Interaction between human cervical mucus and sperm surface antibodies

Anti-sperm Antibodies as an Increasing Threat to Male Fertility: Immunological Insights, Diagnostic and Therapeutic Strategies

It is a fact that sperm possess antigenic properties. Substantial scientific research suggests that specific antibodies that attach to sperm antigens can induce infertility in both humans and other species. Antisperm antibodies (ASA) represent a significant etiology of infertility in humans, leading to immunoinfertility. The association between ASA and infertility is multifaceted. The observation of sperm agglutination, although not conclusive for the diagnosis of immunological infertility, may suggest the presence of ASA. Nevertheless, ASA may also manifest in the lack of any sperm agglutination. Managing ASA from an andrological perspective depends on the underlying cause and the specific approaches healthcare professionals adopt. The precise etiology of male infertility resulting from ASA remains unclear. Current research has examined the impact of ASA and its prevalence among infertile males to understand the relationship between ASA and changes in semen parameters. However, the findings have been inconclusive. Numerous techniques have been documented for the management of immunoinfertility. This review examines the importance of ASA in the context of infertility, encompassing the postulated mechanisms underlying the development of ASA, the various assays employed for detecting them, and the available treatments.

Immune infertility in men

Male factors are implicated as the cause of roughly half of cases of infertility, and the presence of antisperm antibodies (ASA) may be responsible for some of these. Their presence is associated with a reduction in natural conception and live birth and impacts the success of assisted reproductive technologies. Interpretation of the data regarding ASAs and fertility is complicated by a lack of standardization in testing methodology and test thresholds and a lack of data on their prevalence in the healthy fertile population. Although their pathogenesis remains elusive, and many cases are idiopathic, a disruption in the immunologic blood-testis barrier (BTB) appears to contribute to the formation of ASA. As delineation of the specific antigen targets of ASA advances, it has been recognized that they may affect almost all aspects of sperm function, and ASA against different targets likely have specific mechanisms of impairing fertility. Intracytoplasmic sperm injection (ICSI) appears to be the most reliable method by which to overcome fertility impairment due to ASA, achieving similar outcomes to ASA-negative patients with regard to fertilization rates, embryonic development, clinical pregnancy rates, and live birth rates. The lack of consistency in testing for and reporting ASA remains a substantial barrier to achieving clarity in describing their role in infertility and the optimal management approach, and future research should use a unified approach to the detection and description of ASA. Determination of the specific antigens targeted by ASA, and their function and clinical relevance, would contribute to improving the understanding of ASA-mediated impacts on fertility and tailoring treatment appropriately to achieve the best outcomes for patients.

Latheef S, Sharun K, Khurana SK, K. A, Tiwari R, Bhatt P, K. V, Chaicumpa W. Role of Antisperm Antibodies in Infertility, Pregnancy, and Potential forContraceptive and Antifertility Vaccine Designs: Research Progress and Pioneering Vision

Sperm of humans, non-human primates, and other mammalian subjects is considered to be antigenic. The effect of changes in autoimmunity on reproductive cells such as spermatozoa and oocytes play a critical but indistinct role in fertility. Antisperm antibodies (ASAs) are invariably present in both females and males. However, the degree of ASA occurrence may vary according to individual and gender. Although the extent of infertility due to ASAs alone is yet to be determined, it has been found in almost 9-12% of patients who are infertile due to different causes. Postcoital presence of spermatozoa in the reproductive tract of women is not a contributory factor in ASA generation. However, ASA generation may be induced by trauma to the vaginal mucosa, or by anal or oral sex resulting in the deposition of sperm inside the digestive tract. It is strongly believed that, in humans and other species, at least some antibodies may bind to sperm antigens, causing infertility. This form of infertility is termed as immunological infertility, which may be accompanied by impairment of fertility, even in individuals with normozoospermia. Researchers target ASAs for two major reasons: (i) to elucidate the association between ASAs and infertility, the reason ASAs causes infertility, and the mechanism underlying ASA-mediated infertility; and (ii) to assess the potential of ASAs as a contraceptive in humans in case ASAs influences infertility. Therefore, this review explores the potential application of ASAs in the development of anti-spermatozoa vaccines for contraceptive purposes. The usefulness of ASAs for diagnosing obstructive azoospermia, salpingitis, and oligoasthenoteratozoospermia has been reviewed extensively. Important patents pertaining to potential candidates for spermatozoa-derived vaccines that may be utilized as contraceptives are discussed in depth. Antifertility vaccines, as well as treatments for ASA-related infertility, are also highlighted. This review will address many unresolved issues regarding mechanisms involving ASAs in the diagnosis, as well as prognoses, of male infertility. More documented scientific reports are cited to support the mechanisms underlying the potential role of ASA in infertility. The usefulness of sperm antigens or ASAs (recombinant) in human and wild or captive animal contraceptive vaccines has been revealed through research but is yet to be validated via clinical testing.

