The indirect mixed antiglobulin reaction test using a commercially available kit for the detection of antisperm antibodies in serum

Stress Biomarkers Transferred Into the Female Reproductive Tract by Seminal Plasma Are Associated with ICSI Outcomes

This study aimed to determine whether male stress is related to seminal stress biomarkers and pregnancy achievement in women exposed to their partner's seminal plasma (SP) in the intracytoplasmic sperm injection (ICSI) cycle. In this pilot prospective study, 20 couples undergoing ICSI, as well as 5 fertile sperm donors and 10 saliva donors, were investigated. Women were exposed to their partner's SP via unprotected sexual intercourse during the ICSI cycle and intravaginal application on the day of ovum pick-up (Day-OPU). Semen samples were collected from male partners by masturbation on the Day-OPU. Saliva and serum samples were collected prior to masturbation. Body fluids were frozen at - 80 °C until assayed. Biomarkers of activity of the sympathetic adrenomedullary axis (salivary alpha-amylase and adrenaline), sympathetic neural axis (noradrenaline and dopamine), hypothalamic-pituitary-adrenal (HPA) system (cortisol), and immune system (C-reactive protein and interleukin (IL)-18) were estimated to examine their association with SP composition and clinical pregnancy achievement. The clinical pregnancy rate was 45.0%. In the unsuccessful ICSI group, blunted levels of salivary and serum cortisol were found compared to the successful ICSI group and the fertile sperm donors. With regard to seminal markers, decreased cortisol level and elevated noradrenaline, noradrenaline/cortisol ratio, and lL-18 levels were strongly associated with ICSI failure (areas under the ROC curves were, 0.813, 0.848, 0.899, and 0.828, respectively). These findings confirm that stress response systems activity affects SP composition, which in turn is associated with ICSI outcomes in women exposed to their partner's SP during an ICSI cycle.

Sperm Parameters, ASAs and Apoptosis After Processing by the Double Tube and Swim up Methods

The aim of this study was to improve the quality of semen samples by using a novel double-tube (DT) method. The DT method was developed to select sperm and compared with traditional swim-up (SU) technique for 31 semen samples. Sperm DNA integrity were tested with TUNEL and SCSA. Content of antisperm antibodies (ASA) in the semen was measured by ELISA and MAR. Levels of the caspase-3 in the sperm were assessed by western blotting. After SU and DT, 15 couples and 16 couples were underwent IVF-ET. The number of RCDs, the percentage of SDF and DFI, ASA and the level of caspase-3 were significantly decreased after DT and SU (p = .001 and p< .001). When the DT and SU compared, there were significant changes in the number of RCD, the percentage of SDF and DFI, ASA and the level of caspase-3 (p< 0.05-0.001). There was a higher cleavage rate (p = .017) and a lower abortion rate (p< .05) in DT-IVF group than in SU-IVF group. DT selection yielded spermatozoa with low RCDs, DFI, ASA, and caspase-3 which would be benefit for ART.

Differences of Indirect MAR Test in the Unexplained Infertile and Fertile Couples

Infertility is the inability of a partner to get pregnant after regular sexual intercourse without contraception for 12 months. Based on the cause, male infertility is caused by genetic, hormonal, infectious, sexual, and unexplained infertility. However, many infertile couples are classified into unexplained infertility without an antisperm antibody (ASA) immunological examination. This study aimed to prove that couples classified as unexplained infertility can be caused by ASA wives. This was an observational study with a cross sectional study design. The sample consisted of 2 groups, in which the first group consisted of 36 fertile couples and the second group consisted of 35 unexplained infertility couples. All samples were carried out indirect MAR test to obtain the ASA value of the wife. If the wife's ASA value was >40%, the ASA results were positive. Conversely, if the ASA value was <40%, the ASA results were negative. From these 2 groups, there was a statistically significant difference (p<0.0001) that the wife's ASA value in the unexplained infertility group was significantly higher than that in the fertile group. This study concluded that the positive ASA results from the indirect MAR test were significantly found in the unexplained infertility sample.

