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

Necrospermia, antisperm antibodies, and vasectomy

OBJECTIVE

To present a case of necrospermia and antisperm antibodies after vasectomy reversal and in which motile sperm, subsequently used in intracytoplasmic sperm injection (ICSI) treatment, was found after testicular sperm retrieval.

DESIGN

Case report and literature review.

SETTING

Reproductive medicine unit based in a women's hospital in the United Kingdom.

PATIENT(S)

A 36-year-old man with secondary infertility who presented with necrospermia and antisperm antibodies after vasectomy reversal.

INTERVENTION(S)

Testicular sperm retrieval and IVF with ICSI.

MAIN OUTCOME MEASURE(S)

Presence of motile sperm in testicular sperm extraction biopsies.

RESULT(S)

Motile sperm found after testicular sperm retrieval successfully fertilized oocytes in an ICSI cycle.

CONCLUSION(S)

It appears difficult to dissociate the presence of antisperm antibodies from the necrospermia in our patient. Testicular sperm retrieval appeared to partially overcome the effect of the antisperm antibodies by retrieving sperm before they reach seminal plasma, where they would be exposed to the antibodies.

Current practice in the management of vasectomy reversal and unobstructive azoospermia in Merseyside & North Wales: a questionnaire-based survey

OBJECTIVE

To investigate the current incidence of vasectomy reversal procedures, the techniques used and which practitioners use them.

PATIENTS AND METHODS

Using a questionnaire, 130 general surgeons and urologists practising in Merseyside and North Wales were surveyed.

RESULTS

The response rate was 74%, with 24 urological surgeons and 14 general surgeons undertaking vasectomy reversal. Annually, urological surgeons carried out significantly more procedures than did general surgeons, at 8.5 and 5.3 (P = 0.029), respectively. They were also more likely to use double-layer closure and microsurgical techniques, whilst significantly less likely to use stents. Urologists reported significantly greater patency rates, at 76% and 52% (P = 0.017), respectively, with no significant differences in subsequent pregnancy rates (30% vs 25%). Only one practitioner checked tubal patency in the female partner before vasectomy reversal.

CONCLUSIONS

The use of vasectomy reversal is a cost-effective treatment for men wanting paternity after vasectomy. The technique used by the clinician and proper audit of the results require close attention; it would also appear to be obvious that all the partners of men seeking a vasectomy reversal should have their fertility status established before reversal, something that is clearly not done at present.

Diversity of antisperm antibodies bound to sperm surface in male immunological infertility

PROBLEM

The presence of antisperm antibodies (ASA) in males can reduce fecundity, however, relationship between the two is disputed. This study was performed to investigate if there is diversity of ASA bound to sperm surface using immunobead test (IBT) combined with complement dependent sperm immobilization test (SIT).

METHODS

The ASA bound to sperm surface were detected using the direct IBT (D-IBT) in 275 semen samples. In some cases with ASA detected by D-IBT, sperm immobilizing antibodies bound to sperm surface were also evaluated using direct SIT (D-SIT).

RESULTS

The incidence of the immunoglobulin G (IgG), IgA, and IgM classes of ASA detected by D-IBT were 2.5, 1.8, and 0.4%, respectively. Totally, nine (3.3%) infertile men had ASA on the sperm surface. D-SIT was tested positive in four (66.7%) of six cases with ASA assessed by D-IBT.

CONCLUSIONS

Some of the sperm-bound antibodies are associated with complement dependent sperm immobilizing antibodies, indicating that there exists a heterogeneity of sperm-bound antibodies. This result might be one of the reasons for the controversy about the relationship between ASA and immunological infertility in men.

Sperm acrosome status and sperm antibodies in infertility

PURPOSE

We studied whether the spermatozoa from sperm autoimmune infertile men undergo premature acrosomal loss and whether this relates to the presence of sperm antibodies in wives.

