Infertility: Immunological Aspects

Abstract

Naturally occurring antisperm‐antibodies (ASA) exert an impairment to fertility, which is related to the extent of sperm autoimmunisation. It determines the degree of the interfering effect on sperm penetration through the cervical mucus independently from the antigenic specificity of ASA. Whether or to what extent an ASA‐interfering effect occurs, in each individual patient, downwards from the impairment of cervical mucus penetration is still hard to establish. The main reasons are the inability of current diagnostic tests to determine the antigenic specificity of ASA and to quantify the antibody density on the sperm surface, the main determinants of the ASA‐impairment at level of sperm/oocyte interaction. The current empirical treatment strategy (intrauterine insemination as first line‐treatment) would give way to a more rational one, with the development of tests detecting ASA directed against defined fertilisation‐related antigens.

Key Concepts:

  • Immunological infertility refers to couple infertility due to antisperm‐antibodies (ASA) occurring in the male or female partner.

  • Antisperm‐antibodies (ASA) exert an impairment to fertility, which is related to the extent of sperm‐immunisation.

  • The impairment of sperm penetration through the cervical mucus represents the primary mechanism of ASA interference with fertility.

  • An ASA interference at the level of gamete interaction can occur or not, depending on the relevance of the specific antigens, targeted by natural ASA in each individual patient, to the fertilisation process.

Keywords: antisperm‐antibodies (ASA); immunological infertility; fertilisation; sperm‐immunisation; cervical‐mucus interaction

Figure 1.

The IgG‐MAR was initially developed as a modification of the Coombs test, by mixing on a slide a drop of semen sample, a drop of a suspension of group 0, Rh‐positive human red cells, sensitised with incomplete human IgG (antiserum anti‐D) and a drop of anti‐human IgG. Sperm‐coated ASA are revealed as mixed clamps of motile spermatozoa and red blood cells and the percentage of motile spermatozoa incorporated into mixed agglutinates is noted ((a), left). It has been largely superseded by the commercially available sperm Mar test, where erythrocytes are replaced by latex beads sensitised with incomplete human IgG ((a), right). MAR kits for the sperm‐coated IgA are also available. In the IBT, a drop of patient's washed sperm suspension is mixed on a slide with commercially available polyacrylamide beads coated with anti‐human IgG, IgA and IgM. The percentage of motile spermatozoa coated with beads is noted (b).

Figure 2.

Diagnostic algorithm for male autoimmune infertility.

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Further Reading

Krause WKH and Naz RK (ed.) (2009) Immune Infertility. Berlin, Heidelberg: Springer‐Verlag.

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Francavilla, Felice, and Barbonetti, Arcangelo(Jul 2012) Infertility: Immunological Aspects. In: eLS. John Wiley & Sons Ltd, Chichester. http://www.els.net [doi: 10.1002/9780470015902.a0000967.pub2]