Sperm antibodies in serum and semen in men with bilateral congenital absence of the vas deferens

Prediction of male infertility by the World Health Organization laboratory manual for assessment of semen analysis: A systematic review

Objective

To discuss the role, reliability and limitations of the semen analysis in the evaluation of fertility with reference to the World Health Organization (WHO) fifth edition guidelines, with semen analysis reference values published in 2010. We also discuss the limitations of using a single threshold value to distinguish ‘abnormal’ and ‘normal’ parameters.

Methods

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to search the MEDLINE, EMBASE, and the Cochrane electronic database for articles discussing the effectiveness of semen analysis.

Results

Limitations affecting the reliability of semen analysis as a predictor of fertility were found. These include: the lack of consideration of the female factor, the vaguely defined threshold values, and the intra-individual variation in semen parameters.

Conclusions

Impaired semen parameters alone cannot be used to predict fertility as these men still have a chance of being fertile, except when a man has azoospermia, necrospermia or globozoospermia.

Cystic fibrosis and congenital agenesis of the vas deferens, antisperm antibodies and CF-genotype

Antisperm antibodies are formed as a result of vasal and epididymal obstruction. Fourteen males of different ages (pre-, peri- and post-pubertal) with bilateral congenital vasal agenesis and epididymal obstruction secondary to cystic fibrosis (CF), and seven men with congenital bilateral aplasia of the vas deferens (CBAVD) were evaluated with regard to both the presence and levels of serum antisperm antibodies, and the CF-genotype. While IgA and IgG were not detected among pre- and peri-pubertal CF patients, 4 out of 10 (40%) exhibited IgM binding to sperm tail-tip. Post-pubertal CF patients showed high antisperm antibody (ASA) levels in 3 of the 4 males (75%) evaluated for the three isotypes assayed. ASA were found in 5 of 7 CBAVD patients (71%); IgG (n = 3) and IgM (n = 4) were found to be the predominant isotypes bound to sperm tail-tip. CF-genotype analysis revealed two pre-pubertal patients with the DeltaF508/DeltaF508 CF-genotype and a positive ASA response, thus suggesting an earlier or more severe blockage. In addition, the two CBAVD patients found to have a ?/? CF-genotype on the initial screening did not have ASA. The altered antigenicity of sperm associated with initiation of spermatogenesis appears to modify the antisperm antibody isotypes. Further studies on a larger number of patients may allow for a better understanding of the ASA response, as well as a better understanding of a possible phenotype/genotype association between the CF-genotype and the immunologic response.

Immunology of the testicular excurrent ducts

The sperm autoantigen concentration in the epididymis equals or exceeds that in the testis. This makes the epididymis a probable site of initiation of an antisperm autoimmune response. The mechanisms regulating antisperm antibody formation in the testicular excurrent ducts and some related aspects with clinical interest are reviewed.

Relationship of epididymal sperm antibodies to their in vitro fertilization capacity in men with congenital absence of the vas deferens

OBJECTIVES

To test, using the immunobead binding technique, for the presence of antisperm antibodies on epididymal sperm, in epididymal fluid, and in serum of men with congenital absence of the vas deferens. To evaluate the in vitro fertilization (IVF) capacity of human epididymal sperm in the presence of antisperm antibodies.

DESIGN

Prospective. At the time of oocyte insemination, sperm from the proximal caput epididymis or vasa efferentia were tested by direct immunobinding technique. The epididymal fluid and serum were tested by indirect immunobinding technique.

SETTING

Center for Reproductive Health, University of California-Irvine.

PATIENTS

Forty-five patients with congenital absence of the vas deferens participating in the microsurgical epididymal sperm aspiration and IVF program.

MAIN OUTCOME MEASURE

Incidence of antisperm antibodies to epididymal sperm and their relationship with IVF results.