MATERIALS AND METHODS

We evaluated acrosome status of live washed native and overnight capacitated spermatozoa from 17 sperm nonautoimmune fertile and 23 sperm autoimmune infertile men using an immunofluorescent peanut lectin binding assay. We used cytotoxic and immunobead binding assays to prescreen the serum and seminal plasma of these men, and serum and cervical mucus of the wives for immunological infertility. We performed immunofluorescent sperm antibody assays on all study samples to ascertain sperm antibody isotype levels in each sample. Levels of acrosomal loss in husband native and capacitated spermatozoa were correlated with levels of IgG, IgA and IgM sperm antibodies in the study samples.

RESULTS

Sperm autoimmune infertile men had a significantly larger percentage of sperm (p <0.0001) that had lost the acrosome and a lower percentage of sperm with intact acrosome (p <0.0001) in native and capacitated preparations in contrast to those of fertile controls. Levels of cytotoxic and IgA antibodies, especially in seminal plasma and cervical mucus, correlated significantly with percentages of sperm with a total loss of acrosome in native and capacitated sperm preparations (p < or = 0.01).

CONCLUSION

Infertile men with sperm antibodies in serum and seminal plasma undergo premature acrosome loss. This loss may expose the reproductive tract immune system, especially that involving IgA, in autoimmune infertile men and the wives to high immunogenic levels of sperm acrosome membrane antigens, thereby rendering them immunologically infertile.

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.

Vasectomy and vasectomy reversal

Vasectomy remains the safest method of birth control and there is much to commend it in the setting of a stable family relationship. However, some aspects of this operation have been wrongly presented in an attempt to widen its popularity and increase public acceptance. A simple procedure it may be but it is not totally free of complications; sometimes the operation has to be repeated and rarely it may reverse spontaneously even after the most stringent precautions. The family planning officer who counsels a prospective candidate and the surgeon who undertakes the procedure must ensure that these facts are understood by the patient with crystal clarity and that this fact is duly recorded on a signed and witnessed permission slip. Any organization which includes vasectomy in its programme of family planning should include advice and referral for vasectomy reversal in exactly the same way that the pill may be stopped or a coil can be removed. Fertility can be successfully restored by vasovasostomy in 50% of men who wish to have their vasectomies reversed, which often is due to a change in circumstances beyond their direct control.

Prevalence of antisperm antibodies by SpermMARtest in subjects undergoing a routine sperm analysis for infertility

To evaluate the prevalence of antisperm antibodies (ASA) attached to the sperm plasma membrane in male partners of infertile couples, the binding of latex particles to spermatozoa was investigated using SpermMARtest, included routinely in semen analysis. A total of 860 men were examined, who were referred consecutively for semen analysis. Of these, 750 men were referred because of infertility (0.6-10 years in duration) whereas 110 were volunteers with a history of previous fertility. Samples were assessed by the SpermMARtest kit using latex particles sensitized with human IgG. Sperm-latex binding was read after 3 min and samples scored as negative, positive or highly positive when < 10, > 10-40, or > 40% binding occurred, respectively. Of the samples 132 (17.3%) were excluded because of azoo- or severe oligo-asthenozoospermia. IgG attached to spermatozoa were detected in nearly 13% of semen samples from the infertile population and in one of 110 fertile men (0.9%). From the infertile group, 6.2% of samples showed > 40% binding, and 6.7% intermediate binding, with an overall ASA prevalence of 12.9% in subjects undergoing semen analysis for infertility.

Local immunity in the male reproductive tract

In previous studies we have demonstrated that the male urinary tract forms part of the common mucosal immune system, and that the gut contributes to local defences at this site. The question arises as to the extent to which the reproductive tract also forms part of the common mucosal immune system. Rats were immunized by a variety of routes designed to stimulate a local response in the intestine and/or the reproductive tract. Rats immunized only by the intratesticular (i.t.) route yielded no antibody-containing (ACC) response in any of the tissues examined. Intestinal immunization using intraperitoneal priming followed by intraduodenal challenge (i.p./i.d.) yielded a substantial IgA-specific ACC response in the jejunum, but no ACC were detectable in any of the reproductive tract tissues. However, when intestinal and testicular immunizations were combined, large numbers of IgA-specific antibodies were detected in all tissues examined. Chronic drainage of the thoracic lymphatic duct throughout the post-challenge period abrogated the ACC response in all tissues of the reproductive tract, indicating that the ACC appearing at these sites after immunization were of gut origin. The IgA-specific anti-OVA antibody detectable in serum, saliva and testis homogenate reflected the ACC counts in histological sections. The studies reported here confirm that the male reproductive tract does form part of a common mucosal immune system and that gut-associated lymphoid tissues may contribute cellular precursors for ACC, particularly those of IgA specificity, appearing in the tract after local challenge.(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.

