Association between recurrent spontaneous abortions and circulating IgG antibodies to sperm tails in women

The Change of Semen Superoxide Dismutase and Acrosin Activity in the Sterility of Male Patients with Positive Antisperm Antibody

In this study, we report the change of semen superoxide dismutase (SOD) and acrosin activities in the male sterility patients with positive antisperm antibody (AsAb). The activity of SOD was measured by xanthine oxidase assay and sperm acrosin activity was calculated by BAEE/ADH. Our data show that compared with the normal fertility group, the semen SOD activity in AsAb-positive patients was significantly lower. Similarly, the sperm acrosin activity in AsAb-positive patients was also significantly lower. Our results suggest that the sterility resulting from positive AsAb may be related with the changes of semen SOD and sperm acrosin activities.

Clinical associations and mechanisms of action of antisperm antibodies

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.

Effects of sera from infertile women with sperm immobilizing antibodies on fertilization and embryo development in vitro in mice

PROBLEM

This study was performed to investigate if patients' sera with anti-human sperm antibodies show inhibitory effects on in vitro fertilization (IVF) and embryo development in mice.

METHOD OF STUDY

Patients' sera were collected from eight infertile women having sperm immobilizing antibodies and 17 infertile women without the antibodies. Male ICR mice and female F1 mice (BALB/c X C57BL/6J) were used. In mouse IVF, pre-incubated sperm were cultured in the medium containing patient's serum with or without sperm immobilizing antibodies, or bovine serum albumin (BSA) as a control. The fertilization rates and the incidences of blastocyst formation were compared.

RESULTS

A mouse sperm immobilization test was established. Five (62.5%) of eight serum samples with sperm immobilizing antibodies and nine (52.9%) of 17 serum samples without the antibodies showed sperm immobilizing activities in mice. There was no significant difference between the two groups. Five sera with sperm immobilizing activities in human and mice, and five sera without sperm immobilizing activities in human or mice were used for the further experiments. The fertilization rates in BSA, patient's serum with sperm immobilizing antibodies, and that without the antibodies were 82.5% (746/904), 43.6% (508/1165), and 64.5% (669/1037), respectively. There were significant differences between the groups. The incidences of blastocyst formation were 59.9% (447/746), 31.7% (161/508), and 47.7% (319/669), respectively. There were also significant differences between the groups.

CONCLUSIONS

Some of the patient's serum with and without sperm immobilizing antibodies could immobilize sperm with complement. However, as compared with control, sera with sperm immobilizing activities against human and mouse sperm significantly blocked IVF and inhibited embryo development in mice. Further studies are required to investigate the mechanisms of the blocking effects of antisperm antibodies on fertilization and embryo development using the mouse model.

Value of flow cytometric assay for the detection of antisperm antibodies in women with a history of recurrent abortion

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.

Sperm immobilizing antibodies in the sera of infertile women cause low fertilization rates and poor embryo quality in vitro

PROBLEM

The effects of sperm immobilizing antibodies in the sera of infertile women on fertilization and embryo quality in vitro were investigated.

METHOD OF STUDY

Before the introduction of sperm immobilization test (SIT) as a routine test for female infertility, 85 oocytes were collected in nine in vitro fertilization (IVF) cycles from four infertile women who were afterward found having had sperm immobilizing antibodies in their sera and the oocytes were inseminated with swim-up sperm in a medium containing the patient's serum. Fifty oocytes were collected in five IVF cycles from five infertile women possessing the antibodies in their sera and the oocytes were inseminated with swim-up sperm in a medium supplemented with human serum albumin (HSA).

RESULTS

In the former group, 41 of 85 oocytes were fertilized, giving a fertilization rate of 48.2%. In the latter group, 43 of 50 oocytes were fertilized, giving a fertilization rate of 86.0%. There was a significant difference of the fertilization rate between the groups (P < 0.0001). Embryo quality was assessed by the Veeck's classification. The grade 1 and grade 2 embryos were considered good quality. Using this classification, 16 (39.0%) of 41 embryos incubated in the medium containing the patient's serum were good quality, while 34 (79.1%) of 43 embryos incubated in the medium supplemented with HSA were good quality. There was also a significant difference between the groups (P = 0.0003).

