Detection of testicular endocrine abnormalities and their correlation with serum antisperm antibodies in men following vasectomy

We measured the serum gonadotropin response to gonadotropin-releasing hormone in 25 men who underwent vasectomy 2 to 64 months before the study. Ten age-matched fertile men were used as controls. Baseline serum follicle-stimulating hormone, luteinizing hormone and testosterone levels were not significantly different between vasectomized men and controls. However, mean serum follicle-stimulating and luteinizing hormone responses to an intravenous bolus injection of 100 mcg. gonadotropin-releasing hormone were significantly greater in the vasectomy group (p equals 0.008 and 0.003, respectively). There was no correlation between these responses and the interval after vasectomy. Serum antisperm antibodies were present in 13 vasectomized men (52 per cent) using enzyme-linked immunosorbent assay and microagglutination techniques. A significant correlation (p equals 0.003) was found between the presence of serum antisperm antibodies and a normal follicle-stimulating hormone response to gonadotropin-releasing hormone stimulation. Of 13 patients with demonstrable antisperm antibody titers 9 (69 per cent) had normal follicle-stimulating hormone responses, compared to only 1 of 12 (8 per cent) without identifiable antisperm antibody titers. Our data suggest that certain men following vasectomy have abnormalities in seminiferous tubule and Leydig cell functions of the testes. These abnormalities are unrelated to the interval after vasectomy and are not identifiable with routine static hormonal measurements. In addition, serum antisperm antibodies are most likely to be present in men who demonstrate normal seminiferous tubular activity after vasectomy.     

A prospective study of antisperm antibody development in acute epididymitis

The association between acute epididymitis and development of antisperm antibodies was investigated by the gelatin agglutination technique in prospectively collected serum samples from 27 patients. Agglutinating antisperm antibodies, mainly of the IgG class, were detected in seven men (27 per cent), a significantly increased frequency compared to prevalences previously found among blood donors and men from infertile couples. The antibodies developed de novo in four patients (15 per cent). The increased incidence of positive sera and the kinetics of the antibody responses strongly indicate a causal link between acute epididymitis and autoimmunization against spermatozoa. In the majority of the patients the antibody titers were low, being of only theoretical importance in respect to later fertility.     

Immunological status of patients before and after vasovasostomy as determined by the immunobead antisperm antibody test

With the immunobead antisperm antibody test a prospective study was conducted to evaluate the immune status of 55 men before and after vasectomy reversal. A third of the vasectomy patients (19 of 55) had significant serum-sperm antibodies (20 per cent binding or more) detected by the indirect immunobead antisperm antibody test. Of 31 vasovasostomy patients 12 (38 per cent) had significant sperm-surface antibodies (20 per cent binding or more) by the direct immunobead antisperm antibody test. Preoperative serum assays correctly classified the antibody status of 69 per cent of the vasectomy patients. The immunological impact of spermatic granuloma formation, duration of vasal obstruction, patient age and presence of sperm in the vasal fluid at operation also were assessed. An inverse relationship between the proportion of antibody-bound sperm and the percentage of motile sperm in the ejaculate of vas reversal patients was found with videomicrographic semen analysis. The percentage motility was significantly lower among patients with greater quantities of sperm-surface antibodies. No other parameter of semen analysis showed this difference when compared for positive or negative immunobead antisperm antibody test results.     