Macaque sperm coating protein DEFB126 facilitates sperm penetration of cervical mucus

BACKGROUND

Sperm coating protein beta-defensin 126 (DEFB126) is adsorbed onto the entire surface of macaque sperm in the caudal epididymis and is retained on viable sperm collected from the cervix and the uterine lumen of mated female macaques. We investigated the role of sperm coating protein DEFB126 in cervical mucus penetration (CMP).

METHODS

Cervical mucus (CM) was collected from peri-ovulatory female macaques and loaded into CMP chambers. Sperm were introduced to CMP chambers following treatment with either polyclonal antibodies raised to DEFB126 or seminal plasma proteins (SPPs), 1 mM caffeine+1 mM dibutyryl cyclic adenosine monophosphate (dbcAMP) (induces release of DEFB126 from sperm surface), neuraminidase (NMase) or poly-L-lysine (PLP). Following removal of DEFB126 or SPPs from the sperm surface, sperm were treated with concentrated DEFB126 or concentrated SPPs prior to being introduced to CMP chambers. The numbers of sperm that penetrated and traversed CM were scored over 6 min.

RESULTS

Treatment of sperm with anti-DEFB126 antibodies, 1 mM caffeine+1 mM dbcAMP, NMase, and PLP resulted in similar and significant levels of inhibition of sperm CMP, whereas addition of anti-SPPs antibodies had no effect. In experiments where DEFB126 and SPPs were removed, CMP capability of sperm was restored by addition of DEFB126 back to the sperm surface, whereas treatment of sperm with concentrated SPPs slightly inhibited sperm penetration.

CONCLUSIONS

DEFB126 and its high negative charge appears to be critical for the movement of sperm through CM in the macaque, while SPPs adhered to the sperm surface offer no advantage in CMP.

Antisperm antibodies and conception

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.

Diagnosis and treatment of immunologically infertile males with antisperm antibodies

The presence of antisperm antibodies (ASA) can reduce fecundity in both males and females. The present review describes a strategy, established by investigations of the diverse inhibitory effects of ASA on fertility, for the appropriate diagnosis and treatment of infertile males with ASA. For infertile males with ASA, diagnosis using the direct-immunobead test (D-IBT), the postcoital test (PCT) and the hemizona assay (HZA) should be carried out as the basis for decision-making. If the patient with ASA has an abnormal hemizona index, it seems reasonable to advise selecting intracytoplasmic sperm injection-embryo transfer (ICSI-ET) as a primary treatment. However, it has been shown that some immunologically infertile males with normal fertilizing ability established pregnancy by timed intercourse (TI) or intrauterine insemination (IUI). In such patients with ASA having normal hemizona index, TI or IUI can be selected based on the PCT result. Therefore, the treatment strategy for males with ASA is similar to that for infertile males with oligozoospermia or asthenozoospermia. In conclusion, it should be emphasized that a diversity of ASA exists and their effects on fertility in infertile males. Although there is an argument that routine testing for ASA in males is not always necessary, one should be aware that in some cases of failed IUI or IVF, ICSI is selected afterward because of the diagnosis of ASA. (Reprod Med Biol 2005; 4: 133-141).

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.