CONCLUSIONS

These findings might indicate that sperm immobilizing antibodies in the sera of infertile women cause low fertilization rates and poor embryo quality in vitro. It is suggested that SIT in the sera of infertile women should be performed at least before proceeding IVF. The manipulation of gametes and embryos from patients having sperm immobilizing antibodies should be carefully carried out especially to avoid contaminating patient's serum and follicular fluid in the culture medium in order to have a better IVF result.

Quality of embryo does not affect the implantation rate of IVF-ET in infertile women with antisperm antibody

OBJECTIVE

To determine whether low quality score of embryos and advanced maternal age affect the implantation rate in infertile women with sperm-immobilizing antibody.

DESIGN

A retrospective study.

SETTING

The IVF Unit of the Department of Obstetrics and Gynecology at Tokushima University Hospital.

PATIENT(S)

Four infertile groups were studied: 20 women with sperm-immobilizing antibodies; 169 with tubal; 129 with male factor; and 72 with unexplained etiology.

INTERVENTION(S)

All women were hyperstimulated with GnRH analogue and scheduled ovarian stimulation with FSH and hMG for oocyte retrieval.

MAIN OUTCOME MEASURE(S)

Relationship of quality of transferred embryos, implantation rate and maternal age among four groups of infertile couples.

RESULT(S)

In the antisperm group, the fertilization rate (57.6%) and mean (+/- SD) score of transferred embryos (5.4+/-1.9) were significantly lower than those in the tubal group (72.4% and 6.2+/-1.9, respectively). However, the implantation rate in the antisperm group (23.6%) was significantly higher than those in other three groups (tubal, 8.6%; male factor, 9.5%; unexplained, 7.6%). With advancing maternal age, the implantation rate decreased in the three comparative groups. In contrast, the implantation rate in the antisperm group did not decrease with advancing maternal age.

CONCLUSION(S)

Women with antisperm antibodies have several disadvantages to overcome in order to achieve successful IVF-ET, such as a low fertilization rate and poor quality of transferred embryos. However, a high implantation rate was observed in this group, even in women at advanced age. The occurrence of a cellular or humoral immune reaction against sperm may augment the uterine receptivity for the implantation of fertilized ova or blastocyst.

Sperm artificially exposed to antisperm antibodies show altered deoxyribonucleic acid

PURPOSE

Our purpose was to assess sperm deoxyribonucleic acid (DNA) integrity after exposure to antisperm antibodies.

METHODS

Donor semen were divided and exposed to sera containing IgG, IgA, and IgM antisperm antibodies. Untreated portions served as the control. After incubation (1 hr, 23 degrees C), the sperm were centrifuge-washed, resuspended, and incubated (23 degrees C) for 2, 5, 7, or 9 days. Acridine orange staining and kinematic parameters were measured. The sentinel (17q21 from D17S855) and beta-globin genes were amplified and analyzed using denaturing gradient gel electrophoresis.

RESULTS

Sperm preexposed to antisperm antibodies had deleted sentinel gene on days 7 and 9. The beta-globin gene was intact. There were no differences in acridine orange staining.

CONCLUSIONS

Sperm artificially exposed to antisperm antibodies resulted in a subtle deletion of genetic material. The DNA alteration process was slow and was undetectable at the gross level. More studies are needed to confirm the findings and determine whether DNA repair mechanisms can reverse the damage.

Antisperm antibodies: etiology, pathogenesis, diagnosis, and treatment

OBJECTIVE

To critically review the English-language literature and describe the current diagnosis, prevalence, etiology, and treatment of antisperm antibodies (ASA).

DESIGN

A comprehensive literature search of the English-language literature published between 1966 and December 1997 was performed on MEDLINE. Articles were also located via bibliographies of published works.

