Antisperm antibodies. Antisperm antibodies and infertility: an unsolvable question?

The Epidemiology of Anti-Sperm Antibodies Among Couples with Unexplained Infertility in North West Bank, Palestine

INTRODUCTION

Anti sperm antibodies (ASA) can present in serum and semen and they may lead to impair the sperms function leading to infertility. The precise mechanism of generation of these antibodies is yet to be discovered.

AIM

This study was performed to determine the prevalence of anti-sperm antibodies (ASA) in patients with unexplained infertility. The study was initiated also to explore the possible factors that may associate with ASA formation and how ASA status is associated with pregnancy rates after going with in vitro fertilization - intracytoplasmic sperm injection (IVF-ICSI).

MATERIALS AND METHODS

A cross-sectional study was conducted on 42 normal infertile couples consulting Razan Medical Center for Infertility & I.V.F. in Nablus, Palestine, from December 2012 - March 2013. Serum levels of immunoglobulins G (IgG) ASA were measured in participants (males and females) using enzyme-linked immunosorbent assay (ELISA). In addition, participants also filled a questionnaire about the presence of previous varicocele repair, inguinal hernia repair, orchitis, testicular trauma and vasectomy reversal among males and severe coitus bleeding and coitus during menses or puerperium among females. Couples were also asked about previous IVF-ICSI procedures and the outcome of the procedure in terms of either they got pregnant or not. Data was analysed using SPSS software.

RESULTS

The prevalence of ASA was 14.3% (6/42) among all couples, 9.5% (4/42) among males and 4.8% (2/42) among females. There was no significant relationship between previous varicocele repair, previous inguinal hernia repair, or orchitis and formation of ASA (p value =0.64, 0.56, and 0.26 respectively). Previous trauma, vasovasostomy, severe coitus bleeding and coitus during menses or puerperium were not observed in any of the study sample. ASA did not seem to affect the outcome of IVF-ICSI (p-value =0.54).

CONCLUSION

Prevalence of ASA in infertile couples in the north part of Palestine is similar to that obtained worldwide. ASA formation does not relate to any of the studied risk factors and does not seem to associate with pregnancy rate after IVF-ICSI. We recommend further studies using a larger sample size and including all parts of Palestine in order to generalize the obtained results.

Male fertility and varicocoele: role of immune factors

The role of antisperm antibodies (ASA) in the aetiopathogenesis of varicocoele-related male infertility remains unclear. The objective of this study was to determine whether varicocoele is associated with antisperm immune response and whether this factor provides additional affect on male fertility. We performed a multicentral, prospective study that included the clinical examination of 1639 male subjects from infertile couples and 90 fertile men, the evaluation of the absolute and relative risks of immune infertility associated with varicocoele and the impact of the autoimmune response on the semen quality. The methods used were as follows: standard examination of seminal fluid according to WHO criteria; ASA detection in seminal fluid using mixed antiglobulin reaction (MAR) and direct flow cytometry; measurement of spontaneous and ionophore-induced acrosome reactions; oxidative stress evaluation with luminal-dependent chemiluminescence method and evaluation of DNA fragmentation by sperm chromatin dispersion. The prevalence of varicocoele-related immune infertility is about 15% and does not depend on the grade of vein dilatation both in primary and secondary fertility disorders. Varicocoele is not an immediate cause of autoimmune reactions against spermatozoa, but is a cofactor increasing ASA risk; the OR of immune infertility after a testicular trauma in varicocoele patients increases twofold. In varicocoele patients, the autoimmune antisperm reaction is accompanied by a more significant decrease in the semen quality (concentration and number of progressively motile and morphologically normal spermatozoa in the ejaculate), acrosome reaction disorders (presence of pre-term spontaneous and lack of induced reactions) and an increase in the proportion of spermatozoa with DNA fragmentation. These disorders correlate with the level of sperm oxidative stress; reactive oxygen species (ROS) production in ASA-positive varicocoele patients is 2.8 and 3.5 times higher than in ASA-negative varicocoele patients and fertile men respectively. We did not find correlation between the grade of spermatic cord vein dilatation and ROS production.

