if the man had a decrease in Kibrick titer; a decrease in titer was more likely in men whose titers were higher initially. No correlation with F-D agglutination activity was found. side effects were of limited incidence; only 16% of the men had any discomfort at all, and only 2% of them had severe problems. However, all discomfort and problems were transient.

Male infertility: etiologic factors in 385 consecutive cases

During a three years period, evaluation of etiologic factors in 385 consecutive infertile men revealed chronic prostato-vesiculitis as the commonest cause (25.7%) followed by varicocele (21.8%). In 77% of the patients with chronic prostatitis the authors found a decreased spermatozoa motility rate. AN obstruction of the sperm duct was found in 7,8%, autoagglutination in 5.7%. Idiopathic infertility was diagnosed in 10.9% of the patients. The significance of these findings and the contributions of other causes in this series are discussed.

The results of intermittent high dose steroid therapy for male infertility due to antisperm antibodies

Forty-five males who had been infertile for 2 to 10 (average 5.3) years, with significantly positive antisperm antibody tests (serum spermagglutination titers more than 32) and demonstrably improved sperm penetration of cervical mucus, were treated with repeated 7-day courses of methylprednisolone (MP) 32 mg three times a day from days 21 to 28 (in a few cases days 1 to 7) of their wives' menstrual cycles. Antisperm antibody tests were repeated after treatment and related to the occurrence of pregnancy in the wife. Fourteen wives (31%) became pregnant in a cycle following treatment of the husband. The production of pregnancy was always associated with a marked drop in sperm immobilizing titer and usually with disappearance of antibodies from seminal plasma; both of these effects were sometimes observed without a significant change in serum spermagglutination titers. Three patients (6%) had transient severe side effects, and 14 (26%) have had mild side effects, out of 54 patients treated so far.

Steroid treatment of male subfertility caused by antisperm antibodies

47 subfertile men with significant titres of antisperm antibodies were treated with one of two steroid regimens. The results were assessed by changes in sperm-counts and in serum antibody titres and by subsequent pregnancies. 15 oligozoospermic men were treated with prednisone 5 mg three times a day for 3--12 months. Sperm-counts became normal in 10 men and 4 of their wives became pregnant. 14 men with normal sperm-counts received the same treatment: antibody titres fell slightly and 3 of their wives became pregnant. 18 other men with normal sperm-counts were given one or more courses of methylprednisolone 96 mg/day for 7 days. There was a more pronounced fall in antibody titres in these men, and 7 of their wives became pregnant. Testicular biopsies in 3 men with high titres of antibodies and very low sperm-counts which became normal with prednisone showed adequate spermatogenesis; however, focal round-cell infiltration of seminiferous tubules was observed in 1 case. It is suggested that a steroid-responsive immune orchitis can occur spontaneously in man, and may contribute to the infertility of men with antisperm antibodies.