The relationship between antisperm antibodies prevalence and genital Chlamydia trachomatis infection in women with unexplained infertility

BackgroundChlamydia trachomatis infection is one of the most common sexually transmitted diseases. Sperm-associated antibody could impair fertility through various mechanisms; both factors could be correlated to affect the fertility status of women.DesignA retrospective case-control study was performed enrolling ninety (n = 90) patients with primary or secondary infertility as the case group, in addition to another eighty (n = 80) healthy women attending the family planning clinic to investigate the correlation between C. trachomatis past and current infections and antisperm antibodies (ASA) in women with unexplained infertility.ResultsThe PCR prevalence of C. trachomatis did not differ significantly among both groups (2.4% versus 1.6%, p value = 0.66). In contrast, significantly higher prevalence of anti-C. trachomatis specific IgG (39% versus 19%, p value = 0.87) antibodies was found among infertile women. ASA prevalence was significantly higher in infertile group (20% versus 5%, p = 0.04). The final study results have failed to find a positive correlation between current or past C. trachomatis infection and the level of antisperm antibodies level in women suffering of un-explained infertility.ConclusionAntisperm antibodies were significantly higher in infertile women, but without a significant difference between the incidences of ASA in infertile women with past or current C. trachomatis current infection.     

The relationship between antisperm antibodies prevalence and genital chlamydia trachomatis infection in women with unexplained infertility

Chlamydia trachomatis infection is one of the most common sexually transmitted diseases and sperm-associated antibody could impair fertility through various mechanisms. Both factors could be correlated to affect the fertility status of women. A retrospective case-control study was performed enrolling ninety (n = 90) patients with primary or secondary infertility as the case group, in addition to another eighty (n = 80) healthy women attending the family planning clinic to investigate the correlation between C. trachomatis past and current infections and antisperm antibodies (ASA) in women with unexplained infertility. The PCR prevalence of C. trachomatis didn't differ significantly among both groups (2.4 versus 1.6%, P = 0.66). In contrast, significantly higher prevalence of anti-C. trachomatis specific IgG (39% versus 19%, P = 0.87) antibodies were found among infertile women. ASA prevalence was significantly higher in infertile group (20 % versus 5%, P = 0.04). The final study results have failed to find a positive correlation between current or past C. trachomatis infection and the level of antisperm antibodies level in women suffering of un-explained infertility. Anti-sperm antibodies were significantly higher in infertile women, but without a significant difference between the incidences of ASA in infertile women with past or current C. trachomatis current infection.     

Effect of therapy on infertile couples with antisperm antibodies

One hundred seventy-eight couples with positive antisperm antibody titers in serum and genital secretions were offered treatment with prednisone. Of 60 couples who received prednisone only, 43% conceived. Of 25 who had no therapy, 48% conceived. Fifty-four patients treated with prednisone received additional therapy and 31% conceived. Ten of 39 patients not treated with prednisone but receiving other therapies conceived. Cytotoxic antibodies were reduced in 30% to 42% of serum samples and in 24% to 33% of genital secretion samples. In those couples with decreased cytotoxic antibodies pregnancy rates were 40% to 60% compared with 0% to 23% in those with decreased hemagglutinating antibody titers. Our data suggest that prednisone did not improve overall pregnancy rates; pregnancy rates were comparable in both groups treated with other therapies; donor insemination was the most successful of the alternative therapies; reduction of cytotoxic antibody titers after prednisone treatment was associated with increased pregnancy rates.     

Presence of antisperm antibodies in fertile and infertile persons.

The sera of 70 infertile and 30 fertile couples were tested for the presence of sperm agglutinins with Kibrick's macroagglutination technique and Boyden's haemagglutination test. 15.7% of the couples studied showed the presence of sperm agglutinins (by Kibrick's method) of which 5.7% were from males and 10.0% were from females. By the haemagglutination test, 13% of the couples studied were found to possess sperm agglutinins, of which 3% were from males and 10% were from females. 30 fertile men and women studied for sperm agglutinins were found to be negative by both methods. It was also observed that these two tests detected different types of sperm agglutinins. The cervical mucus samples from 45 females (15 fertile and 30 infertile) were tested for sperm agglutinins with a mucus penetration test. 23.1, 16.5, and 57.4% of the samples from infertile females, showed 0-degree, 1-degree and 2-degree penetration respectively. In case of samples from fertile females, 6.6, 13.2 and 79.2% showed 0-degree, 1-degree and 2-degree penetration respectively. Addition of serum from infertile females to cervical mucus from the infertile female increased the 0-degree penetration percent cases to 50%, as compared with 23.1 when only cervical mucus was used. Addition of serum from fertile females, or horse serum or pure albumin or globulins did not increase the 0-degree penetration cases.     