Effect of isotypes of antisperm antibodies on semen quality

A direct immunobead test (IBT) was performed on 233 men who attended an immunological centre. Thirty-four (14.6%) of these men were found to be positive (greater than 20% binding) for antisperm antibodies (ASA). IgA, IgG and IgM were the most common sperm-associated immunoglobulins. In 50% of men with ASA asthenozoospermia, teratozoospermia, leukocytospermia or hypofunction of the seminal vesicles was observed. Semen parameters were altered most frequently when IgM was present in association with IgA and/or IgG. This suggests that there is an active inflammatory process in the reproductive tract, as evidenced by leukocytospermia, and this could be responsible for the abnormal semen parameters. ASA generation could be a consequence of this process rather than being the cause of the abnormal semen quality. If ASA do affect fertility, this could take place in the female reproductive tract.

Antisperm antibodies in split ejaculates

The split ejaculation technique concentrates the most motile and viable spermatozoa in the first part of the ejaculate. Several clinicians use this fraction for insemination and in vitro fertilization. Eleven vasovasostomized men with antisperm antibodies participated in this study. The mixed antiglobulin reaction (MAR) for IgG, IgA, and secretory component was carried out on the whole ejaculate and the fractions of the split ejaculate. The isotype and concentration of free antisperm antibodies were determined in serum, the whole ejaculate and the fractions of the split ejaculate by the indirect MAR and the tray agglutination test. The detection of bound antisperm antibodies revealed almost identical reactions in fractions one and two and in the whole ejaculate. The results suggested that the majority of antisperm antibodies in the ejaculate from vasovasostomized men are transuded from serum not only at the epididymal and/or the prostatic level but also in the seminal vesicles.

Screening assays for immunologic infertility: a comparison study

Because the immunobead antisperm antibody test (IBT) is difficult to learn and results are heavily operator-dependent, we compared findings on IBT with those of SpermMAR and SpermCheck in 58 patients to determine whether the latter two tests could demonstrate improved screening ability. Assays performed on both sperm and serum (i.e., direct and indirect) yielded 100% positive predictive values when IBT was used as the standard. Both SpermCheck and SpermMAR are easier to perform, and, as the former has a slightly greater sensitivity, we recommend SpermCheck for the detection of immunologic infertility.

Antisperm antibodies and lymphocyte subsets in semen--not a simple relationship

The significance of white blood cells in the ejaculate remains a matter of controversy. Several authors have suggested that such cells are important in the modulation of an antisperm antibody response, i.e. a predominance of suppressor/cytotoxic to helper/inducer T cells may prevent the development of antisperm antibodies. In order to examine this relationship further we have documented the white blood cell types, with emphasis on the T-lymphocyte populations, in the ejaculates of men from infertile couples with and without antisperm antibodies; the latter group was divided further into two groups--vasovasostomized men and idiopathic men. All seven of the men without antisperm antibodies had a predominance of suppressor/cytotoxic T cells to helper/inducer T cells in the ejaculate. However, only in some of the men with antibodies was there a predominance of T-helper/inducer cells. It is clear that the relationship between antisperm antibodies and seminal leucocytes is therefore not as straightforward as has been proposed.