Prognosis for sperm fertilizability: analysis of different variables in men

An overview of various sperm tests is presented. The standard semen analysis obtained by most clinicians evaluating infertility usually consists of sperm concentration, percent motility, quality of motility, and sperm morphology. Unfortunately, unless the motile density is extremely low, the count and motility are not good prognosticators of fertility potential. Values above the norm for normal fertile couples unfortunately cannot reliably predict normal fertility potential. It is important to find sperm tests that are easy to perform, are relatively inexpensive, and provide an accurate prognosis. Strict morphology was hoped to be such a tool with initial optimism that it was far superior to standard morphology. Unfortunately, this test also failed to be the ideal inexpensive prognostic test after further evaluation. One test that is inexpensive and highly correlates with fertilizability is the presence of antisperm antibodies since their presence frequently does not alter count, motility, or morphology. This test should be performed as part of the routine semen analysis. Other tests highly correlate with the achievement of pregnancy and are simple and inexpensive to perform, but, interestingly, do not correlate with fertilizability. These include the hypoosmotic swelling test (HOST) and the sperm stress test. Abnormalities in these tests imply a different abnormality of sperm that leads to conception failure and that is the transfer of a toxic factor from the sperm to oocyte to embryo that prevents the embryo from implanting. Certainly, the simple, inexpensive HOST should be performed routinely. Other tests of sperm function, e.g., sperm penetration assay, sperm zona pellucida binding assay, and acrosome reaction, have their definite place in the evaluation of the infertile male. However, because they are expensive and difficulty to perform they lend themselves to certain specific circumstances but not to routine testing.

ICSI as an effective therapy for male factor with antisperm antibodies

This study was conducted to evaluate if in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) is an effective treatment for infertility complicated by the presence in the male partner of sperm autoantibodies. Over a 1-year study period comparisons of fertilization, pregnancy, and implantation rates were made in couples where the male partner was negative or weakly positive for sperm autoantibodies (<50%) (gr 1); autoantibodies were strongly positive (>80%) (gr 2); or autoantibodies were moderately positive (50-80%) (gr 3). Only patients having oocytes fertilized by ICSI were included. The fertilization, clinical pregnancy, implantation, and miscarriage rate for group 1 (n = 67) was 56, 43, 21, and 14%. Comparable values for group 2 (n = 20) were 55, 40, 23, and 25%, and for group 3 (n = 6) were 63, 33, 23, and 0%. IVF with ICSI demonstrates comparable fertilization, pregnancy, implantation, and miscarriage rates in female partners of males with and without sperm autoantibodies.

Comparison of human cervical mucus and artificial sperm penetration media

The cervical mucus penetration tests aid research and determine the clinical importance of positive sperm antibody tests. Limited availability and variability of human cervical mucus have instigated the search for mucus substitutes for these tests. This study compares sperm migration in cervical mucus with that in artificial media including hyaluronate solution, egg white and albumin Tyrode solution. Results were quantified by measuring the migration distance (the maximum distance of capillary migration from a semen reservoir by spermatozoa after 1 h) and the sperm concentration at half the migration distance. The mean of both measures for cervical mucus and hyaluronate solution were equivalent [4.4 +/- 1.1 (SD) versus 4.3 +/- 1.0 cm and 118 +/- 51 versus 111 +/- 44x10(3)/ml], and higher than in egg white and albumin Tyrode solution. Antisperm antibodies impaired sperm penetration in cervical mucus and hyaluronate solution in a similar manner (r = 0.92). These results suggest that hyaluronate solution sufficiently resembles human cervical mucus in terms of penetrability that it may be used as a substitute for mucus in capillary tube tests of sperm function. The higher penetrability of cervical mucus and hyaluronate solution is probably related to a channelling effect due to their polymeric structure.

Autoimmunogenicity of the human sperm protein Sp17 in vasectomized men and identification of linear B cell epitopes

OBJECTIVE

To assess whether human sera positive for antisperm antibodies have detectable levels of Sp17 autoantibodies and to determine the linear B cell epitopes to which these are raised for both native and recombinant Sp17.

