Male autoimmune infertility

Abstract

Naturally occurring antisperm-antibodies (ASA) exert an impairment to fertility, which is related to the extent of sperm autoimmunization. It determinates the degree of the interfering effect on sperm penetration through the cervical mucus independently from the antigenic specificity of ASA. Therefore, spermautoimmunization relevant to infertility can be diagnosed in the presence of a high proportion of ASA-covered spermatozoa, associated with a poor result of a carefully performed postcoital test. Whether or to what extent an ASAinterfering effect occurs, in each individual patient, downstream from the impairment of cervical mucus penetration, is still hard to establish. The main reason is the inability of current diagnostic tests to determine the antigenic specificity of ASA and to quantify the antibody density on the sperm surface, which are main determinants of ASA-impairment at the level of sperm/oocyte interaction. In any case, from a clinical point of view, to establish whether, or to what extent, this ASA- interfering effect occurs, in each individual patient, is not needed to diagnose ASA-related subfertility, because such impairment cannot occur in the absence of the interference at the level of mucus penetration. But, it would be relevant in choosing the more appropriate assisted reproductive treatment option.