What are anti-sperm antibodies, and should men be concerned?
When it comes to male fertility, most conversations revolve around sperm count, motility, and overall sperm health. However, one lesser-known factor that can significantly impact male fertility is the presence of anti-sperm antibodies (ASAs).
What are anti-sperm antibodies?
Anti-sperm antibodies are proteins produced by the immune system that mistakenly target and attack sperm cells. Normally, the immune system doesn’t interfere with sperm production because of a protective barrier in the testes called the blood-testis barrier. This barrier keeps the immune system from recognising sperm as foreign invaders. However, when this barrier is breached—due to injury, infection, or surgery—the immune system may start treating sperm as a threat and consequently start producing antibodies to neutralise them.
How do anti-sperm antibodies affect fertility?
Anti-sperm antibodies can interfere with fertility in several ways. Studies suggest that ASAs are found in approximately 10-15% of infertile men, highlighting their significance in certain cases. The impact on fertility may be seen in one of several ways:
- Reduced sperm motility: Antibodies can attach to the surface of sperm, making it harder for them to swim efficiently toward the egg.
- Impaired sperm function: Antibodies can alter the sperm’s ability to penetrate and fertilise the egg.
- Sperm clumping: ASAs can cause sperm to stick together, thus further reducing their mobility.
These issues can make natural conception more challenging, but it’s important to note that not all cases of anti-sperm antibodies lead to infertility. The extent of their impact varies depending on the level and type of antibodies present.
What causes anti-sperm antibodies?
Several factors can lead to the production of anti-sperm antibodies. Understanding these causes can help in prevention and early detection:
- Trauma or injury: Physical damage to the testes can disrupt the blood-testis barrier.
- Infections/inflammations: Infections of the testicles and the reproductive tract can compromise the barrier. Inflammation and orchitis from conditions such as mumps may also compromise the barrier.
- Surgery: Procedures like a vasectomy (and even its reversal) can expose sperm to the immune system.
- Testicular conditions: Conditions like testicular torsion or varicocele may also play a role.
Symptoms to watch for
Anti-sperm antibodies typically don’t cause noticeable symptoms, which makes them hard to detect without medical testing. However, some men might notice abnormalities in their ejaculate, such as changes in consistency, clumping, or an unusually thick or thin texture. While these signs are not definitive indicators of ASAs, they can point to potential underlying reproductive issues. Men with ASAs often only discover the issue when they face difficulties conceiving with their partner. If you’ve been trying to conceive for a year or more and have any history of trauma, surgery or infection then getting a semen analysis that includes anti-sperm antibody testing is recommended.
How are anti-sperm antibodies diagnosed?
Diagnosing ASAs involves a specialised test called the immunobead binding test or mixed antiglobulin reaction (MAR) test. These tests assess if antibodies are present in a semen sample and their impact on sperm function. Unfortunately, these tests are not part of a routine semen analysis and are usually reserved for cases where other common causes of infertility have been ruled out. This is because ASAs are relatively rare, and testing requires specialised techniques.
Are anti-sperm antibodies reversible?
The reversibility of anti-sperm antibodies depends on their underlying cause. In cases where ASAs result from a temporary condition, such as an infection, treating the root cause may reduce antibody levels over time. However, if the antibodies are due to irreversible factors like surgery or trauma, they may persist long-term. Additionally, research suggests that levels of anti-sperm antibodies can fluctuate over time, influenced by changes in health, infections, or other stressors. While direct reversal of ASAs is rare, modern fertility treatments like IVF and ICSI are highly effective in overcoming their impact, allowing many men to achieve successful pregnancies with their partners.
Treatment options
Treatment for anti-sperm antibodies depends on the severity of their impact on fertility and your overall health. Some treatments are more commonly recommended based on the specific challenges caused by ASAs, ensuring tailored approaches for each individual. It’s important to note that with advancements in fertility treatments, many men affected by ASAs can still successfully conceive with the right intervention. Here are some common approaches:
- Intrauterine insemination (IUI): In cases where ASAs have a mild impact, washing the sperm to remove antibodies and directly inseminating it into the uterus may help.
- In Vitro Fertilization (IVF) with Intracytoplasmic Sperm Injection (ICSI): If ASAs severely impair fertility, IVF combined with ICSI, where a single sperm is injected directly into an egg, can bypass many of the issues caused by the antibodies.
- Medication: In some cases, corticosteroids may be prescribed to suppress the immune response, though this approach is less common due to potential side effects and has limited research showing its benefits.
- Lifestyle adjustments: Reducing stress, eating a balanced diet, and addressing any underlying infections or conditions can improve overall reproductive health.
What can men do to prevent anti-sperm antibodies?
While not all cases of ASAs are preventable, some steps can reduce the risk:
- Wear protective gear during sports to avoid testicular injuries.
- Seek prompt treatment for infections in the reproductive tract.
- Discuss potential risks with your doctor before undergoing surgery like a vasectomy.
Final Thoughts
Anti-sperm antibodies can be a complicated issue; so, it’s important that men seek proper medical guidance from a doctor with male fertility specialisation. Proper support and counselling about treatment options is paramount, so that men and couples can make an informed decision about any future fertility treatment. While not routinely tested, ASAs are identifiable and manageable with modern diagnostic and treatment options. Additionally, since facing fertility challenges can take an emotional toll, it’s essential to seek not only medical but also emotional support. If you suspect ASAs might be affecting your fertility, consult a reproductive specialist and remember that solutions are available.
References
- World Health Organization (2021); WHO Laboratory Manual for the Examination and Processing of Human Semen. Sixth Edition (2021); Geneva, Switzerland: World Health Organization; Licence: CC BY-NC-SA 3.0 IGO
- Bohring C, Krause W (2003); Immune infertility: towards a better understanding of sperm (auto)-immunity. The value of proteomic analysis. Hum Reprod 18: 915-924
- Bohring C, Krause W (2005); The role of antisperm antibodies during fertilization and for immunological infertility. Chem Immunol Allergy 88: 15-26
- Marconi M, Nowotny A, Pantke P, Diemer T, Weidner W (2008); Antisperm antibodies detected by mixed agglutination reaction and immunobead test are not associated with chronic inflammation and infection of the seminal tract. Andrologia 40: 227-234
- Bohring C, Krause E, Habermann B, Krause W (2001); Isolation and identification of sperm membrane antigens recognized by antisperm antibodies, and their possible role in immunological infertility disease. Mol Hum Reprod 7: 113-118
- Shibahara H, Shiraishi Y, Suzuki M (2005); Diagnosis and treatment of immunologically infertile males with antisperm antibodies. Reprod Med Biol 4: 133-141
- Schlegel PN, Sigman M, Collura B, De Jonge VJ, Eisenberg ML, Lamb DJ, Mulhall JP, Niederberger C, Sandlow JI, Sokol RZ, Spandorfer SD, Tanrikut C, Zini A, Brannigan RE, Kim SK, Kirkby E, Hermanson L, Kaczmarek J, Oristaglio JT, Treadwell JR (2024); Diagnosis and treatment of infertility in men: AUS/ASRM guideline (2020; amended 2024). American Urological Association Education and Research