Localization of binding sites of naturally occurring antisperm antibodies on human spermatozoa by immunofluorescence

Antisperm antibodies (ASA) may affect sperm motility, acrosome reaction, sperm penetration of cervical mucus, binding to the zona pellucida, and sperm-egg fusion. We investigated the localization of ASA of infertile men or men after vasectomy bound on the sperm surface using an immunofluorescence method. Binding occurred in the acrosomal region, midpiece, and tail. Most of the ASA in both groups of patients bound to the midpiece alone or in combination with other regions of spermatozoa. Only few ASA samples showed binding to all the three sperm regions. A combination of binding to the acrosomal region and to the midpiece was never observed. In infertile patients with ASA, the binding site was compared with sperm parameters. ASA binding to the sperm head influenced the acrosome reaction. Binding of ASA on tail and/or midpiece was not associated with a significant alteration of viability and motility. Immunofluorescence appears to be a valuable tool in the diagnosis of immune infertility, in particular when impairment of the acrosome activity is suggested.

Influence of antisperm antibodies on the acrosome reaction as determined by flow cytometry

OBJECTIVE

To evaluate the influence of antisperm antibodies on the acrosome reaction (AR).

DESIGN

Clinical study.

SETTING

University of Marburg, Department of Andrology, Clinical Training Center of the European Academy of Andrology.

PATIENT(S)

Spermatozoa from a pool of healthy donors were incubated with 30 seminal plasma samples from infertile men containing antisperm antibodies; they were compared to a control group of 10 samples without antisperm antibodies and five samples with buffer only.

INTERVENTION(S)

The spontaneous acrosome reaction (SAR) and the induced acrosome reaction (IAR) by calcium ionophore A23187 were observed and determined by means of a flow cytometer. Flow cytometric double-staining estimates of acrosomal integrity were determined by using a monoclonal antibody (TUS 19), marked with a secondary fluorescein isothiocyanate-labeled antibody. Cell viability was determined by counterstaining with propidium iodide (PI).

MAIN OUTCOME MEASURE(S)

Number of acrosome reacted spermatozoa.

RESULT(S)

The spermatozoa treated with antisperm antibodies showed significantly higher SAR and IAR responses than the control group.

CONCLUSION(S)

Some of the antisperm antibodies from individual patients are able to enhance the acrosome reaction in donor sperm, but none of them appeared to inhibit acrosome reaction.

Antisperm antibodies detection by flow cytometry is affected by aggregation of antigen-antibody complexes on the surface of spermatozoa

Flow cytometry (FCM) analysis of live antibody-coated spermatozoa subjected to immunofluorescence staining (FCM test) is considered an objective method for the quantitative detection of antisperm antibodies (ASA). But the cross-linking of cell surface antigen (Ag) with bivalent antibodies and/or antigen-antibody (Ag-Ab) complexes with second antibodies may induce the reorganization of surface components (patching and capping) and result in their shedding from the sperm surface. The present study estimates the relationship between aggregation of Ag-Ab complexes on the sperm surface and the results of indirect FCM test. Swim-up spermatozoa of normozoospermic men were incubated with ASA-positive sera from infertile patients and with second antibodies fluorescein isothiocyanate (FITC)-labelled goat anti-human IgG polyclonal antiserum under different conditions and then analysed by FCM and fluorescence microscopy. It was shown that low temperature, cytochalasin B, excess or lack of the primary and/or secondary antibodies and sperm fixation by paraformaldehyde may inhibit aggregation and shedding of Ag-Ab complexes and dramatically increase ASA quantity determined on the sperm surface. However, inhibition of aggregation on the live sperm surface was observed only in a minority of ASA-positive samples and was poorly reproducible using semen of different donors. A high probability of Ag-Ab complex shedding from the sperm surface during experimental manipulation limits the use of indirect FCM test for quantitative ASA determination.

