Immunological factor of male infertility is one of the least studied causes of infertility in the modern medicine. It accounts for about 10% of all infertile marriages. Male infertility of this type is more common than in women, and is caused by the formation of sperm antibodies in the body (ASAT).
During each act of intercourse the woman's body gets a lot of "foreign" cells, which are mature sperm cells. In the absence of the immune system malfunctions, her protective immune cells (lymphocytes) accept male sperm cells as her "own" cells. Various immune disorders become the reason that women’s lymphocytes seek to destroy sperm cells, taking them for "outsiders". Anti-sperm antibodies contribute to blockage of spermatogenesis and mobility disturbance of sperm cells contained in the ejaculate, in addition, they prevent acrosomal reaction, complicate fertilization, capacitation and binding to the zona pellucida.
As a result, no merging of the egg and sperm cell occurs, which prevents normal fertilization of the egg. Sometimes the embryo still survives, and there is a positive diagnostics of pregnancy, but anti-sperm antibodies continue their destructive activity in the female body, which ends with toxemia of pregnant women, fetal developmental pathology, as well as leads to spontaneous abortion.
Causes of male immunological infertility
Immunological infertility in men occurs mostly as a result of testicular trauma - blunt or acute. Very often these injuries are accompanied by rupture of capillaries and seminiferous tubules. Because of this, antigens get into the bloodstream, causing a corresponding immune response. Thus, sperm antibodies that prevent normal formation of sperm cells, contributing to the development of male infertility begin to be formed in blood and semen after the trauma. Such immune attacks are usually aimed at all sperm cells, rather than just those that are formed in the injured testicle.
Presence of ASAT prevents the sperm motility; in addition, anti-sperm antibodies contribute to their agglutination. As a result, sperm cells cannot penetrate into the uterus, bypassing the cervical canal, which is why an aberration of the acrosomal reaction occurs. And even in vitro fertilization cannot be performed without it. According to various reports, ASATs are present in 20-40% of men - representatives of infertile married couples, where the infertility is registered in one or both spouses.
nfertility is registered in one or both spouses. Another important cause of anti-spermal immunity is various urogenital infections. It is believed that the formation of sperm antibodies against the background of infectious diseases is determined by ability of viral, bacterial and fungal organisms to cling to the membrane of sperm cells, provoking cross-reactions. That's when the body produces antibodies directed not only against infectious agents, but also against sperm cells.
The most significant in this case infections include mycoplasma, chlamydia, HPV and herpes viruses. However, it should be taken into account that the antibodies raised against sperm antigens not always pose a threat to their existence. There are more than forty antigens of sperm and seminal plasma, but only few of them affect the result of the egg fertilization.
- Diagnostics of immunological infertility in men
Male immunological infertility can be diagnosed through several methods:
1) MAR-test
MAR-test is a common addition to the spermogram analysis, which demonstrates normal sperm motility. MAR-test allows to determine how many active sperm cells carry on themselves the anti-sperm antibodies. Sperm cells coated with antibodies seem fertile on a usual spermogram, but in fact they are not able to carry out fertilization, since this is prevented by the ASATs attached to them.
MAR-test is performed simultaneously with the analysis of spermogram (ejaculate study), and its implementation does not require any additional conditions. Typically, during the initial study of ejaculate there is determined the presence of G-class antibodies (MARg). Sometimes it is advisable to determine A-class sperm antibodies as well. Indicators of the test up to 10% are considered normal. From 10% to 50% - a reason to suspect pathology; in this case there is usually prescribed an additional examination. And finally, the excess of the 50% value - a pronounced immune factor of infertility.
If a patient has signs of impaired sperm motility or strongly pronounced pathospermia then there is assigned one more sperm analysis (ELISA test), which is intended for the studying of sperm antibodies contained in the blood and semen. Implementation of this test is also recommended in case of unexplained azoospermia, in order to determine whether it is obstructive or not.
2) Postcoital test
This test allows to determine the degree of sperm reaction on mucus, which covers the cervix. It is carried out in two ways: in vivo (Shuvarsky-Sims-Huhner test) and in vitro (Kurtsrok-Millertest). Both methods are performed before ovulation during the day after intercourse. The first case involves studying of the cervix and vagina content. The second - the analysis of sperm and mucus taken from the cervix. Reduced sperm activity is a negative test result. It should be taken into account that postcoital test is not always completely reliable.
3) Immunobead-test
This test is similar to the MAR-test. The spectra of antibodies detected in the course of these tests, in some cases, are different, so the results of sperm analyzes of one man may have differences.
4) Latex agglutination test
This type of test is developed by German immunologists, and it is the least explored in our country. The advantage of the test is the possibility of a direct determination of ASAT presence in semen, blood plasma or mucus. Furthermore, latex agglutination test has a high sensitivity. Moreover, spectrum of the antibodies identified through this method may be different from MAR and immunobead test results; therefore, typically, it is better to use all types of tests as complementary.
Treatment of immunological infertility in men
Treatment of male infertility caused by immunological factors is very complex and often ineffective. In the case of sperm antibodies determination, therapy, first of all, should be aimed at the elimination of the factors, which caused the immunological factor of infertility. Sometimes it contributes to the unprompted disappearance of ASATs.
In the absence of the effectiveness of therapy aimed at the treatment of the underlying disease, there are used other treatment regimens, such as oral administration of enzymes, immunosuppression with cytostatics and glucocorticoid hormones, insemination with washed sperm. However, most of these methods are either fraught with serious complications, or are not sufficiently effective.
Then the infertile couple can have posterity only with the help of two methods, one of which is in vitro fertilization. However, this method is only applicable if the sperm cell that cannot reach the egg still has the ability of egg fertilization. If egg fertilization does not occur, the infertile couple has only one chance left - application of such method of assisted reproductive technology as ICSI.