Antisperm immunity and infertility

Immunoinfertility is one of several causes of infertility in humans. Although progress on antisperm immunity and infertility has advanced during the past three decades, the nature of a real antisperm antibody (ASA) is still poorly understood. Dozens of sperm antigens have been isolated and characterized in association with infertility. However, it is difficult to identify a single predominant target antigen that could interact with all the ASAs. There are some protective mechanisms preventing ASA production in males and females. As chronic infection, vasectomy and vasovasostomy, heavy metals, and testicular cancer and torsion may induce the production of ASAs, they may be responsible for decreased motility and sperm penetration of cervical mucus, and the blockage of the acrosome reaction and the sperm-egg interaction. Many ASA assay methods have been developed, each with advantages and disadvantages. Efforts for the treatment of ASA-mediated infertility have been attempted. However, current therapy for ASA-associated infertility is almost empiric and largely unproven.

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 in infertile men and their correlation with seminal parameters

Aim:  Antisperm antibodies (ASA) in males cause the autoimmune disease 'immune infertility'. The present study intended to detect the presence of ASA and their incidence in men with unexplained infertility, as well as to evaluate the correlation between the presence of ASA and semen parameter alterations. Methods:  Blood and sperm assessment were collected to carry out a direct and indirect mixed antiglobulin reaction (MAR) test and semen analysis in infertile and fertile men from the University Hospital of the Faculty of Medicine, Sao Paulo State University, Sao Paulo. Results:  In the MAR test, 18.18% of infertile men were positive for ASA. In fertile men, no positivity was found. A significant correlation between the presence of ASA with an increased white blood cell count plus a decreased hypoosmotic swelling test result was observed. Conclusions:  The results indicate that ASA are involved in reduced fertility. It is not ASA detection per se that provides conclusive information about the occurrence of damage to fertility. The correlation between infertility and altered seminal parameters reinforce the ASA participation in this pathology. (Reprod Med Biol 2007; 6: 33-38).

Antisperm Antibodies in Semen, Sera and Follicular Fluids of Infertile Patients: Relation to Reproductive Outcome afterIn VitroFertilization

PROBLEM

Data given in the literature, regarding the influence of antisperm antibodies (ASA) in the semen and/or sera on in vitro fertilization (IVF) procedure outcome are controversial. The aim of this study was to compare the prevalence of ASA in semen, peripheral blood and follicular fluid as well as to determine total immunoglobulin concentration in the serum and follicular fluid. Selected parameters were analyzed with regard to IVF outcome.

METHOD OF STUDY

The study enrolled 52 married couples. ASA in the semen was determined by direct immunobead mixed antiglobulin reaction (MAR Screen test), while in the peripheral blood and follicular fluid was determined by indirect immunobead MAR Screen test. Immunoglobulin (IgG, IgM and IgA) concentration in the follicular fluid and serum was determined by a liquid-phase immunoprecipitation assay with nephelometric end-point detection and analyzed with regard to IVF outcome.

RESULTS

Semen MAR test IgG was < 20% in 38 couples, and > 20% in 14 couples. Fertilization (73.2% versus 71.5%) and pregnancy rates (28.9% versus 28.57%) in both groups of patients were not significantly different. The results of direct and indirect MAR test were not associated with fertilization and pregnancy rates. Total serum IgG, IgM and IgA in infertile women were within normal ranges. Follicular fluid IgG was within normal values for serum samples, while IgA and IgM were decreased.

CONCLUSION

The presence of ASA on sperm or in the serum and follicular fluid was not associated with IVF outcome in the couples with good quality semen characteristic.