RESULT(S)

Data were excerpted from articles identified by MEDLINE search. The diagnosis, prevalence, etiology, and treatment of ASA are described.

CONCLUSION(S)

There is sufficient evidence that ASA impair fertility in couples with unexplained infertility. A number of different methodologies are available, which may be used in their detection. However, in many cases, test interpretation is subjective. Although there is not enough evidence to support systemic treatment for ASA, application of a variety of assisted reproductive technologies improves outcome.

A convenient mixed immunobeads screen for antisperm antibodies during routine semen analysis

OBJECTIVE

To determine if leftover unused IgG, IgA, and IgM immunobeads could be combined as a convenient screen for antisperm antibodies in unwashed sperm. For comparisons, the mixed antiglobulin reaction (SpermMar) and immunobead test were performed.

DESIGN

Prospective comparative study.

SETTING

Clinical and academic research environment.

SUBJECT(S)

Donor human sperm negative for antisperm antibodies.

INTERVENTION(S)

Sperm specimens (n = 9) were equally divided and sera with antisperm antibodies added to one portion (positive control).

MAIN OUTCOME MEASURE(S)

Assessment of antisperm antibodies in sperm.

RESULT(S)

The mixed immunobeads screen qualitative results were the same for both the SpermMar and immunobead tests. The mixed immunobeads screen (positive when > or =10% motile sperm was bound) had a sensitivity and specificity of 100%. The percentages of bound sperm for the mixed immunobeads screen correlated with the SpermMar but not the immunobead test. The mixed immunobeads screen intraassay and interassay coefficients of variation were 28.9% and 45.6%, respectively.

CONCLUSION(S)

Matching results between the mixed immunobeads screen and the SpermMar or immunobead test suggested that the screen could be used to detect antisperm antibodies in unwashed sperm. There was no advantage to washing the sperm, although the screen was flexible and applicable for both unwashed and washed sperm.

Expression of human leukocyte antigens in patients with autogenic and allogenic circulating antisperm antibodies

Circulating antisperm antibodies have been shown to have an adverse effect on a couple's ability to achieve fertilization. This study investigated the HLA class II pattern in couples with infertility associated with antisperm antibodies. Forty-nine couples with significant circulating antisperm antibodies confirmed with immunofluorescence technique and 15 control couples had HLA class II-DR, DQ typing. The Terasaki lymphotoxicity test was used. In women with antisperm antibodies, HLA class II haplotypes DR4, DR6, and DQW3 were more common than in the control group. For the men, DR6 and DQ7 were more common in those with antisperm antibodies, than in controls. With sharing of the haplotypes by the couples, DR4, DR6, and DQ7 were more common in couples with antisperm antibodies, but deficient in DQW3. HLA class II-DR4, DR6, and DR7 sharing in couples and deficiency of DQW3 may be associated with circulating antisperm antibody production.

Effects of sperm immobilizing antibodies on pregnancy outcome in infertile women treated with IVF-ET

PROBLEM

Since it was found that anti-sperm antibodies could impair in vitro development of fertilized eggs in the presence of complement in rats, the effects of sperm immobilizing antibodies on human pregnancy were examined in infertile women treated with IVF-ET.

METHODS

The pregnancy outcomes of 143 ET cycles in 58 infertile women with sperm immobilizing antibodies and 363 ET cycles in patients with tubal infertility as control were compared. Diagnosis of chemical pregnancy was done when the urinary hCG level had risen over 50 IU/L but a gestational sac could not be demonstrated later. Antibody titers of sperm immobilizing antibodies (SI50 units) were measured by a quantitative sperm immobilization test.

