Seminal sperm antibodies exhibit an unstable spontaneous course and an increased incidence of leucocytospermia

The prognostic significance of seminal sperm antibodies for male fertility is difficult to define. Among other factors, spontaneous remissions and transient induction through genito-urinary infections may change their significance for male fertility considerably. We therefore investigated their spontaneous course over time and their association with leucocytospermia. For the investigation of possible relationships between the mixed antiglobulin reaction (MAR) test results for IgA and IgG sperm antibodies and leucocytospermia, 138 patients with <1 million leucocytes/ml ejaculate were compared with 1051 patients with <1 million leucocytes/ml ejaculate (WHO normal range). In a second part of the study the spontaneous course of MAR IgG and IgA test results was investigated in 58 of the 1189 patients who had three or more MAR tests and a leucocyte concentration of <1 million/ml ejaculate. The mean interval between the first and second MAR test was 4.1 (SD ±4.2) and between the second and third MAR test 6.0 (SD ± 6.7) months. In total, 64% of patients with an MAR IgG test result >40% showed a stable spontaneous course. Patients with lower MAR IgG test results and the majority of all MAR IgA-positive patients were found to have an undulating course of MAR test results. There was a higher incidence of leucocytes <1 million/ml ejaculate in patients with higher MAR results ( p <0.05 for IgG, p <0.001 for IgA). The unstable spontaneous course of MAR IgG results <40% and all MAR IgA results suggests that evaluations of the in-vivo significance of seminal sperm antibodies for male fertility should be based on repeated MAR determinations. Moreover, the association of leucocytospermia (<1 million leucocytes/ml ejaculate) with an increased incidence of positive MAR test results suggests a thorough evaluation, treatment and follow-up of possible genital tract infections in MAR-positive patients with <1 million leucocytes/ml ejaculate.