DESIGN

Enzyme-linked immunoaborbent assays were performed against recombinant HSp17 on 15 serum samples from prevasovasostomy and postvasovasostomy patients. Positive sera then were used in mimotope analyses to determine HSp17 immunodominant linear B cell epitopes. These were compared with the linear B cell epitopes of recombinant HSp17.

SETTING

University research laboratory.

PATIENT(S)

Fifteen vasectomized or vasovasostomized men.

MAIN OUTCOME MEASURE(S)

Serum antibody reactivity to human Sp17.

RESULT(S)

Sera from vasectomized and vasovasostomized men exhibit Sp17 antibodies raised predominantly to two immunodominant linear B cell epitopes (amino acids 4 to 19 and amino acids 118 to 127), which differed from those of recombinant HSp17 (amino acids 52 to 79 and amino acids 124 to 136).

CONCLUSION(S)

The results show that Sp17 is an antigen to which vasectomized men raise autoantibodies. Two linear B cell epitopes predominate in native Sp17 and these differ from (but overlap with) those of the bacterially expressed recombinant protein.

Anti-sperm antibodies in female mice: responses following intrauterine immunization

PROBLEM

The goal of this study was to measure anti-sperm antibodies in serum following intraluminal uterine immunization and to compare this with the formation of antibodies following intraperitoneal (i.p.) or anal immunization.

METHOD

Mice were immunized with human sperm, and antibody was measured using an indirect immunobead assay.

RESULTS

High levels of anti-sperm antibodies could be measured following intrauterine immunization and i.p. immunization. Anal immunization resulted in lower levels of antibody formation. Antibody formation after intrauterine immunization was less consistent following transcervical insertion than following needle insertion of sperm.

CONCLUSION

The data suggest that intrauterine immunization can result in anti-sperm antibody formation under some conditions.

The detection of antisperm antibodies in serum: a comparison of the tray agglutination test, indirect immunobead test and indirect SpermCheck assay

Testing for antisperm antibodies (ASAs) is an important part of the work-up of the sub-fertile couple, yet there is little consensus regarding the most appropriate methods. The SpermCheck assay (GSC; Bio-Rad Laboratories Inc., Diagnostics Division, Hercules, CA, U.S.A.) is supplied with wash buffer, controls and bead reagent which detects all three major classes of ASAs (IgA, IgG and IgM) in a single test. This study compared results on a bank of samples using the tray agglutination test (TAT), immunobead test (IBT), GSC and a modified SpermCheck assay to detect a single isotype in each test (SISC). The IBT and SISC showed excellent correlation, with 127/141 (90.1%) tests agreeing. There was an apparent lack of sensitivity to IgM with GSC as 8/15 (53.3%) samples testing positive with IBT and 7/15 (46.7%) testing positive with SISC were negative with GSC. Of the 24 IBT-negatives, seven (29.2%) were positive for TAT, indicating a high incidence of non-immunological agglutination, though this decreased as the TAT titre increased. The proportion of samples testing positive for IBT increased with TAT titre: 3/20 (15.0%) for TAT-negative samples, 6/10 (60.0%) for low titres and 21/24 (87.5%) for high titres. This was also observed when comparing the GSC with TAT. The TAT therefore appears useful as a first-line screen, whilst the inability of the GSC to adequately detect IgM limits its use as an indirect test. Both the IBT and SISC can be used to further investigate the type and class of ASA present.

Treatment of immunological infertility by sperm washing and intrauterine insemination

The purpose of this study is to review our experience with sperm washing and intrauterine insemination as a method to reduce the presence of sperm antibodies in serum of couples with immunological infertility. Our results support the premise that sperm washing and intrauterine insemination can diminish the level of sperm-bound immunoglobulins and can improve the chance of conception in a selected group of couples with a diagnosis of immunological infertility. Patients with > 50% attachment of IgG, IgA, or both antisperm antibodies in this study had a greater chance of achieving a pregnancy. The high level of antibody attachment seen in our study appears to represent true immunological infertility and therefore is more likely to respond to therapy that reduces antibody attachment and bypasses cervical mucus.

