The presence of antisperm antibodies (ASA) in the ejaculate is an immune cause of male infertility.
There exist some treatment options to become a father in spite of having ASA in the semen. Some of them include the use of Assisted Reproductive Technology (ART).
Provided below is an index with the 8 points we are going to expand on in this article.
What are antisperm antibodies?
An antibody, also known as immunoglobulin, is a substance produced by the immune system that identifies and attacks strange substances.
There are five types of immunoglobulins depending on the characteristics of each. Particularly, antisperm antibodies belong to types IgA and IgG.
ASA adhere to spermatozoa because they are powerful antigens. Thus, the body of the male identifies them as invaders.
In normal conditions, sperms can be found within the testes, protected from the rest of the body thanks to the so-called blood-testis barrier, where access to antibodies is not possible.
What are the risk factors?
If the blood-testis barrier broke down, ASA would reach the testicles and adhere to spermatozoa right after detecting antigens IgA and IgG on their surface.
Moreover, in some cases it is the female's body which detects spermatozoa as invaders. In this case, antisperm antibodies show up after intercourse.
Simply put, the risk factors for the appearance of ASA vary depending on whether they are present in the body of the male or the female.
Although ESAs can also occur in the female population, the number of women who will produce antisperm antibodies is very low. Some of the situations in which women develop antisperm antibodies are when there are gynecological infections and/or inflammations of the genital tract.
In any case, SSAs hinder the progressive motility of the sperm and interfere in their encounter and interaction with the egg. This would complicate the achievement of pregnancy.
What are the diagnostic tests for ASA?
This type of immune infertility can be detected using different techniques that detect the presence of ASA in biological fluids.
More specifically, the presence of ASA can be determined by examining the sperm (direct tests). Also, they can be determined by examining the seminal plasma or the cervical mucus in the woman (indirect tests).
The following are the most common direct tests, which are used to confirm that ASA are adhered to spermatozoa, and therefore the ones used:
It mixes the semen with small latex particles previously treated with specific antibodies that detect the IgA antisperm antibodies. When these particles interact with ASA, sperm agglutination can be observed under the microscope.
Reference values according to the World Health Organization (WHO) to interpret the results of SpermMar tests are:
- <10% of sperm adhered: negative result.
- 10-50% of sperm adhered: questionable diagnosis.
- >50% of sperm adhered: positive result for ASA.
The SpermMar test IgG kit is a simple test that is performed at Andrology labs on a regular basis.
This is a specific test used to detect two different types of antisperm antibodies: IgG and IgA. This study is more complete than the Mar-Test since it also provides information on the location of the AAE in the spermatozoa (head or tail). However, Immunobeads is also more expensive and takes longer to perform.
It uses microscopic polyacrylamide spheres covered with ASA specific antiglobulins. This is a more comprehensive screening test than the SpermMar test IgG kit, since it provides information on the particular location of the ASA in sperm (head or tail). However, it is more technically challenging and requires more time.
The result is positive when the value is above 20 percent.
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Treatment & fertility
When a semen analysis, along with other additional tests, indicate that there exists immune infertility due to the presence of antisperm antibodies, treating it is required to achieve a successful pregnancy.
In principie, removing ASA permanently is not possible, but there exist various treatment options that may help.
What follows are the two main treatment options available for these men to be able to conceive, all of them based on the use of reproductive technologies:
Immunosuppressive therapy using corticosteroids
High doses of corticosteroids can help diminish the amount of antisperm antibodies, and restore male fertility temporarily, thereby increasing the chances of pregnancy during a particular time frame.
Corticosteroids are a type of hormones produced in the suprarenal glands, and have an anti-inflammatory and immunosuppressive effect.
Nevertheless, their effectiveness has not been proven in all patients. Additionally, high doses of corticosteroids can have several side effects, including cardiovascular risks.
Sperm washing & IUI
In case a man has to turn to assisted conception to have a baby, a sperm washing before Artificial Insemination (AI) or In Vitro Fertilization (IVF) helps to diminish the number of ASA in the sperm sample.
A sperm washing, however, has two main drawbacks: 1) it is not 100% effective due to high affinity between ASA and sperm antigens; and 2) it affects sperm motility.
As for AI, these patients may be referred to any of the following types, based on the location of the ASA:
- Intrauterine Insemination (IUI)
- Antisperm antibodies are present in the cervical mucus. So, given that IUI places the sperm directly into the uterus, it helps to overcome the cervical barrier.