Analysis of spermatozoa from the proximal vas deferens of vasectomized men

This study assessed the condition of spermatozoa from the proximal vas deferens of men after vasectomy. The fluids of both proximal vas deferens were collected from 67 vasectomized men by cannulating the vas deferens at the time of vasectomy reversal. Selected sperm parameters were analysed after incubation of the spermatozoa for 30 min at 37°C. Spera concentration in the proximal vas from vasectomized men (16 312 ± 21 496 million per ml, geometric mean: 7948 ± 398 million per ml) was significantly higher than that of fertile men and was maintained at a constant level independent of the duration of vas obstruction. The means of sperm motility (36.2 ± 26.2%), spermatozoa with normal morphology (50.7 ± 21.7%), sperm viability (53.0 ± 25.3%) and hypo-osmotic swelling test (HOS-test, 53.9 ± 21.7%) were statistically lower than the respective values for normal fertile men. There was no significant correlation between the duration of vas obstruction and the above semen parameters. In 46.4% of vas fluids all spermatozoa were immotile and this condition was more common after 3 years of vasectomy. Immotile spermatozoa in the proximal vas fluids at the time of vasectomy reversal may be an important factor for predicting semen quality and fertilizing ability after vasovasostomy. There were no significant differences in the results of sperm-cervical mucus penetration test (CMPT) between spermatozoa fiom vasectomized and fertile men. Antisperm antibodies on the surface of spermatozoa from the vas of vasectomized men were determined by the immunobead test (IBT; 78.6% for IgG, 32.1% for IgA) and sperm cervical mucus contact test (SCMC, 36.4%). The presence of antisperm antibodies on the spermatozoa from the vas of vasectomized men may explain, in part, the lower pregnancy rate after vasovasostomy. These parameters of spermatozoa from the proximal vas of vasectomized men may closely reflect those in the cauda epididymis after vasectomy.     

Varicocele and antisperm antibodies

Semen analysis and immunofluorescent antisperm antibodies were tested in 65 patients with varicocele. The mean sperm count and motility values in our study were 36.8 +/- 2.9 million per ml and 38.4 +/- 2.5 per cent, respectively. Both parameters were found not to differ significantly in three grades of varicocele. Immunofluorescent antisperm antibodies were detected in 24.6 per cent of the cases. A significant correlation was demonstrated between the presence of the antibodies and genital infection.     

Changes in testis of guinea pig after vasectomy.

Thirty adult guinea pigs were bilaterally vasectomized and subsequently sacrificed at one, three, and six months after operation. Cell counts were performed on five seminiferous tubules from each animal to identify and quantitate changes in spermatogenesis. Forty-three per cent of the animals had alterations in spermatogenesis that were characterized by generalized hypospermatogenesis and presence of multinucleated spermatids. There was a high incidence (93 per cent) of sperm-agglutinating antibodies in the vasectomized group. Sperm antibodies were not detected in the normal and sham-operated animals. Mean testicular weights and seminiferous tubule diameters were significantly reduced in the hypospermatogenic animals. The intersitial tissue of the vasectomized and sham-operated animals was morphologically indistinguishable from that of unoperated animals.     

Formation of antisperm autoantibodies in rats vasectomized at prefertile age

Bilateral vasectomy was performed in 40 inbred Lewis rats. Twenty prefertile rats were operated upon at the age of 2-3 weeks and 20 adult rats at the age of 10-11 weeks. Sera were sampled 16 and 8 weeks later respectively. Circulating antisperm antibodies were demonstrated in 90% of the vasectomized rats by means of the indirect immunofluorescence technique. No significant difference between the two groups could be found. Sham-vasectomy was performed in 20 rats age 2-3 weeks and in 20 rats aged 10-11 weeks. No antisperm antibodies could be detected in sera from either of these groups 16 and 8 weeks respectively postoperatively. Also, no antisperm antibodies could be demonstrated in sera sampled from 5 control rats at the age of 2-3 weeks or in sera sampled preoperatively from the 40 rats aged 10-11 weeks. Sperm granulomas were observed in 95% of the rats vasectomized at the age of 2-3 weeks, almost, all granulomas being located in the epididymis. 95% of the rats vasectomized at the age of 10-11 weeks also developed sperm granulomas. These were located in the proximal end of the vas deferens. The difference in distribution was significant (p less than 0.001).     

Effects of human antisperm antibodies on development of preimplantation embryos.

