Antisperm antibodies

Antisperm antibodies are antibodies produced against sperm antigens.

Types

Antisperm antibodies (ASA) are immunoglobulins of IgG, IgA, and/or IgM, which are directed against sperm antigens. ASA can be detected in ejaculate, cervical mucus, follicular fluid, and blood serum.[1]

Prevalence

ASA can arise whenever sperm encounter the immune system.[2] ASA occur in women and men, including women or men who receive anal sex from men or who perform oral sex on men.[3]:210[4]

ASA have been considered as infertility cause in around 10–30% of infertile couples, and in males, about 12–13% (20,4% in meta-analysis[5]) of all diagnosed infertility is related to an immunological reason. The incidence can well be higher as the contribution to idiopathic infertility (31% of all cases) still remains elusive. However, these antibodies are also present in approximately 1–2.5 % of fertile men and in 4% of fertile women; the presence of ASA in the fertile population suggests that not all ASA cause infertility.[6]:27

While around 75% of vasectomized men who have the process reversed by vasovasostomy have high levels of ASA in their blood,[7]:v these circulating antibodies do not affect fertility in men; only ASA in the male reproductive tract appears to do so.[8]:134 About 40-45% of sex workers test positive for antisperm antibodies. Research has shown that these numbers increase for those who don't use contraceptive methods.[4]

Causes

Risk factors for the formation of antisperm antibodies in men include the breakdown of the blood‑testis barrier, trauma and surgery, orchitis,[4] varicocele,[9] infections, prostatitis, testicular cancer, failure of immunosuppression and unprotected anal or oral sex with men.[1][10]

As of 2017, it is unclear how or why women generally do not develop ASA to sperm generally, and why some women do develop them; the clearest correlations are that women whose male partners have ASA in their semen are more likely to have ASA, and women with ASA tend to react only to their partner's sperm and not to other men's sperm.[11]:161[2] The hypotheses for how women form ASA, as of 2017, includes cross-reactivity with microbial antigens, antibodies raised against ASA in their partner's semen, and a cytokine-driven immune response to ASA in their partner's semen.[11]:165–169 In women, spermatozoa in the genital tract after intercourse are not a factor in the production of antisperm antibodies. But this is possible with a trauma to the vaginal mucosa during the intercourse or the deposition of sperm in the gastrointestinal tract by oral or anal intercourse.[4][10]

Influence on reproductive processes

In both men and women, ASA production are directed against surface antigens on sperm, which can interfere with sperm motility and transport through the female reproductive tract, inhibiting capacitation and acrosome reaction, impaired fertilization, influence on the implantation process, and impaired growth and development of the embryo.[1][5]

Research

As of 2017 research was ongoing in several areas related to ASA.

Research has been conducted, but not clinically tested, to use sperm antigens or recombinant ASAs as contraceptive vaccines for humans,[12] as well as captive and wild animals.[13]

The mechanisms through which both women and men develop ASA is also poorly understood and a subject of research.[11]:161[8]:133

As of 2017 research was also ongoing as to how to overcome infertility caused by ASA for people who want children. As of that date there had been only small studies performed on in vitro fertilization methods including artificial insemination, with and without pretreatment to remove ASA, as well as intracytoplasmic sperm injection.[14]