RESULTS

33 (23.1%) of 143 cycles in the patients with sperm immobilizing antibodies and 56 (15.4%) of 363 cycles in the control patients were diagnosed as pregnancy. The pregnancy rates were significantly higher in the former than in the latter (P < 0.05). In the patients with sperm immobilizing antibodies, 12 (36.4%) were chemical pregnancies, 5 (15.2%) were clinical abortions, and 16 (48.5%) had deliveries. In the control group, 18 (32.1%) were chemical pregnancies, 10 (17.9%) were clinical abortions including ectopic pregnancies and 28 (50.0%) had deliveries. There was no significant differences in each category. When the SI50 titers at the time of conception were considered, chemical pregnancy rates were 22.2% (4/18) in patients with SI50 titers below 10 units, but those in patients with SI50 titers above 10 were 50.0% (5/10) and above 100 were 60.0% (3/5), respectively, (P > 0.05). In four of five patients who had both chemical and clinical pregnancies, the SI50 titers at the time of conception were higher in the chemical pregnancy cycles than in the clinical pregnancy cycles.

CONCLUSIONS

Though the pregnancy rates were significantly higher in the patients with sperm immobilizing antibodies as compared to those with tubal infertility, chemical pregnancy rates were also higher in the patients with higher sperm immobilizing antibody titers. These results suggest that sperm immobilizing antibodies may cause the damage of early development of human embryos in vivo in the small number of patients with a high titer of the antibodies.

Prospective study showing that antisperm antibodies are not associated with pregnancy losses

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.

Infertility due to antisperm antibodies

Immunoinfertility is an important problem, involving a significant number of infertile couples. Although the presence of antibodies on sperm has better prognostic value than those in serum or seminal plasma, it may not be the sole authentic evidence of immunoinfertility. Infertility from antisperm antibodies is likely only when they bind to a relevant sperm antigen involved in a specific fertility function. The variance in functional deficits seen in immunologic infertility is most likely related to antibodies directed at different sperm antigens or different class, subclass, or isotypes. Antibodies to FA-1 seem to be of significant importance in human immunoinfertility. In approaching couples with infertility, a high index of suspicion for antibodies is necessary to avoid misdiagnosis. In the optimal situation, all semen analyses should be screened for sperm-bound antibodies, but if this is impractical, testing should be performed on high-risk individuals (Table I). In couples in which the man has sperm-bound antibodies, and in whom there is no identifiable female factor, treatment should be instituted. Most treatments for immunoinfertility have been disappointing because of poor results, adverse effects, or high cost. Corticosteroid therapy has shown some promise in published reports (mostly poorly designed studies), but increase in pregnancy rate is modest and adverse effects may be significant. In our opinion, informed consent should be documented prior to institution of corticosteroid therapy, and subjects should be closely monitored. Advanced reproductive technologies offer a higher safety profile, and, with increasing technology, higher pregnancy rates. We recommend progressing from "low-tech" procedures, such as IUI and reserving the higher level procedures, such as IVF and ICSI, for those couples in whom pregnancy does not occur. The highest level reproductive technologies give the best current prospects for pregnancy in patients with this difficult problem but also are invasive and costly. It is hoped that further work in the laboratory will give rise to newer, safer, and less expensive effective treatments in the very near future.

The effect of sera antisperm antibodies in the female partner on in vivo and in vitro pregnancy and spontaneous abortion rates

PROBLEM

To determine the incidence of antisperm antibodies (ASA) in female sera from infertile couples or those suffering from recurrent abortions. Also to determine if the pregnancy and/or abortion rates are any higher in those positive versus those negative for ASA.

METHOD

All registered patients had sera drawn and ASA measured by indirect immunobead test on initial study. Pregnancy and abortion rates were determined for patients undergoing in vivo or in vitro therapy.

RESULTS

There was a low incidence of ASA in patients having in vivo or in vitro treatment. There was no decrease in pregnancy rates (PRs) or increase in spontaneous abortions (SAB) in those positive for ASA.

CONCLUSION

Antisperm antibodies in female sera do not seem to be etiologic in causing infertility or SAB. Future studies might consider changing the antigen source from donor sperm to husband's sperm.