Antisperm antibodies in women: variability in antibody levels in serum, mucus, and peritoneal fluid

OBJECTIVE

To look for patterns of antisperm antibody expression in women by exploring the levels of antisperm antibodies in different body fluids. This was achieved by studying sequential serum samples from individual patients and by comparing the levels of antisperm antibodies in serum from a number of patients with the levels of antisperm antibodies in cervical mucus or peritoneal fluid (PF).

DESIGN

Prospective studies were performed on sequential serum samples within a menstrual cycle. Retrospective studies were done to compare antisperm antibodies in serum and mucus or PF. The immunobead assay was used to measure antisperm antibodies in these fluids.

SETTING

Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.

PATIENTS

A random sample of patients undergoing evaluation for infertility.

RESULTS

The levels of antisperm antibodies in sera drawn from patients at different points in a menstrual cycle stimulated by the presence of exogenous hormones did not change during the follicular phase of the menstrual cycle. Also, in many samples, the antisperm antibody level in serum did not correlate with the antisperm antibody levels in mucus or PF.

CONCLUSIONS

The data suggest that measurement of antisperm antibodies at a single point in time or from a single fluid is not sufficient when evaluating a woman for immunological infertility. The data also suggest that numerous and complex factors contribute to the expression of antisperm antibodies in women.

Male infertility: current concepts

The purpose of the article is to review the current concepts regarding the etiology and treatment of male-factor infertility. The following general conclusions can be drawn: (a) conventional parameters for sperm quality and male fertility are inadequate and any assessment should involve several different tests of sperm cell function to increase the fertility prognosis; (b) the causes of disturbed sperm quality are still poorly understood; (c) the role of the varicocele is still controversial but some of the discrepancies reported in the literature may be explained by the negative influence of other factors such as smoking, epididymal pathology or glandular infections operating either in conjunction or independent of the varicocele; (d) the role of chronic inflammatory processes in the reproductive organs, in particular the involvement of chronic chlamydial infections, has been underestimated, largely because it is often asymptomatic and difficult to demonstrate objectively; (e) partial androgen insensitivity may account for a significant number of cases of severe oligozoospermia; (f) no major advances have been made in the medical treatment of poor sperm quality; (g) assisted fertilization techniques such as IVF and GIFT offer encouraging possibilities for the treatment of male-factor infertility; and (h) recent advances in microsurgical techniques are increasing the treatment possibilities for certain forms of obstructive azoospermia and severe oligozoospermia.

Sperm transport in the human female reproductive tract--a dynamic interaction

The interaction between sperm and the human female tract has been largely ignored. This review summarizes the data available from animal species with specific reference to sperm in the oviduct. Our knowledge of sperm transport within the human female tract is explored and, using the data available from animal species, three lines of future experimental design are suggested. Firstly, there is the need to improve and develop techniques to recover sperm successfully from the tract. Second, an in-vitro approach which examines the modulation of reproductive tract fluids on sperm function is advocated. Third, an in-vitro tissue/cell culture system is required to investigate in more detail the interaction between the epithelium and sperm. Using such approaches many of the questions posed in this review can be addressed confidently in the near future.

Intrauterine insemination as a treatment of infertility in women with antisperm antibodies

Twenty-four women with infertility caused by antisperm antibodies were treated by homologous intrauterine insemination. Initially, all the women had timed intrauterine insemination by washed spermatozoa for three cycles. The pregnancy rate per couple was 4.20%. The remaining 23 patients received a combined treatment of chlomiphene citrate and intrauterine insemination for three cycles, which did not increase the pregnancy rate per couple and per cycle (4.3% and 1.4% respectively). Thereafter, the remaining 22 patients received a combined treatment of hMG and intrauterine insemination for another three cycles which resulted in a pregnancy rate per cycle (6.1%) and per couple (18.20%) that was significantly greater (P less than 0.01). We conclude that infertile women with antisperm antibodies can benefit after a trial of induction of multiple follicular development with hMG in combination with intrauterine insemination.