References
  1. Restrepo, B; Cardona-Maya, W (October 2013). "Antisperm antibodies and fertility association". Actas Urologicas Espanolas. 37 (9): 571–8. doi:10.1016/j.acuro.2012.11.003. PMID 23428233.
  2. Kokcu, A; Yavuz, E; Celik, H; Bildircin, D (November 2012). "A panoramic view to relationships between reproductive failure and immunological factors". Archives of Gynecology and Obstetrics. 286 (5): 1283–9. doi:10.1007/s00404-012-2480-6. PMID 22843034.
  3. Ulcova-Gallova, Zdenka; Losan, Petr (2017). "Chapter 14: Impact on Fertility Outcome". In Krause, Walter K.H.; Naz, Rajesh K. (eds.). Immune Infertility: Impact of Immune Reactions on Human Fertility (2nd ed.). Springer. ISBN 978-3-319-40788-3.
  4. Selvaraj, Kamala; Selvaraj, Priya (2014). "Chapter 24: Immunology in Infertility". In Rao, Kamini; Carp, Howard; Fischer, Robert (eds.). Principles & Practice of Assisted Reproductive Technology, Volume 1. JP Medical Ltd. p. 311. ISBN 9789350907368. OCLC 865062991.
  5. Cui, D; Han, G; Shang, Y; Liu, C; Xia, L; Li, L; Yi, S (15 April 2015). "Antisperm antibodies in infertile men and their effect on semen parameters: a systematic review and meta-analysis". Clinica Chimica Acta. 444: 29–36. doi:10.1016/j.cca.2015.01.033. PMID 25659295.
  6. Shetty, Jagathpala; Sherman, Nicholas E.; Herr, John C. (2017). "Chapter 2: Methods of Analysis of Sperm Antigens Related to Fertility". In Krause, Walter K.H.; Naz, Rajesh K. (eds.). Immune Infertility: Impact of Immune Reactions on Human Fertility (2nd ed.). Springer. ISBN 978-3-319-40788-3.
  7. Krause, Walter K.H.; Naz, Rajesh K. (2017). "Preface". In Krause, Walter K.H.; Naz, Rajesh K. (eds.). Immune Infertility: Impact of Immune Reactions on Human Fertility (2nd ed.). Springer. ISBN 978-3-319-40788-3.
  8. Marconi, Marcelo; Shetty, Wolfgang Weidner (2017). "Chapter 8: M Site and Risk Factors of Antisperm Antibodies Production in the Male Population". In Krause, Walter K.H.; Naz, Rajesh K. (eds.). Immune Infertility: Impact of Immune Reactions on Human Fertility (2nd ed.). Springer. ISBN 978-3-319-40788-3.
  9. Jensen, CFS; Østergren, P; Dupree, JM; Ohl, DA; Sønksen, J; Fode, M (September 2017). "Varicocele and male infertility". Nature Reviews. Urology. 14 (9): 523–533. doi:10.1038/nrurol.2017.98. PMID 28675168.
  10. Bronson, Richard; Fleit, Howard B. (2015-01-01). "Immunologically Mediated Male and Female Reproductive Failure". Mucosal Immunology: 2157–2181. doi:10.1016/B978-0-12-415847-4.00111-7. ISBN 9780124158474.
  11. Clarke, Gary N. (2017). "Chapter 10: ASA in the Female". In Krause, Walter K.H.; Naz, Rajesh K. (eds.). Immune Infertility: Impact of Immune Reactions on Human Fertility (2nd ed.). Springer. ISBN 978-3-319-40788-3.
  12. Naz, Rajesh K. (2017). "Chapter 17: Antisperm Contraceptive Vaccine". In Krause, Walter K.H.; Naz, Rajesh K. (eds.). Immune Infertility: Impact of Immune Reactions on Human Fertility (2nd ed.). Springer. ISBN 978-3-319-40788-3.
  13. Jewgenow, Katarina (2017). "Chapter 18: Immune Contraception in Wildlife Animals". In Krause, Walter K.H.; Naz, Rajesh K. (eds.). Immune Infertility: Impact of Immune Reactions on Human Fertility (2nd ed.). Springer. ISBN 978-3-319-40788-3.
  14. Check, Jerome H.; Aly, Jasmine (2017). "Chapter 15: Sperm Antibodies and Assisted Reproduction". In Krause, Walter K.H.; Naz, Rajesh K. (eds.). Immune Infertility: Impact of Immune Reactions on Human Fertility (2nd ed.). Springer. ISBN 978-3-319-40788-3.
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