RESULTS

Sixteen men (35%) tested positively to the direct immunobead test on epididymal sperm; 7 (16%) were positive in epididymal fluid and 13 (29%) were positive in serum. Five pregnancies (31%) occurred in the positive group of which two were from patients who had sperm binding of 100% for immunoglobulin (Ig)G (all over sperm surface) and 90% (midpiece, tail) and 50% (tail, tiptail), respectively, for IgA. Five pregnancies (18%) were obtained in the negative group. No statistical difference was observed in the overall fertilization rate between the two groups.

CONCLUSION

Human epididymal sperm and epididymal fluid retrieved from men with congenital absence of the vas deferens can react positively to immunobead test. However, the presence of antisperm antibodies do not seem to impair the IVF capacity of epididymal sperm.

Sperm antibodies

Anti-sperm antibodies (ASA) occur in 1% to 30% of infertile couples. Mechanisms by which ASA impair fertility include prevention of fertilization by decreasing acrosome reaction and/or zona pellucida binding, and postfertilization effects. Treatment for ASA involves assisted reproductive technologies.

Low incidence of sperm antibodies in men with congenital absence of the vas deferens

The incidence of antisperm antibodies in serum and seminal fluid of 27 azoospermic men with congenital absence of the vas deferens is evaluated. The presence of antisperm antibodies was assessed using the immunobead test, the agglutination test, and immobilization test. Five patients with vasovasostomy or vasoepididymostomy attempts were included in the study and tested for the presence of antisperm antibodies. Contrary to a previous report, a low incidence (11%) of antisperm antibodies has been found in patients with congenital absence of the vas. In agreement with previous studies, in five patients who had failed vasoepididymostomy or vasovasostomy, a high incidence (71%) of antisperm antibodies was found.

On the familial occurrence of congenital bilateral absence of vas deferens

In this report we present the familial occurrence of congenital bilateral absence of vas deferens (CBAVD) in a 29-year-old, healthy and phenotypically normal male and in his maternal uncle. The incidence and the familial occurrence of CBAVD are reviewed and discussed.

Immunoglobulin E in serum and semen of infertile men

Determination of IgE level in serum and semen of 92 men by an enzymatic immuno-assay method verified its presence in semen of most of them (92.3%) in much smaller amount than that present in serum (2.6%). IgE levels in serum and semen were significantly correlated. Serum levels were significantly higher in men with obstructive azoospermia, specially when associated with infection. Serum levels of IgE were higher in the fertile men, and in cases without infection as compared with those with prostatitis though this difference was not significant.

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.

Alloplastic spermatocele: diffusion across the allograft material and survival of spermatozoa in vitro and in vivo

Alloplastic spermatoceles have not proved to be a very successful method for acquiring fertile spermatozoa from patients with obstructive azoospermia. Many basic aspects of spermatocele function have apparently not yet been considered; therefore, we performed experiments to determine the motility survival of rat spermatozoa in spermatoceles in vivo and in vitro, and of human spermatozoa in spermatoceles in vitro. Also, net diffusion of Na+, K+, 3H-H2O, 3H-inulin and 3H-polyethyleneglycol from alloplastic spermatoceles was determined in vitro. Spermatoceles were constructed from expanded polytetrafluoroethylene. In general, neither rat nor human spermatozoa motility survived 24 hr. incubation in alloplastic spermatoceles in vitro or in vivo. Na+ and K+ diffused from alloplastic spermatoceles, demonstrating that specific intraluminal electrolyte concentrations cannot be maintained in polytetrafluorethylene spermatoceles. 3H-H2O diffused freely across the spermatocele wall, demonstrating that fluids can enter or exit the spermatocele lumen and potentially effect sperm survival. 3H-inulin (m.w. 5000) and 3H-polyethyleneglycol (m.w. 4000) were largely retained in the spermatocele lumen over the 3-day experimental period. It is recommended that other basic aspects of spermatocele design be worked out experimentally before perhaps premature designs are installed in human patients.