Significant progress is being made in the study and treatment of infertility due to antisperm antibodies. Increased knowledge of the antigenicity of sperm and oocytes and continued study of the immunology of the male and female reproductive tracts should yield a greater understanding of the mechanisms of immunologic infertility. Such an understanding will permit novel and specific therapy for the infertile couple. Until such research is forthcoming, continued clinical research is imperative to increase the efficiency and success of treatment.
PIP: The blood testis barrier, a specialized inner Sertoli's cell attachment, is listed among modulators of antigenicity. Antigen mediated mechanisms include suppressor T-lymphocytes which partially mediate the normal state of immunologic unresponsiveness toward sperm autoantigens. The cervix is a site of sperm filtration, and uterine fluid has significant concentrations of IgG and IgA. The postcoital test (PCT) screens for sperm antibodies. In a study, 25% of women in 172 infertile couples had antisperm antibodies in their cervical mucus, and 12.7% had antisperm antibodies in their sera. 64% of 66 couples had adequate PCT in which there was no male autoimmunity to sperm. The PCT was 26% in 122 couples with untreated male autoimmunity. Increased phagocytosis of sperm by macrophage of the female reproductive tract is another mechanism, as is impaired interaction with zona pellucida when antibodies occupy sperm receptor sites blocking sperm binding. In a study of men with antisperm antibodies, 18 of 23 (78%) had poor egg penetration compared to 5 (16%) of 30 normal men. The risk of spontaneous abortion is higher in women whose male partner has antisperm antibodies. Cytotoxic sperm antibodies were found in 47% of husbands of women who miscarried habitually. Diagnostic tests for immunological infertility include the Kibrick or gelatin agglutination test (GAT), the Franklin Dukes test or tray slide agglutination test (TSAT), the microtray agglutination test (MAT), the Isojima or sperm immobilizing test (SIT), the mixed antiglobulin reaction test (MAR), and the immunobead test (IMB). In the sera of 140 subfertile men, antisperm antibodies were found in 2.3% by the Kibrick test, 4.6% by the Franklin Dukes test, 18.6% by the Isojima test, and 15.2% by the MAR test. Therapy of infertility includes the condom method, intrauterine insemination, immunosuppressive therapy with corticosteroids, in vitro fertilization, and donor insemination.