A comparison of the sperm mixed-agglutination reaction test with the peroxidase-labelled protein A test for detecting antisperm antibodies in infertile men with varicocele

OBJECTIVE

To compare the sperm mixed-agglutination reaction (sMAR) with the peroxidase-labelled protein A method (POPA) in infertile patients with varicocele.

PATIENTS, SUBJECTS AND METHODS

The study comprised 30 men with a history of varicocele-associated infertility and 30 fertile men (control group). Antisperm antibodies against spermatozoa in the semen and against progenitor spermatozoa in testicular tissue were detected using the two methods.

RESULTS

The tests were positive in 15 (50%) of patients with both the sMAR and the POPA methods, while no autoantibodies were detected in the control group. There were no significant differences between the methods. The sensitivity and specificity of both tests was approximately 93%, with no significant difference between them (P>0. 05).

CONCLUSION

Both methods may be used for detecting sperm autoantibodies in infertile patients with varicocele.

The intra- and inter-assay variation of the indirect mixed antiglobulin reaction test: is a quality control suitable?

The test most commonly used to detect sperm antibodies is the mixed antiglobulin reaction (MAR), standardized by the World Health Organization. The indirect MAR test detects soluble sperm antibodies in seminal plasma by using healthy donor spermatozoa as antigen. In this study we systematically investigated the influence of donor spermatozoa and the source of sperm antibodies upon the results of the indirect MAR test, and calculated the intra- and inter-assay variations. Using one individual seminal plasma and the same donor semen, results of the indirect MAR test are highly reproducible (low intra-assay variation). Two dimensions of inter-assay variation must be considered: (i) serial ejaculates of an individual donor may be used at different times; (ii) different donors may be applied to identical antibody sources. Donor spermatozoa strongly influenced the results of the indirect MAR test. Using multivariate statistical tests, highly significant main effects between the different donors (P < 0.001) and specific reciprocal effects between donor spermatozoa and seminal plasma samples (P < 0.001) were observed. The high inter-assay variation of the indirect MAR test will lead to incorrect results. There is urgent need of a reliable and reproducible test for sperm antibody detection to improve quality control of the methods.

The characterization of human spermatozoa membrane proteins--surface antigens and immunological infertility

The aim of this study was to isolate and characterize highly enriched membrane proteins by two-dimensional (2-D) electrophoresis and to identify surface antigens binding sperm autoantibodies (SpAb). The presence of SpAb may reduce fertility by affecting sperm motility and acrosome reaction. The presence of the SpAb was shown to prevent sperm penetration of cervical mucus, to inhibit sperm-zona pellucida interaction, and to interfere with the sperm-egg fusion. The swim-up method was used to separate mature and motile sperm. Sperm membranes were obtained by hypoosmotic swelling, homogenization and sonication. Membranes were further isolated by differential centrifugation steps. The highly purified human sperm membrane proteins were separated by two-dimensional gel electrophoresis and electrotransferred to polyvinylidene difluoride (PVDF) membrane. The antigens were identified by bound SpAb, the sources of which were seminal plasma samples of infertile patients or of patients following vasectomy. Fourteen surface antigens were detected. Their identification may be (i) important for understanding the mechanism by which SpAb impair sperm fertilization capacity, (ii) suitable as a basis of new methods of fertility regulation, and (iii) helpful in developing reproducible and reliable methods for determinations of SpAb.