Circulating antisperm antibodies in recurrently aborting women

One hundred seventy-three women with a history of three or more recurrent consecutive abortions were analyzed for circulating antisperm antibodies with a radiolabeled antiglobulin assay (RAA), a modified enzyme-linked immunosorbent assay (ELISA), a tray agglutination test (TAT), and a sperm immobilization test (SIT). No pregnancies were subsequently gestated to term in women who were antisperm antibody-positive unless they were inoculated with their husband's leukocytes as treatment for an immune basis (not related to antisperm antibodies) for their recurrent abortions. In women with an immune basis for their recurrent abortions, immunization with leukocytes from their male partners increased the ability of these women previously aborting their fetuses to carry their fetuses to term, even if they had positive results in the ELISA, TAT, and SIT; women with positive results in the RAA continued to abort subsequent pregnancies, despite leukocyte immunization. Immunization of antisperm antibody-positive women with their partner's leukocytes did not incite or increase the antisperm antibody titer, with any of the assay techniques.     

Sperm-agglutinating antibodies in infertile women

This paper explored the experience with sperm-agglutininating antibodies in 168 infertile couples. 2 of the 46 subjects with organic causes for infertility had positive sperm agglutination tests, and neither became pregnant in the 6-18 month followup period. Of the remaining 122 subjects with no organic cause for infertility, 24 (20%) had positive tests (including 13 women with primary infertility and 11 with secondary infertility). 9 of the 24 women (38%) with positive tests became pregnant following condom therapy. There was no correlation between the sperm antibody test and postcoital test, nor between sperm agglutinins and ABO incompatibility. These results suggest that a small number of women have specific reactions against sperm or seminal fluid that inhibit fertility. It is concluded that screening of serum for sperm agglutinins should be continued to provide an estimate of immunologic reactions against semen in cases of infertility.     

Diagnosis and treatment of immunologically infertile males with antisperm antibodies

The presence of antisperm antibodies (ASA) can reduce fecundity in both males and females. The present review describes a strategy, established by investigations of the diverse inhibitory effects of ASA on fertility, for the appropriate diagnosis and treatment of infertile males with ASA. For infertile males with ASA, diagnosis using the direct-immunobead test (DIBT), the postcoital test (PCT) and the hemizona assay (HZA) should be carried out as the basis for decision-making. If the patient with ASA has an abnormal hemizona index, it seems reasonable to advise selecting intracytoplasmic sperm injection-embryo transfer (ICSI-ET) as a primary treatment. However, it has been shown that some immunologically infertile males with normal fertilizing ability established pregnancy by timed intercourse (TI) or intrauterine insemination (IUI). In such patients with ASA having normal hemizona index, TI or IUI can be selected based on the PCT result. Therefore, the treatment strategy for males with ASA is similar to that for infertile males with oligozoospermia or asthenozoospermia. In conclusion, it should be emphasized that a diversity of ASA exists and their effects on fertility in infertile males. Although there is an argument that routine testing for ASA in males is not always necessary, one should be aware that in some cases of failed IUI or IVF, ICSI is selected afterward because of the diagnosis of ASA.     

Adrenal response to adrenocorticotropin stimulation in unexplained infertile women

The response to a rapid intravenous administration of adrenocorticotropin (ACTH, cortrosyn) was compared in 24 unexplained infertile women and 13 fertile women. There was no significant difference in the response to a rapid ACTH stimulation as expressed by the slope of testosterone (T) response in both groups. However, the individual and mean T values prior and following the stimulation were significantly higher in the infertile group (P less than 0.001; P less than 0.005, respectively). There was no significant difference in individual values as well as in mean basal values or in mean values of 17-hydroxyprogesterone (17-OHP) after the stimulation between the two study groups (P less than 0.3; P less than 0.9, respectively). There was no significant difference in individual values as well as in mean values of dehydroepiadnrosterone (DHEA) before or 90 min after the stimulation between the two study groups (P less than 0.1; P less than 0.2, respectively). It can therefore be concluded that the elevated basal testosterone values in the infertile group originated from the ovary. Despite the fact that no attempt was made to reduce androgen values 7 (46.66%) of 15 infertile women who were available for follow-up and treatment conceived following ovulation induction therapy.     

Characterization of human sperm antigens and antisperm antibodies in infertile patients.

OBJECTIVE: To identify which sperm antigens may elicit the production of functionally important antisperm antibodies. DESIGN: Immunoblot analysis was performed on 69 serum and 9 seminal plasma samples from infertile patients, using detergent extracts of pooled donor sperm as the antigen source. Serum and seminal plasma had been previously tested by an indirect immunobead binding test (IBT); 61 IBT-positive and 17 IBT-negative samples were included in the study. Proteins recognized by IBT-positive but not IBT-negative samples were most likely to be cell surface antigens, whereas proteins recognized by both IBT-positive and IBT-negative samples were probably intracellular. Antibodies directed toward surface antigens would be most likely to affect fertilization. Characterization of sperm surface proteins on both acrosome-intact and -reacted sperm used labeling of cell surface proteins with an N-hydroxysuccinimide ester of biotin, fractionation of sperm heads and tails, and lectin binding to determine glycosylation. RESULTS: Specific immunoreactivity (with respect to IBT results) was observed to 35K, 40 to 45K, 57K, 66K, and 88 to 90K MW proteins. Characterization studies identified an 88K MW glycosylated plasma membrane protein, a 66K MW inner acrosomal membrane protein, a 34K MW inner acrosomal membrane protein, and a 35K MW prominent tail protein. CONCLUSION: Immunological infertility may involve several antigens characterized in this study. Further studies are necessary to determine if antibodies to these specific proteins interfere with sperm function.     

