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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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Shi ZD, Zhang YP, Zhai LP, Zhang MH, Dong YL, Yang HJ, Qiu Y. Sperm Parameters, ASAs and Apoptosis After Processing by the Double Tube and Swim up Methods. Am J Mens Health 2021; 15:15579883211001202. [PMID: 33759613 PMCID: PMC7995456 DOI: 10.1177/15579883211001202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The aim of this study was to improve the quality of semen samples by using a novel double-tube (DT) method. The DT method was developed to select sperm and compared with traditional swim-up (SU) technique for 31 semen samples. Sperm DNA integrity were tested with TUNEL and SCSA. Content of antisperm antibodies (ASA) in the semen was measured by ELISA and MAR. Levels of the caspase-3 in the sperm were assessed by western blotting. After SU and DT, 15 couples and 16 couples were underwent IVF-ET. The number of RCDs, the percentage of SDF and DFI, ASA and the level of caspase-3 were significantly decreased after DT and SU (p = .001 and p< .001). When the DT and SU compared, there were significant changes in the number of RCD, the percentage of SDF and DFI, ASA and the level of caspase-3 (p< 0.05-0.001). There was a higher cleavage rate (p = .017) and a lower abortion rate (p< .05) in DT-IVF group than in SU-IVF group. DT selection yielded spermatozoa with low RCDs, DFI, ASA, and caspase-3 which would be benefit for ART.
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Affiliation(s)
- Zhi-Da Shi
- Key Laboratory of Birth Regulation and Control Technology of National Health Commission of China, Key Laboratory for Improving Birth Outcome Technique, Maternal and Child Health Care Hospital of Shandong Province, Jinan, Shandong, People's Republic of China
| | - Yan-Ping Zhang
- Key Laboratory of Birth Regulation and Control Technology of National Health Commission of China, Key Laboratory for Improving Birth Outcome Technique, Maternal and Child Health Care Hospital of Shandong Province, Jinan, Shandong, People's Republic of China
| | - Li-Ping Zhai
- Shandong Provincial Institute of Control of Endemic Disease, Jinan, Shandong, People's Republic of China
| | - Mei-Hua Zhang
- Key Laboratory of Birth Regulation and Control Technology of National Health Commission of China, Key Laboratory for Improving Birth Outcome Technique, Maternal and Child Health Care Hospital of Shandong Province, Jinan, Shandong, People's Republic of China
| | - Yun-Ling Dong
- Key Laboratory of Birth Regulation and Control Technology of National Health Commission of China, Key Laboratory for Improving Birth Outcome Technique, Maternal and Child Health Care Hospital of Shandong Province, Jinan, Shandong, People's Republic of China
| | - Hui-Jun Yang
- Key Laboratory of Birth Regulation and Control Technology of National Health Commission of China, Key Laboratory for Improving Birth Outcome Technique, Maternal and Child Health Care Hospital of Shandong Province, Jinan, Shandong, People's Republic of China
| | - Yi Qiu
- Key Laboratory of Birth Regulation and Control Technology of National Health Commission of China, Key Laboratory for Improving Birth Outcome Technique, Maternal and Child Health Care Hospital of Shandong Province, Jinan, Shandong, People's Republic of China
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Abstract
Sperm have been known to be antigenic for more than a century. There is a strong body of evidence that in humans and in other species at least some antibodies that bind to sperm antigens can cause infertility. Therefore, these antibodies are of interest today for two practical reasons. Firstly, the association of the antibodies with infertility means that they must be detected and then the couples treated appropriately. Secondly, because these antibodies can induce infertility they have the potential to be developed for contraceptive purposes in humans and also for the control of feral animal populations.
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Affiliation(s)
- L W Chamley
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand.