Detection of sperm antibodies on unwashed spermatozoa with the immunobead test: a comparison of results with the routine method and seminal plasma TAT titers and SCMC test

This study investigated whether the immunobead test (IBT) could, for the purposes of simplicity and saving time, be applied directly on an unwashed semen sample instead of washed spermatozoa. These two methods were performed simultaneously on the semen samples of 15 men with a positive MAR test and 10 men with a negative MAR test. A possible association was found between the unwashed samples, showing positive IB binding (greater than 20%) on the tail and/or head and the seminal plasma TAT titers (P less than .00001, Fisher's exact test). In all cases with IB binding of greater than or equal to 20% on unwashed spermatozoa, positive seminal plasma TAT titers (greater than or equal to 32) and SCMC tests (greater than or equal to 50%) were found. In all cases where the binding of the beads was mainly located on the tailtips of the washed or unwashed spermatozoa, negative seminal plasma TAT titers and SCMC tests were found. Coating of the head and/or upper tail regions in both methods was always associated with high TAT titers and a strong-positive SCMC test. It is concluded that the IBT for IgA, but not for IgG, can be performed directly on unwashed semen and that the position of IB binding on the spermatozoa is of prognostic importance with regard to the expected outcome of the SCMC test and seminal plasma TAT titers.

Assessment by fluorescence-activated cell sorting of whether sperm-associated immunoglobulin (Ig)G and IgA occur on the same sperm population

Two-color fluorescence-activated cell sorting of antisperm antibody-positive sperm was used to detect simultaneously the presence of immunoglobulin (Ig)A and IgG antisperm antibodies associated in vivo on a man's sperm. Sperm positive for sperm-associated Ig were analyzed using phycoerythrin-conjugated antihuman IgA and fluorescein isothiocyanate-conjugated antihuman IgG; up to 87% of the same spermatozoa were stained with both labels. Sperm positive for only one of the antisperm antibody isotypes stained up to 90% of a man's sperm with only one fluorochrome. Immunocytochemistry studies revealed similar patterns of sperm binding for sperm-associated IgG and IgA. These results suggest that the sperm antigenic determinants reacting with antisperm IgA and IgG are present on the same sperm population at similar locations on the sperm surface.

Evaluation and treatment of a male factor component to unexplained infertility

The standard semen analysis frequently fails to identify subfertile males even when findings are normal and conversely often fails to identify fertile males with subnormal semen analyses. This has created the need to produce other tests of sperm physiology that will better distinguish a fertile from a subfertile specimen. Understanding more about the nature of the sperm defect should lead to the establishment of more specific and effective therapies. Until that time, it would still be reasonable to try some of the available empirical therapies even though they may work merely by a placebo mechanism.

Evaluation of circulating anti-sperm antibodies in fertile and patient populations

Several reports have demonstrated the presence of anti-sperm antibodies (ASA) in infertile populations; however there is a paucity of information regarding ASA in fertile populations. The purpose of this study was to establish objective criteria for the interpretation of the Immunobead Binding Test (IBT) based on values obtained from fertile individuals. Sera from 20 fertile couples (n = 40) were assayed by using a modification of the IBT previously described by Clarke et al. An initial lower limit of binding for positivity (lower limit) of 14% was used based upon the mean value for each isotype plus 2 standard deviations (SD) of 4 negative control sera assayed 4 to 7 times each. One-way ANOVA or chi-square analyses were used to analyze these data. There was no difference in percent immunobead binding between males and females in the fertile population (P greater than 0.1); therefore the data were pooled. Percent binding for fertile controls was: IgG, 21.7 + 31.9% (mean + SD); IgA, 19.5 + 25.8%; IgM, 16.9 + 14.9%. Initial analysis indicated no significant difference (P greater than 0.10) in percent binding between fertile and infertile individuals. The corresponding frequency of positive values (for at least one isotype) using a 14% lower limit was 23/40 (57.5%). This was not significantly different (P greater than 0.1) from the frequency observed in the patient population (140/242, 57.8%). New lower limits of positivity for each isotype were established based upon the mean plus 2 SD from the fertile control data: IgG, 85.4%; IgA, 71.1%; IgM, 46.7%.(ABSTRACT TRUNCATED AT 250 WORDS)

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.