- Intratubal Insemination (ITI)
- Used when antisperm antibodies are located in the semen due to damage to the blood-testis barrier. For this reason, it is necessary to place the sperms closer to the egg in order for it to be able to hit it. This type of AI is falling into disuse nowadays, though.
Artificial insemination is an effective technique to achieve pregnancy. Unfortunately, when antisperm antibodies are found in the head of sperm, fertilization is unlikely. Conversely, this would not happen if ASA are located in the tail.
Although turning to IVF is another option, the pregnancy rates do not increase, since identifying the sperms that are free of ASA and able fertilize the egg is not possible.
FAQs from users
Why is ICSI an option in cases of immunological infertility due to the presence of anti-sperm antibodies?
Immunological sterility due to anti-sperm antibodies is an entity that is rarely found as the only cause of infertility, being in most cases associated with the alteration of other factors that intervene in the probability of conceiving. These include a decrease in ovarian reserve, a tubal factor, the presence of some alteration in the cervix or endometrial cavity, alterations in seminal parameters, DNA fragmentation in the spermatozoa, etc.
In cases where anti-sperm antibodies are present in the woman's cervical mucus, sperm microinjection (ICSI) prevents the sperm from coming into contact with the antibodies and, therefore, avoids the damage they may cause. ICSI, besides allowing us to select the spermatozoa with the best motility and morphology from the male seminal sample, avoids the contact of the spermatozoa with the female cervical mucus, and in this way the male cells will not be affected by the pH, bacteria or the presence of possible antibodies. For this reason, IVF-ICSI is considered the best fertility treatment option for couples in whom we detect that anti-sperm antibodies may be hindering pregnancy.
Why do antisperm antibodies cause infertility?
The production of antisperm antibodies (ASA) can occur in the male and/or in the female. In the male, it is due to a disruption in the blood-testis barrier that brings the sperm inside the testicle into contact with blood antibodies. In the female, it is thought to be due to damage to the wall of the genital tract that allows the presence of AAEs primarily in the cervical mucus.
These AAE can cause decreased sperm motility, or agglutination of sperm, as well as molecular damage that prevents fertilization or produces altered embryonic development.
As for treatment, corticosteroids were positioned as the first therapeutic step since they improved sperm quantity and motility, although their efficacy in increasing the number of gestations was doubtful. It seems that artificial insemination with or without corticosteroids improves the possibility of gestation, but it is IVF that achieves the highest pregnancy rates, and is the main therapeutic option for women with the presence of ESA.
Can vasectomy reversal induce the production of antisperm antibodies?
In fact, this is a common cause leading to the appearance of antisperm antibodies (ASA) in the semen. Whilst the vasa deferentia were sealed after a vasectomy, pressure caused by sperm can cause the blood-testis barrier to break down. As a result, sperms are exposed to the immune system, leading to the production of ASA:
What kills sperm in the female body?
Women can also produce antisperm antibodies that kill sperm right after having unprotected sexual intercourse. The cause are infections of the reproductive tract. It should be noted that, in order to diagnose this type of immune infertility, a series of diagnostic tests to evaluate the cervical mucus are required.
If the result of a SpermMar test is above 50%, does it mean I have antisperm antibodies?
This result indicates that half the sperm present in the ejaculate are agglutinated, that is, adhered to the latex particles. In other words, the answer is yes: there are antisperm antibodies.
Suggested for you
Throughout this post, we have made several references to Intrauterine Insemination (IUI) being the most adequate technique for patients with ASA. To learn more, we recommend that you click here: What Is Artificial Insemination (AI)? – Process, Cost & Types.
There exist two types of immune infertility aside from antisperm antibodies. To learn more about this, read: What Is Immune Infertility? – Treatment & Pregnancy Options.
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FAQs from users: 'Why is ICSI an option in cases of immunological infertility due to the presence of anti-sperm antibodies?', 'Why do antisperm antibodies cause infertility?', 'Can vasectomy reversal induce the production of antisperm antibodies?', 'What kills sperm in the female body?' and 'If the result of a SpermMar test is above 50%, does it mean I have antisperm antibodies?'.
Authors and contributors
Dr. Chavez has made several publications, courses and presentations at conferences on fertility, assisted reproduction, gynecology, both nationally and at European level. Since the opening of Ovoclinic Madrid, she is the medical director and gynecologist of the clinic. More information about Marian Chávez Guardado