The clinical and biologic significance of serum inhibins in subfertile men

Inhibin B is a marker of spermatogenesis and Sertoli cell function. The objective of this study was to evaluate the biologic significance of inhibins in subfertile men and the usefulness of inhibin B for the detection of male reproductive dysfunction. Forty-seven subfertile men were evaluated by semen analysis and clinical examination. In addition to semen analysis and hormone determinations, inhibins A and B (Serotec) in all 47 and inhibin A in 25 of these samples using another kit (Biosource) were measured. Higher inhibin B (median, range: 160.3, 81.8-328.5 pg/mL vs. 94.9, 15.6-389.7 pg/mL, P = 0.024) and lower FSH (P = 0.001) were detected in men with sperm concentrations > or =20 million/mL (n = 9), compared to oligozoospermia (sperm concentration <20 million/mL, n = 38). Inhibin B correlated significantly negatively with FSH, LH, and E2, and patient's age and positively with sperm concentration, testicular volume, and TSH. Multiple regression analysis indicated FSH, LH, E2, TSH, and age as the independent variables for inhibin B with a coefficient of determination (R) of 0.53. Simultaneous measurement of both FSH and inhibin B identified more cases with oligozoospermia than either hormone alone. Taking into account the body mass index, the age of the patient, and the indirect mixed antiglobin reaction (MAR) test result in addition to FSH and inhibin B led to the correct semen classification in 45 out of 47 cases. The simultaneous measurement of FSH and inhibin B, taking into account age, body mass index, and the indirect MAR test result appears accurate in identifying subfertility. Inhibin A is detectable in some subfertile men but its significance is not clear.

Significance of antisperm antibodies in female serum in a gamete intrafallopian transfer program

The influence of antisperm antibodies in the female serum on fertilization and pregnancy rate in patients undergoing GIFT was assessed. A study group of 52 couples (69 cycles) with significant levels of antisperm antibodies in the female serum were compared to a control group of 749 couples (1185 cycles). Maternal serum or donor serum was used as growth medium supplement. The TAT test was performed for the detection of antisperm antibodies in the serum. Antisperm-antibody presence in female serum was associated with similar fertilization and pregnancy rates in a GIFT program compared to the control group. The type of serum used as growth medium supplement did not affect statistically the fertilization or pregnancy rate.

Flow cytometry study on the effect of serum and peritoneal fluid of women on sperm-binding activity of immunoglobulin G antisperm antibodies

OBJECTIVE

To investigate the influence of sera and peritoneal fluids (PFs) from fertile and infertile women on the binding of antisperm antibodies to the surface of spermatozoa.

DESIGN

The immunoglobulin (Ig) G antisperm antibodies binding to the surface of liver spermatozoa was evaluated after their incubation in antisperm antibodies-positive serum from an infertile male in the presence and absence of female sera or PFs.

SETTING

Russian Scientific Center for Obstetrics, Gynaecology, and Perinatology.

PATIENT(S)

Serum and PF samples from fertile and infertile women; antisperm antibodies-positive serum from infertile men; high-quality fresh semen from healthy donors.

INTERVENTION(S)

Serum samples were obtained from fertile and infertile women and from infertile men. Peritoneal fluids were collected during routine laparoscopy.

MAIN OUTCOME MEASURE(S)

The proportion of spermatozoa positive for IgG antibodies and the quantity of antisperm antibodies on the sperm surface measured by flow cytometry (FCM).

RESULT(S)

The addition of sera from fertile or infertile women with endometriosis or pelvic adhesion disease to an IgG antisperm antibodies-positive male serum resulted in significant inhibition of the antisperm antibodies binding to the sperm surface.

CONCLUSION(S)

Sera of fertile as well as infertile woman contain factors that block IgG antisperm antibodies binding to the surface of live spermatozoa.

Clinical and biological aspects of male immune infertility: a case-controlled study of 86 cases

A case-control study of clinical, endocrine and seminal characteristics in 86 infertile men and a prospective study of conception rates during 804 follow-up cycles among 75 infertile couples with male immune infertility were performed. Genito-urethral infections or surgery, and palpable epididymal abnormalities were more common among the immunological cases than among the non-immunological infertile controls (n = 180), but sperm concentration, motility and morphology were similar. The spontaneous conception rate in 70 cases was 1.7% per cycle. Treatment by intra-uterine insemination (IUI) resulted in 8.6% pregnancies per cycle, conventional in vitro fertilization (IVF) had a 18.4% success rate per attempt, and two out of three couples treated by intracytoplasmic sperm injection (ICSI) attained pregnancy. Minimal sperm quality required for successful IUI was not lower than that recorded in couples with spontaneous conception. It is concluded that immunological infertility, as diagnosed by a positive mixed antiglobulin reaction (MAR) test, is associated with a low spontaneous conception rate. Techniques of assisted reproduction are useful in the management of couples with infertility resulting from this pathology, but sperm characteristics required for successful IUI are much higher than those needed for successful IVF. A strategy for the logical management of this pathology is proposed.