High implantation rate and consequently high pregnancy rate by in vitro fertilization-embryo transfer treatment in infertile women with antisperm antibody

OBJECTIVE

To examine the effect of antisperm immunity on postfertilization steps, such as implantation of embryos and fetal growth in IVF-ET treatment of women with sperm-immobilizing antibodies.

DESIGN

Retrospective analysis of clinical laboratory data.

SETTING

The IVF-ET program of the Department of Obstetrics and Gynecology. The University of Tokushima, School of Medicine.

PATIENTS

Eighteen women with sperm-immobilizing antibodies and 122 infertile patients with nonimmune etiology as controls. Infertile couples due to a male factor and with unknown etiology were excluded.

INTERVENTIONS

All patients received the same IVF-ET program with GnRH agonist.

MAIN OUTCOME MEASURES

Rates of fertilization and cleavage, implantation rate per embryo transferred and pregnancy rate (PR) in both test and comparison groups.

RESULTS

The rate of fertilization in the antisperm group (61.3%) was significantly lower than that in the comparison group (76.8%). But the implantation rate per embryo transferred (23.5%) and consequently the modified PR per oocyte recovery procedure (34.4%) in immunologically infertile women were significantly higher than those in the comparison group (7.9% and 17.8%, respectively).

CONCLUSIONS

Although sperm-immobilizing antibodies prevent sperm-egg interaction, they do not seem to have any adverse effects on achievement of pregnancy. Moreover, the existence of antisperm immunity in woman with antisperm antibodies is suggested to be favorable for successful pregnancy by the IVF-ET procedure.

Lack of association between sperm antibodies and recurrent spontaneous abortion

The results of this investigation did not confirm the previous report by Witkin and Chaudhry (1). In contrast, they indicate that women with a history of recurrent SABs have a significantly lower incidence of circulating sperm antibodies. This finding is consistent with the considerable amount of evidence indicating that sperm antibodies can interfere with sperm function.

Lymphocyte proliferative response to fertilization antigen in patients with antisperm antibodies

The fertilization antigen, immunopurified from human testes, activated lymphocytes from three of the six men and women with antisperm antibodies. Lymphocytes from none of the six men and women without antibodies were activated with fertilization antigen. Another sperm surface antigen, the germ cell antigen, immunopurified from murine testes, did not activate lymphocytes from any of the individuals with or without antisperm antibodies. These results indicate that the men and women with antisperm antibodies are sensitized against fertilization antigen and not germ cell antigen. These results reinforce our previous findings on the involvement of fertilization antigen in immunoinfertility in humans.

Biphasic production of antisperm autoantibodies follow vasectomy of the Lewis rat

Temporal changes in the specificity of post-vasectomy autoantibodies to SDS-PAGE separated sperm antigens were investigated in Lewis rats. Sera were obtained from nine vasectomized animals prior to vasectomy, every two weeks for 14 weeks, and less frequently thereafter, up to 41 weeks. Changes in antisperm autoantibodies over time were assessed by ELISA and western blot assay and compared to antisperm isoantiserum and normal Lewis rat serum. A "biphasic" pattern of autoantibody production over time was observed in a majority of individuals. This pattern was characterized by early phase autoantibodies, produced between 0 and 6 weeks after vasectomy, which bound antigens at the stacking, separating and ionic fronts and by late phase autoantibodies, produced after 4 weeks following vasectomy which bound antigens at 86, 63, 52, 43, 31 and 26 kDa. Previous work suggested that some high molecular weight autoantigens were disulfide-bonded polymers of the polypeptides at 86, 63, and 43 kba (Handley, et al., 1988). Indirect immunofluorescence with monospecific isoantisera to the 86 kDa autoantigen suggested that its corresponding high molecular weight polymer was located in the tail of cauda epididymal spermatozoa. This polymer possessed several characteristics of T cell independent autoantigens. These data show a change in the specificity of autoantibodies produced over time after vasectomy which may reflect a shift from T cell independent to T cell dependent autoantibody production by the Lewis rat.