The effects of antisperm antibodies (ASAs) present in sera of immunoinfertile patients and vasectomized men were investigated on preimplantation embryonic development in mice. Of the nine immunoinfertile sera tested, two were effective in inhibiting blastulation rates of in vitro cultured murine 2-cell embryos (p less than .05 to .002). Similarly, sera from two of the three vasectomized men were capable of affecting early embryonic development in mice (p less than .05 to .002). Specificities of the embryotoxic effects of ASAs were further confirmed by culturing embryos in the presence of affinity-purified monovalent Fab' antibodies isolated from these sera. Fab' antibodies from only one of the two immunoinfertile patients whose sera affected blastulation rates, and from one of the three vasectomized men were effective in influencing blastulation rates of in vitro cultured 2-cell murine embryos (p less than .05 to .001), mainly due to an arrest of development at 2 to 8-cell and morula stages. In the Western blot procedure, none of the immunoinfertile Fab' antibodies recognized any specific band on blots of extracts from murine ova or 2-cell embryos. However, all the immunoinfertile Fab', but not fertile control Fab', specifically recognized a protein band in the M(r) 25 +/- 2 kD region, on the Western blots of extract from murine blastocyst stage embryos. In addition, Fab' from one immunoinfertile serum, which inhibited embryonic development, reacted specifically with a protein band in the lower molecular range (approximate M(r) 12 kD) on Western blot involving exact from blastocysts. Fab' antibodies of sera from vasectomized men did not react with any specific protein band on blots of extracts from murine ova, 2-cell embryo, or blastocyst. These results suggest that ASAs from some immunoinfertile patients and vasectomized men, especially those reacting with 12-kD blastocyst protein, are capable of affecting preimplantation embryonic development in mice, and thus may contribute toward immunologically medicated infertility both at fertilization and postfertilization stages.     

Sperm antibodies and infertility in patients with testicular cancer

The level of antisperm antibodies using the enzyme-linked immunosorbent assay (ELISA) in the serum of 48 patients with testicular cancer before and after therapy is reviewed. This is not a linear study of each patient, but some conclusions can be drawn: In a high percentage of testicular cancer patients serum antisperm antibodies can be detected: 73.3 per cent before orchiectomy and 43.7 per cent overall. The percentage of patients with antibodies decreases with adequate therapy. In patients with advanced disease there is a higher percentage of positivity (50%) for serum antisperm antibodies than in patients with low-stage disease (30%). The higher percentage of antibodies-positive patients among those with infertility patterns could be an important argument that supports the hypothesis that autoimmune pathology can play a role in oligo/azoospermia in testicular cancer patients.     

Differences in the antigen pattern recognized by antisperm antibodies in patients with infertility and vasectomy

PURPOSE: Antisperm antibodies may impair sperm fertilizing capacity. They are found in infertile patients and in men after vasectomy. Little is known to date of the biochemical nature of the antigens that induce the production of antisperm antibodies. MATERIALS AND METHODS: Sperm membrane proteins were prepared from donor spermatozoa, separated by 1-dimensional polyacrylamide gel electrophoresis and exposed to seminal plasma samples of 36 infertile men and 34 after vasectomy containing antisperm antibodies. RESULTS: Ten antigenic protein bands with different molecular weight were recognized by antisperm antibodies. Antisperm antibodies binding to the antigen band at 55 kDa. were significantly more common in infertile men, while those binding to the 72 kDa. band were more common after vasectomy. Significant differences also occurred in the incidence of detecting the 55 kDa. antigen band by the antisperm antibodies of patients with and without varicocele. Comparing antisperm antibodies from patients with or without a history of genital diseases or trauma did not reveal significant differences in the antigens detected. CONCLUSIONS: It seems likely that the development of antisperm antibody binding to different antigens is related to the mode of antibody induction. Since the antigenic properties of spermatozoa change during passage through the epididymis, the antigens detected by antisperm antibodies from men with vasectomy are mostly related to epididymal passage. The identification of human sperm antigens is essential for understanding the mechanism by which antisperm antibodies influence the fertilization capacity of spermatozoa. It is also necessary for the potential development of reliable diagnostic methods for antisperm antibodies that are relevant to infertility.     

A 15-year followup of a nonmicrosurgical technique for vasovasostomy

A 15-year followup was summarized for patients who had nonmicrosurgical vasectomy reversal. Over-all pregnancy rates were 45 per cent (43 per cent for the first 8 years and 49 per cent for the next 7 years) and 73 per cent of the pregnancies occurred within 1 year after vasectomy reversal. Patients who achieved pregnancy compared to those who did not had significantly better sperm motility and a lower incidence of antisperm antibodies. The data indicate that nonmicrosurgical techniques can be used successfully to reverse vasectomy more economically and more rapidly than the microsurgical approach, while contributing to a reasonable pregnancy rate.     

