The significance of antisperm antibodies: measurement and management

Testicular function in men treated in childhood for undescended testes

PURPOSE

The aim of the study was to evaluate testicular hormones and sperm counts of young men treated in childhood for cryptorchidism

METHODS

Testicular volume, serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone as well as semen specimens were evaluated in 57 men (mean age, 19 years; range, 18 to 27 years) treated in childhood for unilateral (n = 47) and bilateral (n = 10) cryptorchidism. In 3 unilateral cases monorchidism was found. Thirty-seven patients underwent orchiopexy after hormonal treatment (luteinizing hormone releasing factor, 1.2 mg/d for 28 days followed by human chorionic gonadotropin, 500 IU intramuscularly 3 times a week for 3 weeks). The remainder underwent surgery. Mean age at surgical treatment was 5.4 years (range, 2 to 12 years). These patients were examinated again after a mean period of 13.3 years (range, 10 to 19 years).

RESULTS

Reduced testicular volume (<12 mL) was found in 6 of 64 testes (9.3%). LH, FSH, and testosterone levels were found within the normal range in all patients. With linear regression, inverse relations were found between FSH and, respectively, testicular volume (P =.002), sperm concentration (P =.013), sperm motility (P =.023), and normally shaped sperms (P =.019). There were direct relations between testicular volume and sperm concentration (P =.02), sperm motility (P =.000), and normally shaped sperms (P =.001). We did not find any statistical correlation between age at surgery and semen quality. Significantly better results in terms of sperm counts were found in patients directly operated on in comparison to those treated with hormones before orchiopexy.

CONCLUSIONS

Presented data indicate tubular impairment in young men operated on in childhood for cryptorchidism; FSH values increase and testicular volume decrease are related to sperm deterioration. Studies on children treated in the first 2 years of life are required to clarify the usefulness of early treatment of cryptorchidism.

Detection of antisperm antibodies in seminal plasma by flow cytometry: comparison with the indirect immunobead binding test

OBJECTIVE

To compare flow cytometry with the established indirect immunobead binding test (IBT) for the detection of antisperm antibodies in seminal plasma.

DESIGN

A prospective, comparative study.

SETTING

University-based andrology unit.

PATIENT(S)

One hundred and fifty-eight men with suspected male factor subfertility.

INTERVENTION(S)

Seminal plasma samples were incubated with antisperm antibody-negative donor sperm. Surface-bound antibody was detected with fluorescence-labeled antihuman antibody in the flow cytometry assay or with immunobead-labeled antihuman antibody in the IBT.

MAIN OUTCOME MEASURE(S)

The percentage of sperm that tested positive for surface-bound antibody was determined in the two assays. Seminal plasma was antisperm antibody-positive when > or = 20% of the sperm were antibody-bound, and clinically significant levels were present when > or = 50% of the sperm were antibody-bound.

RESULT(S)

Of 71 samples that were negative by the IMT, 66 (93%) also were negative by flow cytometry. Of 63 samples that had > or = 50% immunobead binding, 55 had equivalent results by flow cytometry. Overall statistical analysis showed a good correlation between the two assays.

CONCLUSION(S)

There is a good correlation between the indirect IBT and indirect flow cytometry for the detection of antisperm antibodies in seminal plasma.

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.

Effect of low dose continuous corticosteroid therapy in men with antisperm antibodies on spermatozoal quality and conception rate

The use of steroids for treating male immunological infertility is controversial. The effect of low dose prednisolone on sperm quality in men with antisperm antibodies and the conception rate, was evaluated in 40 men and their wives. Significant circulating antisperm antibodies were detected by immunofluorescence technique. Prednisolone (5 mg) was administered orally, daily for 3-6 months in men with significant antisperm antibodies. Another group of 37 men with significant antisperm antibodies, formed the control group. Both groups had initial pre- and post therapy semen analysis and hypoosmotic swelling (HOS) test. They were followed up for 12-18 months and the pregnancy outcome documented. There were significant improvement in sperm motility and hypoosmatic swelling test with therapy (P < 0.01, P > 0.05) of 13 and 15%, respectively. The pregnancy rate of 20% was much greater than 5% in the control group (P < 0.01). There were no side effects of prednisolone. Low dose prednisolone is useful in Antisperm antibody associated infertility, by improving the sperm quality and giving rise to pregnancies.

Does large loop excision of the transformation zone of the cervix predispose to the development of antisperm antibodies in women?