A comparison of the usefulness of SpermMar and immunobead tests for the detection of antisperm antibodies

We compared two testing protocols designed to detect immunoglobulin (Ig) G antibodies on sperm surfaces: (1) SpermMar (Ortho, Raritan, NJ) and (2) Immunobead Testing (Biorad, Richmond, CA). The standard SpermMar (SPMAR) protocol (direct test of unwashed semen) was performed with 47 ejaculates and found to be more sensitive than Immunobead Testing (IBT) on washed sperm, detecting five samples with greater than or equal to 30% bead binding, all of which by IBT had less than 20% bead binding. In contrast, when SPMAR was performed on washed sperm or with an indirect antibody transfer from serum or seminal plasma, SPMAR results gave mostly low values for bead binding in comparison with IBT. Our data suggest that SPMAR be used only in direct assays employing unwashed ejaculates, that it can be easily incorporated into routine semen analysis as a screening test, and that positive results should be confirmed by IBT (IgG and IgA).

Detection of sperm-bound antibodies in the male partners of infertile couples using the immunobead test

The aim of this investigation was to determine the incidence of sperm-bound antibodies in the male partners of an unselected infertile population using an immunologically specific test (IBT). With this method 34 out of 450 infertile men (7.55%) were positive for one or more of the immunoglobulins IgA, IgG and IgM. For IgG and IgA, the majority of antibody binding was located on the entire sperm with a minor amount bound to the head or tail. For the IgM, the majority of the binding was detected to the tail tip, and tail binding was observed only in a minority of cases.

SpermCheck: a simplified screening assay for immunological infertility

SpermCheck (Bio-Rad Laboratories, Hercules, CA), a new screening test for regional surface antibodies on motile sperm, uses monodispersed latex microspheres of uniform size as a vehicle to link rabbit antihuman immunoglobulins (IgA, IgG, IgM) and provides both negative and positive control sera, as well as sufficient buffer for sperm preparation in ambient CO2 atmosphere. When compared with reference data available for the immunobead test (IBT), the direct protocol (semen) for SpermCheck yielded 94.4% sensitivity with 100% specificity; the indirect protocol (serum) provided a sensitivity of 100% with 94.7% specificity. The microspheres of SpermCheck maintain a nearly uniform concentration per volume, with none to negligible clumping. The greater difference between the optical densities of latex and cytoplasm allows use of a light microscope for the rapid assessment of the percent of regional binding rather than the phase-contrast microscope required for the IBT. SpermCheck eliminates many difficulties encountered with the IBT, making SpermCheck a convenient screening assay for use in the physician's office.

Sexual function and fertility in patients treated for posterior urethral valves

We interviewed 21 men treated in infancy for posterior urethral valves about their sexual function. Of the men 10 provided semen samples (1 of which was incompletely analyzed) and 7 provided urine voided after masturbation. Erections and orgasm were normal in 20 men and 1 had lifelong impotence. Nine men had slow or dry ejaculation. There was no evidence on urinalysis of retrograde ejaculation except in 1 patient. Semen counts were within the fertile range. Of 9 patients 5 had viscous semen with a pH of more than 8.0. Three patients had initiated pregnancies.

Use of specific monoclonal antibodies to secretory IgA for the detection of spermatozoal antibodies in serum and seminal plasma by enzyme-linked immunosorbent assay

The role of anti-sperm secretory IgA has recently received attention since some workers feel it plays an important role in the prognosis of the immunologically infertile couple. Current methods used in our laboratory cannot separately detect anti-sperm secretory IgA. An enzyme-linked immunosorbent assay (ELISA) utilizing specific monoclonal antibodies to secretory IgA was used to detect anti-sperm secretory IgA as well as anti-sperm monomeric IgA and IgG in serum and seminal plasma of a sperm-antibody-positive (ASA+) and sperm-antibody-negative (ASA-) group of men. Results showed significantly raised serum levels in the ASA+ group when compared to the ASA- group for anti-sperm secretory IgA (P less than .001), anti-sperm monomeric IgA (P less than .001), and anti-sperm IgG (P less than .01). Seminal plasma levels were also raised in the ASA+ group, but only significantly so for monomeric IgA (P less than .02). The performed ELISA has definite potential in research, especially with the use of monoclonal antibodies for the detection of anti-sperm secretory IgA, but cannot as yet be used as a prognostic predictor of fertility in the individual antibody-positive patient. Infertility specific antigens will have to be identified and isolated and subsequently used in the ELISA.