Vasectomy: Study of Circulating Immune-Complexes and its Correlation with Antisperm Immunity in Man, with a Twelve-Month Follow-up Study

Circulating immune-complexes (CIC) have been detected in sera of vasectomized subjects using the Clq Binding Assay. Results seem to indicate that CIC are a feature of the early post-operative period and a consequence of acute immunization against sperm antigens. The progressive disappearance of CIC from the third month after vasectomy with the simultaneous increase in antisperm antibody percentage and titre suggests that CIC could be a temporary feature in vasectomized men and do not lead to a chronic disease, related to a Type III immune reaction.     

输精管结扎后小鼠睾丸热休克蛋白表达

目的 :探讨热休克蛋白 70 ( HSP70 )在输精管结扎术前后小鼠睾丸中的表达。方法 :60只昆明小鼠行双侧输精管结扎术 ,并设 3 0只假手术小鼠为对照组。分别于术后 1、2、3个月观察。睾丸组织行常规制片后进行免疫组化染色检测 HSP70的表达 ,小鼠血清采用精子凝集和精子制动试验进行抗精子抗体检测。结果 :在结扎组及对照组睾丸生精细胞中均有 HSP70表达。对照组与结扎术后 2个月组 HSP70表达水平均较低 ,两者之间无显著差异 ;结扎术后 2个月组及 3个月组与对照组及结扎术后 1个月组相比 ,HSP70表达水平显著上升 ( P<0 .0 1 )。结论 :输精管结扎术后一段时间内 ,睾丸的生精过程经历从抑制到恢复正常的变化。这一变化可能与 HSP70相关。     

Immunological effects of vasectomy

It is only recently that the adverse effects of vasectomy have become the subject of numerous scientific and at times speculative articles in medical and in lay periodicals. In this review of the literature on the immunological effects of vasectomy, attention is directed to the following: immunological response; cellular immunity; effects on testes and epididymis, and systemic effects of sperm autoantibodies. In 1970, 50% of vasectomized men were found to have circulating spermatozoal antibodies. A more recent survey provides confirmation for this finding and presents an incidence of only 2% of agglutinating antibodies and 0% of immobilizing antibodies in a fertile control population. Some recent and convincing studies have shown sperm agglutinating and immobilizing antibodies to remain either at the same titer level or actually to increase 5-12 years postoperatively. Titers range from 2 to 2048 among different patients. The highest incidence of titers is 1 year after vasectomy, but titers can be found as early as 6 months or as late as 20 years postoperatively. The wide range in titers can be explained in terms of technical problems in immune assays, since only immunoglobulins and not those antibodies part of immune complex systems can be measured. Since sperm antigens are in abundant supply in vasectomized men because of the continuous resorption of spermatozoa after vasectomy, possibly undetectable antibody titers actually reflect high levels of antisperm antibodies circulating in the form of immune complexes. Also it may be possible that the variety in measured titers of autoantibodies, as well as the nonuniversal (70%) antibody response in a vasectomized population, is a variable dependent on genetic content and, therefore, an individual characteristic. The fact that hormonal reponse takes place rather readily after vasectomy makes at least some degree of cellular response a necessary occurrence. Studies by Alexander and Anderson, which show delayed hypersensitivity skin responses to sperm antigens, indicate at least some degree of cell mediated response. A recent study draws a strong correlation between the presence of sperm agglutinins in the seminal fluid of vasovasostomized men and persistent infertility. It is likely that autoantibodies to sperm as a result of vasectomy have a significant role in persistent infertility in vasovasostomized individuals. The greatest controversy at present concerns the immunologic effect of vasectomy on various organ systems. The incidence and degree of atherosclerotic changes in lower primates are increased after vasectomy, but whether vasectomy has the same effect in men has not as yet been determined.     

Antisperm antibodies and lymphocyte subsets in semen—not a simple relationship

The significance of white blood cells in the ejaculate remains a matter of controversy. Several authors have suggested that such cells are important in the modulation of an antisperm antibody response, i.e. a predominance of suppressor/cytotoxic to helper/inducer T cells may prevent the development of antisperm antibodies. In order to examine this relationship further we have documented the white blood cell types, with emphasis on the T-lymphocyte populations, in the ejaculates of men from infertile couples with and without antisperm antibodies; the latter group was divided further into two groups--vasovasostomized men and idiopathic men. All seven of the men without antisperm antibodies had a predominance of suppressor/cytotoxic T cells to helper/inducer T cells in the ejaculate. However, only in some of the men with antibodies was there a predominance of T-helper/inducer cells. It is clear that the relationship between antisperm antibodies and seminal leucocytes is therefore not as straightforward as has been proposed.     