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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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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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Al-Hussein K, Al-Mukhalafi Z, Bertilsson PA, Jaroudi K, Shoukri M, Hollander J. Value of flow cytometric assay for the detection of antisperm antibodies in women with a history of recurrent abortion. Am J Reprod Immunol 2002; 47:31-7. [PMID: 11883747 DOI: 10.1034/j.1600-0897.2002.1o013.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PROBLEM To verify the proposed relationship between recurrent spontaneous abortions and the presence of maternal antisperm antibodies (ASA) in women as detected by a sensitive and reliable method. METHOD OF STUDY The presence of maternal antipaternal immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies were determined against three different paternal antigens comprising T, B lymphocytes and semen cells by a sensitive flow cytometric crossmatch method to examine their possible correlation with pregnancy outcome. Group 1 consisted of sera obtained from 24 women with a history of abortion, and lymphocytes and semen samples collected from their husbands at the same time of visiting the in vitro fertilization (IVF) Clinic at King Faisal Specialist Hospital and Research Center. Sera, lymphocytes and semen samples were also collected from six couples with no history of abortion who served as controls (Group 2). RESULTS Using a sensitive flow cytometric assay to analyse the samples, without knowledge of clinical status, elevated levels of both IgG and IgM were detected in Group 1. However, no significant association was found when compared with normal females who had healthy pregnancies. CONCLUSION Flow cytometry is a highly sensitive and specific tool for the detection of alloantibodies in human sera from patients with rejected transplanted organs. Our findings suggest that maternal antipaternal antibodies with respect to IgG and IgM classes do not play a major role in women with a history of recurrent abortions, despite the presence of increased levels of antibodies against three different sources of paternal antigens.
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Affiliation(s)
- Khaled Al-Hussein
- Department of Biological and Medical Research, King Faisal Specialist and Research Center, Riyadh, Saudi Arabia.
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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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Vandendael A, Kruger TF, de Villiers A, Menkveld R, Lombard CJ. Significance of antisperm antibodies in female serum in a gamete intrafallopian transfer program. ARCHIVES OF ANDROLOGY 1998; 40:175-80. [PMID: 9583355 DOI: 10.3109/01485019808987941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The influence of antisperm antibodies in the female serum on fertilization and pregnancy rate in patients undergoing GIFT was assessed. A study group of 52 couples (69 cycles) with significant levels of antisperm antibodies in the female serum were compared to a control group of 749 couples (1185 cycles). Maternal serum or donor serum was used as growth medium supplement. The TAT test was performed for the detection of antisperm antibodies in the serum. Antisperm-antibody presence in female serum was associated with similar fertilization and pregnancy rates in a GIFT program compared to the control group. The type of serum used as growth medium supplement did not affect statistically the fertilization or pregnancy rate.
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Affiliation(s)
- A Vandendael
- Department Obstetrics and Gynaecology, Tygerberg Hospital, Parow, South Africa
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Omu AE, Makhseed M, Mohammed AT, Munim RA. Characteristics of men and women with circulating antisperm antibodies in a combined infertility clinic in Kuwait. ARCHIVES OF ANDROLOGY 1997; 39:55-64. [PMID: 9202834 DOI: 10.3109/01485019708987902] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Antisperm antibodies were determined in the sera of 250 infertile couples and 100 puerperal women as controls using the immunofluorescence technique. Couples with significant circulating antisperm antibodies were placed on low-dose prednisolone 5 mg daily for 3-6 months. Initial routine semen analysis and hypoosmotic swelling test were done and repeated after 3 months of therapy. The incidence of antisperm antibodies (ASA) was 18.8 and 17.6% in the men and women, respectively, compared to 4% in the women controls (p < .02). In the men, the main determinants (with incidence) of ASA included smoking (33.9%), past history of sexually transmitted disease (33.3%), surgery to genital tract (28.6%), trauma (27.3%), and unexplained infertility (18.5%). In women whose husbands had antisperm antibodies the incidence of circulating antisperm antibodies was 38.3%, while endometriosis and thyroid dysfunction had incidence of antisperm antibodies of 21.4 and 16.7%, respectively. In the 27 (10.8%) case of unexplained infertility, the incidence of antisperm antibodies was 22.2%. High follicle-stimulating hormone (FSH) in the men and low midluteal-phase progesterone in the women were associated with increased expression of antisperm antibodies. Antisperm antibodies adversely affected quality of sperm. Low-dose prednisolone significantly reduced the titer of antisperm antibodies and improved the sperm parameters and conception rate.