A Digital Method of Sperm Immobilization Test: Comparison to the Conventional Method

Antisperm antibodies have been found in infertile patients and those causing immobilization of sperm are considered to be closely related to unexplained infertility. These antibodies are usually identified by a sperm immobilization test which involves counting motile sperm under microscope. This test is subjective as it relies on the judgement of the examiner with respect to sperm motility. In this study, we analyzed motile sperm by a digital method using Sperm Quality Analyzer. The results were compared with those obtained by the conventional method. We found that the two methods yielded identical results, with 14 of 66 samples tested being positive and 52 negative for sperm immobilizing antibodies. These results show that the digital method is objective and of value in the measurement of motile sperm in determination of sperm immobilizing antibodies.

Effect of human sperm chromatin anomalies on fertilization outcome post-ICSI

The aim of this study was to evaluate the effect of sperm chromatin anomalies on fertilization outcome post-intracytoplasmic sperm injection (ICSI). Therefore, along with semen parameters, Chromomycin A3 (CMA3) staining for protamine deficiency, aniline blue staining for excessive histones, SDS for sperm chromatin stability and SDS + EDTA for the ability of sperm to undergo decondensation were carried out on 55 semen samples from patients referred to the Isfahan Fertility and Infertility Center for ICSI. The results showed that among the aforementioned tests and semen parameters only CMA3 showed a significant correlation with fertilization outcome post-ICSI. Patients were also grouped according to CMA3 level of <30% or >30% or fertilization rate of <50% or >50%. The results show that the mean percentage fertilization and mean percentage of CMA3 positivity is different in both groups, respectively. The area under receiver operator characteristics curve shows that CMA3 is a highly sensitive and specific test for prediction of fertilization outcome post-ICSI. In conclusion, that sperm protamine deficiency has profound effect on fertilization failure in ICSI.

Comprehensive office evaluation in the new millennium

The success of a comprehensive office-based evaluation of male-factor infertility depends on the physician's thorough understanding of risk assessment in the history, identification of pertinent physical examination findings, and correct assessment of laboratory data. Office-based ultrasonographic techniques have already increased the urologist's ability to visualize suspected anatomic abnormalities, and the use of functional tests of sperm has given greater depth to the limited, but essential, prognostic capabilities of the routine semen analysis.

Immunological testing and treatment in reproduction: frequency assessment of practice patterns at assisted reproduction clinics in the USA and Australia

BACKGROUND

The roles that alloimmunity and autoimmunity may play in reproductive failure, including recurrent pregnancy loss and failed IVF, have not been clearly established. To help define practice patterns, we investigated what tests clinicians in the USA and Australia were offering, to which patients (diagnostic groups) the tests were recommended, and in what situations immunological/anticoagulation treatment was advised.

METHODS

A five section survey was completed by senior physicians attending the annual national fertility society meetings in the USA and Australia. Results were tabulated and analysed.

RESULTS

Antiphospholipid antibody testing was offered to patients with recurrent pregnancy loss by almost all physicians surveyed. Patients with previous failure of IVF were tested much less often. Other immune tests (embryotoxic assay, natural killer cells and leukocyte antibodies) were ordered by none of the Australian participants and approximately 25% of the American participants. The use of immunotherapy and anticoagulation therapy for patients who tested positive for various immunological tests was also evaluated for frequency of use and reported secondary complications.

CONCLUSIONS

Large, well-structured studies examining the benefits of immunological evaluation and treatment are necessary before definite recommendations can be made.

Autoimmune factors in reproductive failure

The present review highlights recent studies that investigated the possible influences of autoimmune factors in reproductive success or failure. These factors include antiphospholipid antibodies, antithyroid antibodies, antinuclear antibodies, antisperm antibodies, and antiovarian antibodies. The majority of recent work has focused on these potential autoimmune factors; however, controversy still exists over indicated testing and treatment options. An association of antiphospholipid antibodies and recurrent pregnancy loss has been established, and treatment with subcutaneous heparin appears most efficacious. Other autoimmune factors are under investigation as markers of in-vitro fertilization failure. Limited data from treatment trials are presented.

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.