Association of antisperm antibodies with chronic nonbacterial prostatitis

Antisperm antibodies are significant in male factor infertility. The prevalence of antisperm antibodies in the infertile population is approximately 10 percent, and it is not cost-effective to test for these antibodies in every male partner of an infertile marriage. Earlier studies have demonstrated a higher prevalence of antisperm antibodies among men with a history of bacterial prostatitis or urethritis. Because of this established association, we measured the prevalence of serum antisperm antibodies, using a gel agglutination assay, in 28 men with chronic nonbacterial prostatitis and in age-matched control group of 69 men without a history of prostatitis. The prevalence was 25 percent (test subjects) and 7.2 percent (controls) (p less than 0.05). This finding indicates that nonbacterial prostatitis is a risk factor for the presence of serum antisperm antibodies and that subfertile men with a history of nonbacterial prostatitis should be tested for these antibodies.     

Seminal antisperm antibodies and genitourinary infection

A total of 326 infertile men, 126 with genitourinary tract infection, and 200 without infection, were compared with 60 fertile men. Seminal plasma antisperm antibody with other clinical and microbiologic investigations were performed in all. Infertile men with genitourinary tract infection had antisperm antibody in 11.9 percent, infertile men without infection in 14.5 percent, and fertile men in 5 percent; these differences were not significant. The most common causes of these infections were gram-negative organisms and Chlamydia. Comparison of the levels of the titers of seminal plasma antisperm antibodies showed no significant difference between infertile and fertile men. This study shows no significant relationship between genitourinary tract infection and formation of the seminal antisperm antibody.     

Conservative surgery for transitional cell carcinoma of the renal pelvis

From 1972 to 1986, 14 patients underwent a conservative operation for transitional cell carcinoma of the renal pelvis. Most of these patients had low grade (12), noninvasive (10) tumors involving a solitary functioning kidney (12). The operations performed were open pyelotomy with tumor excision and fulguration (8 patients), partial nephrectomy (5) and percutaneous nephroscopic fulguration (1). There was 1 operative death. Of the 13 surviving patients 8 (62 per cent) remained free of transitional cell carcinoma postoperatively, while 5 (38 per cent) had recurrent disease. Six patients (46 per cent) presently are free of tumor 6 months to 5 years postoperatively. Conservative surgical techniques can provide satisfactory treatment for selected patients with renal pelvic transitional cell carcinoma when preservation of functioning renal parenchyma is necessary to avoid kidney failure.     

益气活血汤对男性AsAb阳性病人外周血T细胞亚群分类的影响

目的 :通过观察中药益气活血汤对男性免疫性不育的作用 ,进一步研究中药对生殖免疫的作用机理。　方法 :30例血清抗精子抗体 (AsAb)阳性的不育病人 ,服用益气活血汤 2个月 ,测定用药前后外周血CD3,CD4 ,CD8以及CD4 CD8比值的变化。　结果 :治疗前后CD3数值变化不明显 (P >0 .0 5 ) ,治疗后CD4数值明显降低 (P <0 .0 5 ) ,CD8数值明显升高 (P <0 .0 5 ) ,CD4 CD8数值明显降低 (P <0 .0 5 )。　结论 :中药益气活血汤可能通过影响外周血T细胞亚群分类的水平 ,从而起到调节机体免疫力、治疗免疫性不育的作用     

Vasectomy and vasovasostomy have no effect on seminal plasma zinc concentrations

Mean zinc concentrations were determined for human seminal plasma obtained from 110 nonvasectomized men (139 micrograms. per ml.), 43 recently vasectomized men (144 micrograms. per ml.), 25 long-term vasectomized men (139 micrograms. per ml.) and 25 men who had undergone vasovasostomy (129 micrograms. per ml.). The results indicate that there is no significant short-term or long-term effect of these surgical procedures on prostatic secretory function as measured by seminal plasma zinc concentration.