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Affiliation(s)
- A E Omu
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Kuwait University, Safat, Kuwait
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Simpson JL, Carson SA, Mills JL, Conley MR, Aarons J, Holmes LB, Jovanovic-Peterson L, Knopp R, Metzger B. Prospective study showing that antisperm antibodies are not associated with pregnancy losses. Fertil Steril 1996; 66:36-42. [PMID: 8752608 DOI: 10.1016/s0015-0282(16)58384-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To obtain prospective data on the relationship between presence of antisperm antibodies in maternal sera and first trimester pregnancy losses. DESIGN First trimester sera obtained from diabetic and nondiabetic women recruited within 21 days of conception were analyzed using the indirect immunobead test for immunoglobulin (Ig)G, IgA, and IgM antisperm antibodies. Regional binding also was considered: sperm head, midpiece, and sperm tail. Results were correlated with pregnancy outcome. SETTING Five university centers. PATIENTS One hundred eleven women who experienced pregnancy loss (55 diabetic; 56 nondiabetic) were matched 2:1 with 104 diabetic and 116 nondiabetic women (controls) who subsequently had a normal liveborn infant. INTERVENTION None. MAIN OUTCOME MEASURE Pregnancy outcome (spontaneous abortion, liveborn) correlated with presence or absence of antisperm antibodies. RESULTS Analyzing samples without knowledge of clinical status, no differences were observed with respect to IgG, IgA, and IgM binding when a positive test was defined as 50% of sperm showing antibody binding. Likewise, no association was found for IgG and IgM antisperm antibodies at 20% binding. The only positive finding was observed for IgA antisperm antibodies at 20% binding (Fisher's Exact test). This one positive finding merely could reflect multiple comparisons. No significant differences between groups were observed when analysis was stratified according to location of antibody binding (head, midpiece, tail tip, entire sperm). When the sample was stratified into those having and not having a prior loss, a relationship between antisperm antibodies and pregnancy loss still was not evident. CONCLUSION Further work is necessary to determine whether IgA antisperm antibodies truly are associated with pregnancy loss or whether antisperm antibodies play any role in repetitive aborters. Findings in this study suggest that antisperm antibodies do not play a major role in pregnancy loss.
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Affiliation(s)
- J L Simpson
- Department of Obstetrics and Gynecology, University of Tennessee, Memphia, USA
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Sukcharoen N, Keith J. The effect of the antisperm auto-antibody-bound sperm on in vitro fertilization outcome. Andrologia 1995; 27:281-9. [PMID: 8659707 DOI: 10.1111/j.1439-0272.1995.tb01106.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
To evaluate the effects of antisperm auto-antibody-bound sperm on the outcome of in vitro fertilization-embryo transfer (IVF-ET), 160 infertile couples undergoing treatment by in vitro fertilization were recruited in this study. In the study group (11 couples, 15 cycles), the male partners were positive for antisperm autoantibodies determined by immunobead test (IBT). In the control group (149 couples, 152 cycles), the men had no such antibodies. The percentages of fertilization rate, cleavage rate and pregnancy rate of the study group and control group wer 75.0 +/- 5.2% vs. 69.3 +/- 2.4%; 82.8% +/- 3.7% and 6.7% +/- 11.8%, respectively. There were no significant differences in in vitro region, type and/or percentage of sperm-bound antibodies also had no effect on the in vitro fertilization outcome. In conclusion, in vitro fertilization-embryo transfer is not significantly affected by antisperm autoantibody-bound sperm determined by immunobead test.