The incidence and influence upon fertility of antisperm antibodies in seminal fluid following vasectomy reversal

Seminal plasma samples from men undergoing vasovasostomy were analysed for antisperm antibodies using the indirect immunobead test. A pre-operative assessment showed antisperm antibodies of either IgA or IgG class to be present in 9/27 (33.3%) men. A significant increase (P less than 0.05) in the post-operative incidence of the antibodies was seen in the men who achieved patency (27/45, 60%) but not in those men for whom no sperm were seen in the ejaculate (4/10, 40%). After follow-up for a minimum of 1 year, conception rates for couples in which the male partner had achieved patency were similar in the groups with no antibodies detected post-operatively (12/18, 66.7%) or with IgA alone (2/3, 66.7%), but was reduced significantly in the presence of IgG (1/9, 11.1%; P less than 0.05) or IgA + IgG (3/15, 20.0%; P less than 0.01).

Detection of antisperm antibodies on the surface of motile spermatozoa. Comparison of the immunobead binding technique (IBT) and the mixed antiglobulin reaction (MAR)

Investigators testing for antisperm antibodies have recently focused on tests that detect the Ig classes of the sperm-bound antibodies. The aim of this study was to compare the sensitivity of two of these tests, viz. the immunobead binding technique (IBT) and the mixed antiglobulin reaction (MAR). Twenty-one male or female sera were tested for IgG and IgA antisperm antibodies with the IBT and the MAR. The sera were selected on the basis of the IBT results, and the MAR was carried out without knowledge of these results. For IgG antisperm antibodies, there was a highly significant correlation between the two tests (P = 0.0043), whereas, for IgA antisperm antibodies, the correlation was poor (P = 0.2951), because the IBT revealed a positive reaction for IgA in sera in which no such antibodies could be detected by the MAR.

The relationship of circulating antisperm antibodies to sperm surface antibodies in infertile men

The correlation between the amount and location of antisperm antibody binding to the sperm surface and the level measured in the serum has not been previously reported. Hence, the value and limitations of screening blood sera from men with suspected immunologic infertility are not currently known. In this study 70 paired sera and semen samples were assayed by the immunobead test (IBT). A screening protocol for blood sera was constructed to be 100% sensitive for detecting semen specimens with 20% or more of sperm binding IgG or IgA immunobeads. The specificity of this screening protocol was determined to be 79%. Serum IgA was not a good predictor of IgA on the sperm surface. The true positive predictive rate for antisperm antibodies on the sperm surface using circulating antisperm antibodies as a screening assay was estimated to be as low as 35%. There was little correlation between the site of immunobead binding following passive antibody transfer from patients' sera to donor sperm and the site of naturally occurring antibodies on the patients' sperm surface. Although direct assessment of antibodies on the sperm surface is preferred, these data suggest that serum IgG alone can be used as a sensitive screening assay for antisperm antibodies in men. A positive screen dictates that a direct assay on semen should be performed.

Simple radioimmunobinding assay for quantitation of sperm antibodies of IgG immunoglobulin class

The immunobead test (IBT) is an excellent test for initial sperm antibody screening and evaluation but is impractical when used to quantitate antibody levels using a twofold dilution series. The aim of this study, therefore, was to develop a relatively simple radioimmunobinding assay that would allow quantitation of sperm antibodies of IgG immunoglobulin class, which predominate in male sera. [125I]-Protein G was chosen as the radioligand because it binds to all IgG subclasses, but not to IgA or IgM. The results of the investigation indicate that the [125I]-protein G assay (PGA) allows efficient quantitation of sperm antibodies, as evidenced by a highly significant (P less than .0001) correlation (Spearman's, Rs = 0.94) between the PGA results and IgG-IBT titres.

Effect of antispermatozoal antibodies in seminal plasma upon spermatozoal function

The indirect immunobead test for antispermatozoal antibodies of the class IgA, IgG and IgM was applied to the seminal plasma of male partners of infertile couples. The presence of both IgA and IgG was associated with a decreased incidence of good post-coital test results and a reduced rate of fertilization of human oocytes. No significant differences were found for men with IgA or IgG alone when compared to men with no detectable antispermatozoal antibodies.