OBJECTIVE

To determine whether large loop excision of the transformation zone of the uterine cervix for cervical intraepithelial neoplasia predisposes to the development of female isoimmunity to human spermatozoa.

DESIGN

A prospective, controlled study.

SETTING

Colposcopy and Andrology units at the John Radclife and Churchill Hospitals, Oxford, United Kingdom.

INTERVENTIONS

Serum samples were collected from 33 women before large loop excision of the transformation zone of the cervix and repeated at a minimum time interval of 4 months after the procedure. Women were questioned regarding the procedure and subsequent reproductive function. A control population of 30 women not undergoing cervical surgery also underwent serial serum screening for antisperm antibodies.

MAIN OUTCOME MEASURE(S)

The detection of serum antisperm antibodies by flow cytometry.

RESULTS

None of the serum samples before large loop excision of the cervical transformation zone had clinically significant levels of antisperm antibodies. There was, however, a significant rise in antisperm antibody levels in women following large loop excision of the transformation zone. Apparent risk factors for the development of antisperm antibodies included a short duration of sexual abstinence and the use of nonbarrier contraception after surgery. There was no rise in antisperm antibody levels in the control population.

CONCLUSION

Large loop excision of the transformation zone of the cervix is a risk factor for the development of antisperm antibodies in women. Women should be advised to use barrier contraception or avoid sexual intercourse until complete healing of the cervix has occurred.

Significance of sperm antibodies detected by the mixed antiglobulin reaction and the tray agglutination test

The most widely used tests to detect seminal and serum sperm antibodies are the mixed antiglobulin reaction (MAR as recommended by WHO) and the tray agglutination test (TAT). It has been suggested that the prognostic significance of sperm antibody tests might be influenced by a concomitant reduction of sperm numbers and/or sperm motility. Furthermore, the relative sensitivity of these sperm antibody tests to detect sperm antibodies is not known. We therefore compared TAT, performed with serum and MAR results retrospectively for 565 infertile patients and MAR IgA and MAR IgG results for 1189 infertile patients. The association of TAT and MAR results with changes in sperm number, morphology and motility was assessed for 565 and 1185 patients, respectively. The influence of MAR and TAT results on sperm cervical mucus penetration test (SCMPT) results was investigated for 349 and 434 patients, respectively. Whereas only 23% of all MAR IgG positive patients were also MAR IgA positive, 82% of all MAR IgA positive patients were also MAR IgG positive. There was a significant (P < 0.0001) correlation between serum TAT, and MAR results. Positive MAR and TAT results were not associated with reductions in sperm number, motility and morphology. There was a significant correlation between MAR IgG and MAR IgA results and the sperm cervical mucus penetration test (SCMPT) results. According to these results, the MAR IgG would be sufficient as an initial screening for seminal sperm antibodies. MAR IgG negative patients with strong indication for immunologic infertility should also be investigated with the MAR IgA and the serum TAT.(ABSTRACT TRUNCATED AT 250 WORDS)

Seminal sperm antibodies exhibit an unstable spontaneous course and an increased incidence of leucocytospermia

The prognostic significance of seminal sperm antibodies for male fertility is difficult to define. Among other factors, spontaneous remissions and transient induction through genito-urinary infections may change their significance for male fertility considerably. We therefore investigated their spontaneous course over time and their association with leucocytospermia. For the investigation of possible relationships between the mixed antiglobulin reaction (MAR) test results for IgA and IgG sperm antibodies and leucocytospermia, 138 patients with > or = 1 million leucocytes/ml ejaculate were compared with 1051 patients with < 1 million leucocytes/ml ejaculate (WHO normal range). In a second part of the study the spontaneous course of MAR IgG and IgA test results was investigated in 58 of the 1189 patients who had three or more MAR tests and a leucocyte concentration of < 1 million/ml ejaculate. The mean interval between the first and second MAR test was 4.1 (SD +/- 4.2) and between the second and third MAR test 6.0 (SD +/- 6.7) months. In total, 64% of patients with an MAR IgG test result > 40% showed a stable spontaneous course. Patients with lower MAR IgG test results and the majority of all MAR IgA-positive patients were found to have an undulating course of MAR test results. There was a higher incidence of leucocytes > or = 1 million/ml ejaculate in patients with higher MAR results (p < 0.05 for IgG, p < 0.001 for IgA).(ABSTRACT TRUNCATED AT 250 WORDS)