Male Autoimmune Infertility
Naturally occurring antisperm-antibodies (ASA) exert an impairment to fertility, which is related to the extent of sperm autoimmunization. It determinates the degree of the interfering effect on sperm penetration through the cervical mucus independently f
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Felice Francavilla and Arcangelo Barbonetti
Abstract
Naturally occurring antisperm-antibodies (ASA) exert an impairment to fertility, which is related to the extent of sperm autoimmunization. It determinates the degree of the interfering effect on sperm penetration through the cervical mucus independently from the antigenic specificity of ASA. Therefore, spermautoimmunization relevant to infertility can be diagnosed in the presence of a high proportion of ASA-covered spermatozoa, associated with a poor result of a carefully performed postcoital test. Whether or to what extent an ASAinterfering effect occurs, in each individual patient, downstream from the impairment of cervical mucus penetration, is still hard to establish. The main reason is the inability of current diagnostic tests to determine the antigenic specificity of ASA and to quantify the antibody density on the sperm surface, which are main determinants of ASA-impairment at the level of sperm/oocyte interaction. In any case, from a clinical point of view, to establish whether, or to what extent, this ASA-interfering effect occurs, in each individual patient, is not needed to diagnose ASA-related subfertility, because such impairment cannot occur in the absence of the interference at the level of mucus penetration. But, it would be relevant in choosing the more appropriate assisted reproductive treatment option.
F. Francavilla () Department of Life, Health and Environmental Sciences, University of L’Aquila, Coppito, 67100 L’Aquila, Italy e-mail: [email protected] A. Barbonetti San Raffaele Sulmona Institute, Viale dell’Agricoltura, Sulmona 67039, Italy e-mail: [email protected] © Springer International Publishing Switzerland 2017 W.K.H. Krause, R.K. Naz (eds.), Immune Infertility, DOI 10.1007/978-3-319-40788-3_12
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F. Francavilla and A. Barbonetti
Introduction: Does Antisperm-Antibodies-Related Infertility Really Exist?
An etiological link between naturally occurring antisperm-antibodies (ASA) and male infertility has been claimed since Rumke [45] and Wilson [53] reported the presence of serum sperm-agglutinating activity in some infertile men in 1954. However, although the clinical significance of ASA has been extensively investigated, it is still a debated matter. On one hand, the previous assertions that any link between sperm antibody presence and impaired conception has to be considered hypothetical [49] and the routine use of current ASA testing is not justified as an essential procedure in the fertility work-up [28] were more recently reasserted in a cohort study where no independent association was observed between the occurrence of ASA and reduced pregnancy rates in subfertile couples [32]. On the other hand, intracytoplasmatic sperm injection (ICSI) has been claimed as the primary choice of treatment in the presence of sperm autoimmunization [33], and a screening test for ASA has been reconfirmed as integral part of semen analysis in the last edition of the WHO Laboratory Manual for the Exami
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