Effect of sperm washing and swim-up on antibodies bound to sperm membrane: use of immunobead/sperm cervical mucus contact tests

The direct immunobead test (IBT) and the sperm cervical mucus contact (SCMC) test were used to evaluate the effect of sperm washes and swim-up on antibodies bound to the sperm membrane in 11 patients with autosperm antibodies (30-100% IgA and 30-100% IgG) but otherwise normal semen measurements. The tests were performed on semen samples before and after a wash/swim-up procedure in Ham F10 + 10% human blood serum. Sperm-bound antibodies in washed spermatozoa that were able to swim into a layer of medium did not differ from those in unwashed samples. The IBT and the SCMC test on unwashed and washed spermatozoa were also not significantly different. However, all other washed semen parameters were improved. Correct washing of semen samples is important when performing the IBT to prevent false negative results. Eight of the 11 partners (73%) of the patients tested became pregnant after treatment with washed sperm. The ongoing pregnancy rate was 64%.

Immunoglobulin class and regional specificity of antispermatozoal autoantibodies blocking cervical mucus penetration by human spermatozoa

The immunoglobulin class and regional specificity of sperm antibodies was analyzed in relation to in vitro cervical mucus penetration using a capillary test. There was a highly significant (chi 2, P less than 0.001) association of strong (greater than or equal to 95% sperm coated) immunobead test (IBT) results for sperm-bound antibodies of IgA immunoglobulin class with poor (less than 3.0 cm/2 h) mucus penetration. There was also a significant (P less than 0.01) association between poor penetration and the presence of antibodies on the sperm tail mainpiece. In contrast, IgG class antibodies did not show any significant association with poor penetration. These results confirm and extend previous work and imply that development of a male antispermatozoal vaccine that inhibits mucus penetration must involve stimulation of local IgA response rather than systemic antibody levels.

Autoantibodies and common idiotypes in men and women with sperm antibodies

Antisperm antibodies have been implicated as a causative factor of infertility and pregnancy wastage. Since concomitant autoimmune phenomena were reported in men with antisperm antibodies, we investigated known antisperm antibody-positive sera from 25 women, 27 men, and the respective seminal plasma samples. The investigated autoimmune panel included a search for antinuclear antibodies, autoantibodies (in IgG, IgM and IgA isotypes) to seven phospholipids (cardiolipin, phosphatidylserine, phosphatidylglycerol, phosphatidylcholine, phosphatidylethanolamine, phosphatidylinositol, and phosphatidic acid), to four histone subfractions (H1, H2A, H3, H4), and to four polynucleotides [ssDNA, dsDNA, poly(I), and poly(dT)], total immunoglobulin levels, and sperm antibody titers. The sera were also evaluated for the presence of a common anti-deoxyribonucleic acid antibody, and anticardiolipin antibody idiotypes. Levels of sperm antibody titers were significantly lower in women than in men. Both men and women with antisperm antibodies demonstrated elevated total IgG levels compared with those of normal control subjects. Only women showed elevated levels of total IgM. Sera from 24% of women and 11% of men with antisperm antibodies demonstrated antinuclear antibody titers greater than 1:40. The most striking autoantibody abnormalities were found among antiphospholipid antibodies. Sera from women with antisperm antibodies demonstrated higher autoantibody production than was found in their male counterparts. A significant correlation was found between antisperm antibodies and IgM anticardiolipin and IgA anti-phosphatidylinositol in women and between sperm antibodies and IgA phosphatidylserine antibodies in men. The presence of anticardiolipin and anti-deoxyribonucleic acid antibody idiotypes was significantly more frequent in women than in men. By means of discriminant analysis and variables selected by this mathematical model, the identification of 24 of 25 women and 26 of 27 men with antisperm antibodies was correctly predicted. These results suggest that women and men respond differently to sperm antigens. The apparent cross-reactivity between sperm antibodies and other autoantibodies, usually associated with autoimmune disease, suggests that a polyclonal B cell activation, similar to that seen in autoimmune diseases, occurs in patients with sperm antibodies.