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Affiliation(s)
- N Sukcharoen
- Assisted Conception Unit, Simpson Memorial Maternity Pavilion, Edinburgh, UK
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Kulin S, Bastiaans BA, Hollanders HM, Janssen HJ, Goverde HJ. Human serum and follicular fluid stimulate hyperactivation of human spermatozoa after preincubation. Fertil Steril 1994; 62:1234-7. [PMID: 7957990 DOI: 10.1016/s0015-0282(16)57191-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To test the effects of steroid-containing media such as follicular fluid (FF) and serum and of steroid-free but human protein-rich medium on hyperactivation (HA) of human spermatozoa with and without a preincubation period. DESIGN Analysis of HA using a computer-aided sperm analysis system. SETTING Academic hospital and andrologic laboratory. PATIENTS Twenty-six sperm samples were obtained from 26 different IVF patients. INTERVENTIONS None. RESULTS After a preincubation period of 3 hours, FF and serum enhanced the HA after 1 hour. A human plasma protein-rich solution did not. Without preincubation, no stimulation of HA was observed. CONCLUSION Steroids may be involved in HA, and a preincubation period may be required for an appropriate FF-induced HA.
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Affiliation(s)
- S Kulin
- Department of Obstetrics and Gynaecology, University Hospital, Nijmegen, The Netherlands
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Naz RK, Menge AC. Antisperm antibodies: origin, regulation, and sperm reactivity in human infertility. Fertil Steril 1994; 61:1001-13. [PMID: 8194608 DOI: 10.1016/s0015-0282(16)56747-8] [Citation(s) in RCA: 99] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To follow-up and expand discussion on the action mechanisms of antisperm antibodies in human infertility, the etiology and control of antisperm antibody induction, sperm antigens involved in immunoinfertility, and strategies for therapy. DESIGN A review of the recent literature with an emphasis on female immunoinfertility. RESULTS The role of antisperm antibodies in clinical infertility continues to be defined. Through assisted reproductive technologies, antisperm antibodies were shown to exert detrimental effects on different prefertilization and possibly postfertilization events. The female reproductive tract is part of the common mucosal immune system and is able to mount effective immune responses against infectious agents, foreign antigens, and, occasionally, sperm cells. Sperm membranes and constituents contain numerous antigenic components foreign to the human body, and yet antisperm antibodies become problematic in few women exposed to semen. Semen and sperm cells contain immunosuppressive factors capable of inhibiting different immune cells. Fertile women apparently produce antisperm antibodies but also possess neutralizing serum anti-idiotypic antibodies that are lacking in virgin and immunoinfertile women. CONCLUSIONS Antisperm antibodies can affect adversely human fertility but normally may be controlled by anti-idiotypic antibodies, which along with immunosuppressor factors in semen prevent their induction to a significant degree. This balance between detrimental and "beneficial" immune response to sperm may be shifted toward an antisperm antibody response by stimulatory factors such as infection. Therapies may be devised to stimulate the anti-idiotypic antibody system, to induce immune tolerance to sperm antigens, and to use antigens to adsorb antisperm antibodies from spermatozoa.
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Affiliation(s)
- R K Naz
- Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Bronx, New York 10461
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Chang TH, Jih MH, Wu TC. Relationship of sperm antibodies in women and men to human in vitro fertilization, cleavage, and pregnancy rate. Am J Reprod Immunol 1993; 30:108-12. [PMID: 8311919 DOI: 10.1111/j.1600-0897.1993.tb00611.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PROBLEM The presence of anti-sperm antibodies (ASA) in female serum has been correlated with decreased fertilization in the in vitro fertilization (IVF) program; however, the impact of each type of ASA (IgG, IgA, IgM) is not known. METHOD To clarify the role of each ASA subtype, the immunobead binding technique was used to identify IgG, IgA, and IgM ASA in the female sera and on the spermatozoa from 137 couples undergoing the IVF program. RESULTS Couples with ASA on spermatozoa had a lower fertilization rate and lower number of transferred embryos: and IgG was the major immunoglobin involved. Couples with ASA in female sera showed significant decreases in the rates of fertilization, cleavage, and number of transferred embryos only when IgM was detected, but not IgG or IgA. However, the presence of IgA ASA in female sera was only associated with a decrease in pregnancy rate, although the number of transferred embryos was not reduced. CONCLUSION These findings suggest that ASA can influence the results of IVF and that the specific effect is dependent upon the subtypes of ASA.
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Affiliation(s)
- T H Chang
- Department of Obstetrics and Gynecology, University of California, School of Medicine, Los Angeles 90024-1740
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