Clinical immunology of vasectomy and vasovasostomy

Post-vasectomy antisperm immune reaction after testosterone-induced azoospermia

We describe preliminary experiments on the effects of testosterone-induced azoospermia on post-vasectomy antisperm antibody reaction in two subjects. Progressive resumption of spermatogenesis following gradual suspension of testosterone therapy was still associated with antisperm antibody formation. Post-vasectomy antisperm antibody production does not seem to be triggered exclusively by acute, sudden and massive reabsorption of spermatoza after vasectomy but also by slow, gradual and late sperm antigen reabsorption.

Occurrence of sperm antibodies in adult rats after prefertile traumatic vas lesions

The occurrence of sperm antibodies has been studied in adult rats, which at prefertile age had been subjected to unilateral vasectomy, unilateral or bilateral crush injury of the vas or bilateral resection of the ductal artery. By means of indirect immunofluorescence technique, circulating sperm antibodies could be demonstrated in the blood in all groups 13 weeks postoperatively: unilateral vasectomy 15/17 (88%), unilateral crush injury 14/20 (70%), bilateral crush injury 13/20 (65%) and vascular injury 14/20 (70%). Sperm granulomas were observed in the unilateral vasectomy group (14/17) and in the bilateral crush injury group (4/20), whereas no sperm granulomas were seen in the unilateral crush injury or the vascular injury group.

The incidence of spermatic granulomas and their relation to testis weight after vasectomy and vasovasostomy in Lewis rats

The occurrence of spermatic granulomas of the vas deferens was studied in Lewis rats at intervals up to 7 months after vasectomy or vasectomy followed 3 months later by vasovasostomy. The incidence of granuloma progressed with time to involve one or both tracts in 100% of vasectomized rats. In addition, the majority of animals developed new granulomas after vasovasostomy, even though fluid flow through the reconnected vas deferens was demonstrated in vitro. When individual tracts were analyzed, the weight of the testis was related to ipsilateral spermatic granuloma formation in both vasectomy and vasovasostomy groups at 3 and 4 months after initial operation. Testes were small in the absence of a granuloma but similar to those of sham-operated rats if a granuloma was present. The possible protective effect of spermatic granuloma formation on the testis is discussed.

A prospective study of antisperm antibody development in acute epididymitis

The association between acute epididymitis and development of antisperm antibodies was investigated by the gelatin agglutination technique in prospectively collected serum samples from 27 patients. Agglutinating antisperm antibodies, mainly of the IgG class, were detected in seven men (27 per cent), a significantly increased frequency compared to prevalences previously found among blood donors and men from infertile couples. The antibodies developed de novo in four patients (15 per cent). The increased incidence of positive sera and the kinetics of the antibody responses strongly indicate a causal link between acute epididymitis and autoimmunization against spermatozoa. In the majority of the patients the antibody titers were low, being of only theoretical importance in respect to later fertility.

Quantitative pathologic changes in the human testis after vasectomy. A controlled study

To determine whether there are any deleterious changes in the human testis after vasectomy, we obtained testicular biopsy specimens from 31 healthy men undergoing vasectomy reversal and from 21 healthy, fertile volunteers. Morphometric analyses of these specimens revealed a 100 per cent increase in the thickness of the seminiferous tubular walls (P less than 0.001), a 50 per cent increase in the mean cross-sectional tubular area (P less than 0.001), and a significant reduction in the mean number of Sertoli cells (P less than 0.01) and spermatids (P less than 0.01) per tubular cross section in the post-vasectomy group, as compared with the control group. Focal interstitial fibrosis was observed in 23 per cent of the specimens from the post-vasectomy group and in none from the control group. There was a significant correlation (P less than 0.01) between interstitial fibrosis and infertility in patients who underwent a surgically successful vasectomy reversal (sperm in the ejaculate). None of the other measured characteristics correlated with infertility after vasectomy reversal. We conclude that significant morphologic changes occur in the human testis after vasectomy. The presence of focal interstitial fibrosis was associated with a high incidence of infertility in this series.

Increased frequency of autoantibodies in men with sperm antibodies

Autoantibodies to thyroid microsomes were more frequent in 102 infertile men with complement-dependent sperm-immobilizing activity (sperm immobilization test [SIT] ) in serum (11.8%) than in a control group of 277 men of comparable ages and semen quality without sperm antibodies (4.3%, P less than 0.05). Frequencies of organ-specific antibodies (antigastric parietal cell, antithyroglobulin, and antithyroid microsome) in 57 men with genital tract obstructions and positive SIT were similar to those for control subjects, and there were no significant differences in the frequencies of non-organ-specific autoantibodies (antinuclear antibody, rheumatoid factor, antimitochondrial, and anti-smooth muscle) in the three groups. Because in men without genital tract obstruction antithyroid microsomal autoantibodies were more common with sperm antibodies than without, the possibility of a genetic factor in the causation of sperm autoimmunity should be considered.

Association between infertility following reversal of vasectomy and the presence of sperm agglutinating activity in semen

A statistically significant association between infertility, following reversal of vasectomy, and the presence of sperm agglutinating activity in post-operative semen samples has been demonstrated in a retrospective study. Sperm agglutinating activity was measured using a microtitration assay, and the number of positive samples rose from 3/78 (4%) pre-operatively, to 34/134 (25%) post-operatively. High titres (greater than or equal to 1:32) of agglutinating activity were observed only when viable sperm were present in the ejaculate. Positive semen titres were obtained only when parallel serum samples were positive at titres of greater than or equal to 1:256. Conception only occurred in the partner of one man whose seminal plasma contained agglutinating activity, but 22/34 (65%) of the men whose semen lacked such activity were fertile.

Prevention of antisperm autoantibody response in vasectomised Swiss white mice by infusion of heterologous antisperm serum

Antisperm autoimmunisation may cause infertility in men following spermatic cord torsion, testicular biopsy and vasectomy with attempted reversal. The demonstration in addition of antisperm autoantibody-associated systemic disease in animals is cause for concern, although there is to date little evidence for these effects in man. We have investigated the use of heterologous antisperm antiserum to block the autoimmunising effect of vasectomy in Swiss white mice. Antisperm autoantibodies were detected by microimmunofluorescence at 1/8 dilution in all eight control mice tested 1 month after vasectomy, and in none of the five mice who had received high-titre or low-titre immune serum (P less than 0.001). However, the high-titre serum was toxic in the amounts used.