Indirect mixed antiglobulin reaction (MAR) as a screening procedure for antisperm antibodies. II. Clinical studies

In this study the question was raised whether the indirect mixed antiglobulin reaction (MAR) using donor spermatozoa could substitute the direct MAR requiring motile spermatozoa in the patient's ejaculate in the screening for antisperm antibodies. Serum and seminal plasma from 48 men selected on the basis of the results in the direct MAR were tested by the indirect MAR. Both tests were carried out for IgG and IgA antisperm antibodies. A statistically significant correlation was found both between the sperm-bound IgG and the free IgG antisperm antibodies in serum as well as in seminal plasma and between sperm-bound IgA and the free IgA antisperm antibodies in seminal plasma whereas no correlation was found between the sperm-bound IgA and the free IgA antisperm antibodies in serum. This finding strongly supports the concept that the major part of the IgA antisperm antibodies in the ejaculate are locally produced.

Antisperm antibodies bind with different patterns to sperm of different men

Immunologic infertility is an important area of current clinical research. The immunobead test is a laboratory method that identifies the classes of antisperm antibodies and their binding sites on the sperm surface. In this study we have investigated the variability in the pattern of antibody binding to spermatozoa after passive transfer from blood serum. Serum from a single donor containing antisperm antibodies of the IgG class was used in all experiments. The spermatozoa from 27 semen donors were found to differ significantly in the degree and location of immunobead binding after exposure to this serum. There was substantial day-to-day variability in the results for individual semen donors and the overall variability in test results was significantly greater when a number of semen donors was used rather than a single donor. These data suggest that details of antisperm antibody binding after passive transfer from body fluids may depend on the sperm donor. The design of research studies involving antibody transfer must take this source of variability into account.

Effect of washing on sperm surface autoantibodies

This study tested the hypothesis that immediate washing "removes" sperm surface antibodies. Nine ejaculates with antisperm antibodies were studied. Separate portions of each ejaculate were washed by centrifugation (Shulman's method) as soon as possible after production (0-h) and 2 h later (2-h). In four samples, portions were also washed by a simple swim-up migration started at 0-h. Washed sperm were tested for surface antibodies using the immunobead binding test. The number of sperm with bound IgG antibodies at 0-h was significantly less than that at 2-h (P less than 0.001) but no significant difference was found in respect of IgA antibodies. Swim-up migration yielded results similar to those of centrifugation and had the advantage of selecting highly motile sperm. The potential application and implication of these findings are discussed.

Prevalence of sperm surface antibodies in the male partners of infertile couples as determined by immunobead screening

A single simple laboratory test for the detection of sperm surface antibodies is described. Spermatozoa from 300 men who were investigated for infertility were tested for sperm surface antibodies using the Immunobead test (IBT). IBTs for IgG, IgA, and IgM were performed on each sample as well as an IBT using an Immunobead with activity against both light and heavy immunoglobulin chains and therefore capable of detecting any of the three isotypes ("GAM-IBT"). An excellent correspondence was found between GAM-IBT-positive samples and those positive by one or more of the isotype-specific Immunobeads. In 29 of 32 positive tests, the GAM bead binding was within 5% of the most positive isotype-specific bead's binding. There were no false-positive or false-negative tests comparing the GAM-IBT with the isotype-specific IBTs.

Indirect mixed antiglobulin reaction (MAR) as a screening procedure for antisperm antibodies. I. Methodological studies

Direct mixed antiglobulin reaction (MAR) cannot always be carried out because it requires motile spermatozoa in the patient's ejaculate. Therefore, the indirect MAR for IgG and IgA using donor spermatozoa sensitized with serum or seminal plasma from patients was investigated with the aim of developing a practical screening procedure for antisperm antibodies involving a characterization of the Ig-class of the antibodies. Samples from 23 men, 13 men with and 10 men without agglutinating antisperm antibodies, were used for the methodological experiments with the indirect MAR. Among three procedures to diminish the amount of nonbound immunoglobulin after sensitizing the donor spermatozoa with serial dilutions of serum or seminal plasma, a swim-up method was found to be optimal. The indirect MAR was carried out with glutaraldehyde-fixed sheep erythrocytes coated with IgG or IgA and various dilutions of anti-IgG and anti-IgA, respectively. These experiments led to a standardization of the indirect MAR, making it sensitive, easy to read, and allowing the reactions for IgG and IgA to be compared on an approximately equimolecular basis.