A computerized postcoital test sperm motility: comparison with clinical postcoital test and correlations with sperm antibodies

Sixty-five infertile women had a conventional postcoital test (PCT), a computerized postcoital test (cPCT), and sperm antibody testing. Twenty-four women had good cervical mucus and good PCT sperm motility (group 1), 23 had poor cervical mucus and poor PCT sperm motility (group 2), and 18 had good cervical mucus but poor PCT sperm motility (group 3). The percentage of motile sperm, mean linearity, and the motility index of sperm by cPCT also were decreased in groups 2 and 3 (p less than 0.001) in contrast to group 1. A reduced PCT sperm count was significantly associated with positive titers of antibodies to autologous sperm in the husbands' serum, whereas a reduced PCT motility correlated with high titers of cytotoxic antibodies to husbands' sperm in the wives' serum and cervical mucus. An increased percentage of vibratory sperm at PCT correlated with elevated titers of cytotoxic antibodies to husbands' sperm in the wives' serum and cervical mucus, and hemagglutinating (r = 0.44; p less than 0.001) and immunofluorescent IgA antibodies to husbands' sperm (r = 0.47; p less than 0.001) in the cervical mucus. Mean swimming speed of sperm by cPCT correlated inversely with cytotoxic and hemagglutinating antibody titers to husbands' sperm, and immunobead-binding IgM and immunofluorescent IgG, IgA, and IgM (r = 0.52; p less than 0.001) antibodies to sperm in the seminal plasma. Motility indices correlated inversely with cytotoxic antibody titers to husbands' sperm in the wives' serum, and hemagglutinating antibody titers to husbands' sperm in cervical mucus. The predictive values of PCT and cPCT for the presence of cytotoxic and immunofluorescent IgA antibodies to autoimmune husbands' sperm were 76% and 71%, respectively, in the serum and 85% and 75%, respectively, in the cervical mucus of the wives. The predictive value of PCT and cPCT for immunobead-binding and immunofluorescent IgM antibodies to sperm in the wives' serum was 71%. Computerized PCT measures more sperm characteristics than PCT, although it is in general agreement with PCT.

How should sperm antibody tests be used clinically?

Immunoglobulin-specific assays are currently available for detection of patients with antibody-mediated infertility. Care must be taken in insuring that the correct immunoglobulin class is assayed, the assay is directed to the possible interaction of antibodies and sperm in the male or female genital tract, and the antigen employed will not detect antibodies against antigens not found on the plasma membrane of living sperm.

Detection of antisperm antibodies: their localization to human sperm antigens that are transferred to the surface of zona-free hamster oocytes during the sperm penetration assay

The authors have developed an extension of the sperm penetration assay for detecting serum immunoglobulins to sperm antigens that are transferred to the plasma membrane of a sperm-penetrated hamster oocyte. After the hamster oocytes have been scored for sperm penetration by observing for the presence of swollen sperm heads, they are incubated in serum followed by either a 20-minute treatment with rhodamine-conjugated protein A (which binds to most subclasses of IgA, IgG, and IgM) or a 2-hour incubation in guinea pig serum (complement). Positive fluorescence indicates that the serum contains antibodies to sperm antigens that were transferred to the surface of an oocyte during gamete fusion. Complement-mediated lysis indicates that the immunoglobulin that is bound can also fix complement. The advantages of this assay for detection of serum antisperm antibodies are that it is an extension of a widely used assay, is rapid and requires readily available reagents and equipment, can detect most subclasses of IgA, IgG, and IgM, detects antibodies to those sperm antigens that may be transferred to the oocyte during fertilization, and indicates whether the detected antisperm antibodies can mediate complement-dependent lysis of the fertilized oocyte.

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 antibodies in normal men: association with a history of nongonococcal urethritis (NGU)

The incidence and specificity of sperm antibodies was examined, retrospectively, in a group of 80 normal men (64 sperm donors and 16 prevasectomy patients). Seven (8.5%) were positive for sperm-bound antibodies by immunobead test (IBT), but the antibodies were restricted to the sperm tail-tip. There was a higher (p less than 0.001) incidence of nongonococcal urethritis (NGU) in the IBT-positive men, suggesting a possible causal relationship.