Evaluation of the antisperm antibodies in infertile couples afflicted with a cervical factor

OBJECTIVES: The purpose of this study was to evaluate methods used for antisperm antibodies detection in infertility. METHODS: The studied cohort comprised 38 infertile couples with a distinct cervical factor. Presence of antisperm antibodies and their levels in circulation were evaluated in sera samples of both partners and also in the cervical mucus and semen with the Latex Agglutination test. Western Blotting was applied as an additional method in antibody detection. We also assessed: the number of sexual partners, potentially allergizing sexual behaviour and other potentially sensitising factors. RESULTS: The positive antisperm antibodies were detected merely twice and only in one case there was evidence of insemination-impeding antisperm humoral response. The Western Blotting method enabled us to obtain a reaction to a range of sperm proteins which reacted with antibodies both in serum and in seminal plasma. CONCLUSIONS: Determination of infertility on immunological grounds on the basis of a single determinant on sperm presents little diagnostic value. In our view, the combination of patient's clinical status with immune-system response to a spectrum of sperm antigens provides means of infertility evaluation. We propose Western Blotting as an useful technique for detection of antisperm antibodies.     

Characterisation of a sperm coating auto-antigen reacting with antisperm antibodies of infertile males using monoclonal antibodies

Objective In a previous study a number of sperm-specific antigens were identified which reacted with antisperm antibodies from both infertile and vasovasostomised males. To investigate the localisation and distribution of these antigens and their role in male fertility, monoclonal antibodies were raised against them; immunoblotting techniques were used to select only those antibodies which competed with human antisperm antibodies for these human auto-antigens.
Design One antibody, NW21, reacted with an 18 kDa auto-antigen present on epididymal sperm but absent from testicular sperm. Immunohistochemical studies showed that the antigen is produced in small basal cells between the columnar epithelium of the corpus epididymis, passes up into the tubule and then coats sperm passing along the epididymis. Sperm stored in the cauda epididymis and ductus deferens stain strongly for this sperm coating glycoprotein.
Conclusions The localisation of this antigen supports the suggestion that auto-immune infertility may represent a response to epididymal rather than testicular sperm. Monoclonal antibodies raised to unique and immunologically accessible sperm coating proteins, produced in the epididymis rather than in the testis, would seem to present an excellent theoretical solution to male contraception.     

Clinical study on circulating antisperm antibodies in women with recurrent abortion

Couples with a history of recurrent spontaneous abortions (RSA) were analyzed for circulating antisperm antibodies (Ab) with an enzyme-linked immunosorbent assay (ELISA), a Franklin-Dukes (F-D) and a sperm immobilization test(SIT). The three tests were positive in 31.5%, 25.9% and 18.5% for wives and 24.1%, 11.1% and 7.4% for husbands in RSA couples. There was a statistical significance (P less than 0.01) as compared with the control group. The ELISA method was found to be most sensitive, and the positive rate of antisperm antibodies in wives was higher than that in husbands. The Ab titer of RSA group varied within 1:8 approximately 1:512, with 60% above 1:32. The pregnant weeks (P greater than 0.05) did not seem to affect the antisperm Ab titer, nor did the aborting frequency. Our study suggests that antisperm Ab is one of the important causes of RSA in women.     

Evaluation of antisperm antibodies in infertile couples with immunobead test: prevalence and prognostic value

We know that antisperm antibodies can cause infertility. We studied the prevalence of the immune response against spermatozoa in infertile couples using immunobead test. 16.2% of the men were autoimmune and 7.3% of the women isoimmune. Both partners were immune in 1.6% of the couples. We also studied the degree of impairment of sperm penetration into cervical mucus in couples in which one of the partners exhibited immunity and we found that generally it correlates with the proportion of sperm exhibiting surface-bound immunoglobulins. In some cases the sperm penetration into cervical mucus was normal in spite of immunization. So other mechanisms of interference should be explored. We found a significant difference (p less than 0.02) in the conception rate between immune and non immune couples (19.3% vs 42%). The pregnancy outcome of immune couples was favorable only in 50% of the cases.     

Vitamin E effect on controlled ovarian stimulation of unexplained infertile women

Purpose  

To determine Vit E effect on the treatment outcomes of women with unexplained infertility undergoing controlled ovarian stimulation and intrauterine insemination (IUI).     

Local hydrocortisone treatment of sperm-agglutinating antibodies in infertile women

Local sperm-agglutinating antibodies (LSAA) in the cervical ovulatory mucus may be a cause of primary infertility. A group of 17 infertile women with LSAA treated without effect with artificial insemination and then condom therapy were studied. After hydrocortisone application to the ectocervix for up to four cycles, LSAA disappeared totally in 13 patients; six of them have given birth to babies. No side effects of treatment were observed. Hydrocortisone for local immunosuppression may become a new method of therapy in cervical immunological infertility.