The effect of an IgA1 protease on immunoglobulins bound to the sperm surface and sperm cervical mucus penetrating ability

A major site of impaired fertility in men with autoimmunity to sperm rests at the level of restricted sperm entry and motion within cervical mucus. We studied the effects of a protease derived from Neisseria gonorrhoeae, whose substrate specificity is limited to human IgA1, on the ability of antibody-bound sperm to penetrate human cervical mucus in vitro. IgA on the sperm surface, but not IgG, was degraded by IgA1 protease. A correlation was seen between the levels of IgA bound relative to IgG and the improvement in sperm cervical mucus penetrating ability after IgA1 protease exposure. These results provide evidence that antisperm autoantibodies of both IgA and IgG classes impair the ability of spermatozoa to populate the female reproductive tract. They implicate the Fc region of the immunoglobulin molecule in mediating this effect and offer the potential to restore male fertility by treating antibody-bound sperm in vitro with immunoglobulin-directed bacterial proteases, before insemination.

Sperm and seminal plasma antigens from autoimmune men induce immunological infertility

Adult male rabbits were immunized with normal saline (controls), sperm extracts from 2 autoimmune men, seminal plasmas from the same autoimmune men, sperm extract from a fertile nonautoimmune man, and seminal plasma from the same fertile nonautoimmune man. All the sperm donors were free from infections. Rabbits immunized with fertile men's sperm extract and seminal plasma had significantly elevated postimmunization hemagglutinating but not cytotoxic sperm antibodies and reproduced normally. Rabbits immunized with autoimmune men's sperm and seminal plasma antigens developed high titers of cytotoxic and hemagglutinating sperm antibodies in their serum and seminal plasma and their reproduction was markedly reduced. Their sera and seminal plasma reduced motility of sperm from a normal donor. The immune responses were confirmed by electron microscopic immunocytochemistry. This technique revealed membrane-bound endogenous IgG on sperm from only those rabbits immunized with sperm extracts from autoimmune men. These antisera reacted against a protein in the 58,000 D range; antisera to fertile man's sperm extract reacted against three proteins with molecular weights of 15,000, 18,400, 25,000, and 44,000 D, as judged by Western blot. Rabbit antisera to seminal plasma from autoimmune men reacted against several proteins; additionally, it detected two proteins with 43,000 and 68,000 molecular weight detected by antiserum to fertile man's seminal plasma. Sperm and seminal plasma antigens from autoimmune men are different in their elicited immunogenic responses from those of fertile nonautoimmune men. These responses are relevant to infertility.

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.

Detection of autoimmunity to sperm: mixed antiglobulin reaction (MAR) test or sperm agglutination? A study on 537 men from infertile couples

Two different ways of testing for antisperm antibodies were compared: the mixed antiglobulin reaction (MAR) test for demonstration of antibodies of the IgG and IgA classes bound in vivo to the sperm membrane antigens and the gelatin agglutination test for detection of nonbound antisperm antibodies in serum and seminal plasma. Samples from 537 men from infertile couples were investigated. Antibodies bound to the sperm membrane were detected in 49 men (9.1%), IgG in 44 (8.2%), and IgA in 38 cases (7.1%). Sperm agglutinins were recorded in seminal plasma from 30 men (5.6%) and in serum (titer greater than or equal to 16) from 43 men (8.0%). The investigation revealed a very close correlation between the results of MAR testing and the occurrence of sperm agglutinins in serum and seminal plasma. However, if one focuses on antisperm antibodies of the IgA class, which seem to play the major role in male immune infertility, the MAR test offered the advantage that a minor group of patients with pure IgG responses could be distinguished, and rare cases with mainly or exclusively locally produced IgA antibodies could be detected.

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.