Conception rates and assisted reproduction in subfertility due to unilateral cryptorchidism

During 774 spontaneous cycles and 87 cycles of assisted reproduction, the conception rates were evaluated in 48 infertile couples in whom unilateral cryptorchidism was the causal factor. In spite of adjuvant therapy of the male partner, the spontaneous conception rate was very low (1% per cycle). Intra-uterine insemination (IUI) and conventional in vitro fertilization (IVF) resulted in similar success rates of 6.1 and 8.7% per cycle/attempt respectively. After intra-cyto-plasmic sperm injection (ICSI), 46.7% pregnancies were obtained per attempt, and sperm requirements for the latter treatment to be successful were lower than for IUI. It is concluded that subfertility in men with unilateral cryptorchidism is severe, conventional IVF has little advantage, but ICSI is highly successful.

Evaluation of the immunological cause of male infertility

The presence of antisperm antibodies was considered as one of the main causes of male infertility. This study was conducted on 776 semen samples of the male partners of infertile couples in order to evaluate the immunological factor. The detection of antisperm antibodies was performed by means of the direct Mixed Antiglobulin Reaction (MAR) test. A positive test was found in 35 samples. Hence, the prevalence of immunological infertility in this study is 4.5% among the male partners of infertile couples. Further explorations were performed on men with positive results, in order to detect the presence of antibodies in the sera by means of the indirect MAR tests, and sperm immobilization tests for quantitating the cytotoxic activity of the antibodies. The indirect MAR tests showed that 97% of the antibodies were present in sera, whereas 51% of the samples were cytotoxic. Routine semen analysis indicated that around 60% of the semen samples with antisperm antibodies were good. Semen culture showed that positive results were detected in 40% of samples. Clinical evaluations revealed that the presence of antisperm antibodies may have been the cause of long-standing infertility, on average 5 years, and were not all primary. Evaluations of all clinical and laboratory findings indicated that unilateral testis obstruction and male accessory gland infection were the main pathologies found.

Office based screening of sperm autoimmunity

Sperm autoimmunity has been reported as a contributory cause of male factor infertility in up to 10% of subfertile men. The standard laboratory technique for the determination of sperm bound antisperm antibodies is the direct immunobead test. However, because of its complex methodology this test does not readily lend itself as a screening tool for this diagnosis. We describe a simple office based procedure, the sperm mixed antiglobulin reaction, for the detection of antisperm antibodies and compare its diagnostic accuracy with the standard direct immunobead test. Both assays were simultaneously performed on each of 102 semen specimens from men with male factor infertility. The rate of detection of sperm autoantibodies was 16.6% and 19.6% by the direct immunobead test and sperm mixed antiglobulin reaction, respectively. Compared to the direct immunobead test, sperm mixed antiglobulin reaction demonstrated a sensitivity and specificity of 100% and 96%, respectively. The positive predictive value was 85% and the negative predictive value was 100%, emphasizing its particularly useful role as a screening tool for office based detection of sperm autoantibodies in men who present for evaluation of fertility potential.

Detection of antisperm antibodies on the surface of living spermatozoa using flow cytometry: preliminary study

OBJECTIVE

To assess the use of flow cytometry (FCM) analysis of living spermatozoa subjected to indirect immunofluorescence staining with the mouse anti-human immunoglobulin (Ig)G monoclonal antibodies (FCM test) as an objective method for the detection of antisperm antibodies in semen and serum.

