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  • Title: [Sperm antibodies and fertility].
    Author: Verpillat P, Boiron J, Roux C, Agnani G.
    Journal: Contracept Fertil Sex (Paris); 1995 Feb; 23(2):87-92. PubMed ID: 12319249.
    Abstract:
    Some cases of infertility considered inexplicable have been found to have an immunologic basis. Spermatozoa are highly antigenic cells. When the state of immune tolerance is disrupted, auto-immunization in the man or isoimmunization in the woman can occur. The appearance of antibodies directed against the sperm antigens results in a condition of hypofertility more than of absolute sterility. Numerous antigens have been identified on sperm using monoclonal antibodies. Immunosuppressive substances have been isolated in the seminal liquid in vitro, and various other protective mechanisms have been identified. Autoimmunity apparently results from failure of the protective processes. Physical, chemical, or infectious trauma may explain the entry of immunocompetent cells. The most commonly used techniques for study of antisperm antibodies are those that detect antibodies directed against surface antigens. Sperm agglutination tests have been criticized for their numerous false positive findings and their failure to identify the classes of immunoglobulins implicated. Tests of immobilization or cytotoxicity are specific, with no false positives, but not sensitive, giving rise to false negatives. The Mixed Antiglobulin Reaction Test (MAR- test) is very specific, easy, inexpensive, and rapid, but it only detects IgG and determination of the place of fixation is difficult. The immunobead test proposed in 1982 overcame some of the limitations of the MAR-test. These two are the methods of choice in exploration of male autoimmunity. Radioimmunologic techniques, an ELISA-type test, and others have given less satisfactory results. The frequency of antisperm antibodies has been estimated at 3 to 15% in nonselected infertile men, 35% among men with some symptoms or a history of the condition, and less than 1% among fertile men. The antisperm antibodies have functional significance only when they are fixed to their antigens. Modifications of sperm mobility are the main problem, with blockage of transport to the oocyte and union with it. It is difficult to establish a prognosis because evaluation must be done individually. As the level of antibodies increases, the chances of spontaneous pregnancy decline. Several treatments have been developed but results have been disappointing. In vitro fertilization after separation of motile sperm without antibodies may improve the prospects of pregnancy.
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