An allergy to the seminal plasma is a rare disorder, although it is probably underestimated. Up until today, only 80 cases were reported in the literature, since it was first mentioned in 1958 by Specken.
It is difficult for a woman allergic to human seminal plasma to get pregnant, both naturally and through artificial insemination. The latter could be an option if semen is thoroughly washed. However, this raises the question of whether IVF should be considered first or not.
Seminal plasma allergy can occur locally or systemically and can have different symptoms that range from a vulvovaginitis to a anaphylactic reaction.
In typical cases, patients have an immune reaction to Immunoglobulin IgE (type I hypersensitivity) and the symptoms of this reaction manifest during intercourse or shortly thereafter. The use of condoms seems to the best and easiest method to avoid the symptoms, but it is impractical for couples who want to conceive.
There are not many options for these couples: desensitization of the antigen responsible for the allergy or assisted reproduction techniques. In fact, pregnancies could be achieved through intrauterine artificial inseminations done with washed sperm.
So far, only three cases of pregnancy thanks to human artificial insemination have been documented. Next, we will analyze a new case of a successful pregnancy, after this technique was used in a woman allergic to the human seminal plasma.
Description of the case
A 26-year-old woman went to the doctor because of a primary infertility diagnosed three years before. The patient had a history of known allergies: asthma, allergies to dust mites, dust and pollen.
The results of the infertility tests were normal. There was no known reason why she couldn't get pregnant. However, this woman reported that she could not have unprotected sex due to an allergy to the seminal plasma.
Her 25 years old husband did a seminogram, after three days of abstinence, and this test showed a normal concentration of 29 mill/ml spermatozoids and a moderate astenozoospermia. The capacitation of the spermatozoids was done using density gradients of 45 and 90%. 6,12 million motive spermatozoids were capacitated, an appropriate number for an assistant reproduction technique to be employed.
The first allergic episode occurred immediately after having unprotected sex with her husband. Symptoms of the allergy included respiratory distress with wheezing sounds, nasal obstruction and a widespread and pruritic erythema.
After treatment with corticosteroids, antihistamines and bronchodilators, there was an extremely rapid clinical improvement. During the following years, this happened again every time the woman had unprotected sex with her partner.
Relevant allergy tests, based on the papules and erythema, were made. The patient had a significant reaction to her partner's seminal fluid. The couple was advised to use condoms to avoid a serious allergic reaction.
Four years after the first allergic reaction, the couple visited a fertility clinic with hopes of getting pregnant. New allergy tests were done, once with the whole semen and once with capacitated semen. The allergy exams using capacitated semen were also positive.
The patient had already made other attempts at artificial insemination in other fertility centres, and despite it having triggered some vaginal itching, the woman did not get pregnant.
The couple was very predisposed to try another artificial insemination and, after several multidisciplinary and ethical debates, doctors decided to try again using antihistamine coverage.
Ovarian stimulation was performed with purified human FSH (1125 U). Ovulation was induced on the 16th day of the cycle, through the administration of hCG (Ovitrelle, Merck Serono, Geneva, Switzerland), when an ultrasound showed two follicles of adequate size (15 and 21 mm). The seminal capacitation was done with gradients and colloidal silica Puresperm at 45% and 90% and through a centrifugation from 400 to 600g.
The pellet with the selected sperm was carefully washed twice, in order to try to eliminate most of the antigens responsible for the allergy.
A volume of 400 ml media containing 12.7 million motile spermatozoids was introduced into the uterine cavity of the patient. An antihistamine (cetirizine, 10 mg) had already been administered to the patient, one hour before.
Nevertheless, 15 minutes after the artificial insemination, the woman developed a generalized reaction. The symptoms were rapidly controlled with corticosteroid and the patient was able to leave the hospital four hours later.
This attempt at insemination ended up giving positive for pregnancy and the woman gave birth to a healthy baby girl after a normal pregnancy.
The antigen responsible for human seminal plasma allergy, has not been identified yet. Belonging to a family of heterogeneous glycoprotein present in the seminal plasma, it's possible it has a prostatic origin. The allergens identified have a size of between 12 and 75 kDa and the most common way of identifying hem is how it was done during the above mentioned case.
Women who are allergic to the seminal plasma can get pregnant using assisted reproduction techniques. However, serious problems might arise from an AI should semen not be properly washed. This is why the multidisciplinary teams should follow these patients closely in order to avoid any unwanted side effects and, in case side effects are produced, to treat them as quickly as possible. In these cases, doctors have to be much more cautious when performing an in vitro fertilization and have to avoid, at all times, the contact between semen allergens and the patient.
Cynthia Frapsauce a, Isabelle Berthaut a, Vanina de Larouziere a, Emmanuelle Mathieu d’Argent b, Jean-Eric Autegarden c, Hanene Elloumi a, Jean-Marie Antoine b and Jacqueline Mandelbaum a.
a Department of Histology and Biology of Reproduction, Tenon Hospital (Assistance Publique Hôpitaux de Paris), Paris, France.
b Department of Obstetrics and Gynecology, Tenon Hospital, Paris, France.
c Department of Allergology, Tenon Hospital, Paris, France.
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