DESIGN

The comparative studies were conducted with the direct and indirect mixed antiglobulin reaction (MAR) and FCM test performed by FCM analyzer FACSCAN (Becton Dickinson Immunocytometry Systems, Mountain View, CA).

SETTING

Clinical infertile service.

PATIENTS

Seventy-six semen and 20 sera samples of infertile patients were analyzed.

RESULTS

For IgG in semen there was a highly significant correlation between the direct MAR and FCM test. Six of 12 IgG-positive samples revealed also IgA, and just one sample, which showed negative MAR, was positive for IgM in FCM test. Flow cytometry test and indirect MAR showed also a highly significant correlation of the results of IgG detection in sera.

CONCLUSIONS

Flow cytometry test may be used to verify that IgG antisperm antibodies are on the surface of living spermatozoa either retrieved directly from an ejaculate or after exposure to serum and to determine proportion of antisperm antibodies-positive spermatozoa, titer, and quantity of antibodies bound to the cell surface.

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.

Determination of adenosine triphosphate in human semen to estimate the fertilizing potential and to quantify sperm antibodies

The measurement of the ATP content of fresh semen is as accurate as the estimation of sperm motility by conventional methods in discriminating between semen of fertile versus subfertile men. The ATP content of frozen thawed donor semen is correlated with the probability of conception per cycle of insemination. Exact quantification of cytotoxic sperm antibodies in serum is possible with the adenosine-triphosphate-release-cytotoxicity test, since measurement is free of the bias of microscopic examination. The procedure has been simplified by testing only one serum dilution and calculating the 'sperm toxicity index'.

Techniques for sperm immobilization test

Several semiquantitative, quantitative, and microassay techniques had been developed to detect antibodies bound to human spermatozoa: sperm agglutination test (SAT), sperm immobilization test (SIT), immunofluorescence test, radioantiglobulin test, enzyme-linked immunosorbent assay (ELISA), mixed erythrocyte-spermatozoa antiglobulin reaction (MAR), "Panning" test, and immunobead test (IBT). Clinical application of these techniques include (a) detection of sperm immobilizing antibodies in sera of sterile women, (b) follow-up study of sperm immobilizing antibodies, and (c) detection of sperm immobilizing antibodies in cervical mucus and other secretions. The chemical structure of antigen epitope corresponding to Mab H6-3C4 may recognize the internally located repetitive unbranched N-acetyllactosamine structure, regardless of terminal substitution at Gal (i.e., sialyl-i as well as i structure). The majority of sperm-immobilization (SI) positive women's sera were absorbed with carbohydrate components on ejaculated sperm, but only one serum competed with Mab H6-3C4 on binding to sperm except a serum from whom lymphocytes were donated to make Mab H6-3C4. The SI agglutinating antibodies (Abs) in women's sera were raised to the carbohydrate epitopes of glycoprotein in HSP, but epitopes might have several different conformational structures. Studies are in progress to find whether or not SI-Abs could be generated to peptide epitope of human seminal plasma (HSP) or sperm.

Evaluation of a simplified adenosine triphosphate release cytotoxicity test for the detection of sperm antibodies in human serum

The adenosine triphosphate release cytotoxicity test (ARCT) is an objective method for the detection of cytotoxic sperm antibodies in serum providing measurements without the bias of microscopic estimation. The procedure has been simplified by testing only one serum dilution and calculating the "sperm toxicity index". The latter is closely correlated with the sperm cytotoxic titer. Immunoglobulin class determination of 32 sera with sperm cytotoxic activity was performed by means of the indirect mixed antiglobulin reaction (MAR test) and the indirect immunobead (IB) test, and revealed that all sera were positive for IgG, 17% for IgM and 20% for IgA. Of 32 sera without sperm cytotoxic activity, 19% contained sperm specific IgG, 6% had IgM class antibodies belong mainly to the IgG class since the results of the ARCT and the indirect MAR test for IgG are closely correlated. The ARCT appears to be useful as a simple and objective method for the detection and quantitation of cytotoxic antisperm antibodies.