Yasuko Shiraishi

Diagnosis and treatment of immunologically infertile males with antisperm antibodies

The presence of antisperm antibodies (ASA) can reduce fecundity in both males and females. The present review describes a strategy, established by investigations of the diverse inhibitory effects of ASA on fertility, for the appropriate diagnosis and treatment of infertile males with ASA. For infertile males with ASA, diagnosis using the direct-immunobead test (DIBT), the postcoital test (PCT) and the hemizona assay (HZA) should be carried out as the basis for decision-making. If the patient with ASA has an abnormal hemizona index, it seems reasonable to advise selecting intracytoplasmic sperm injection-embryo transfer (ICSI-ET) as a primary treatment. However, it has been shown that some immunologically infertile males with normal fertilizing ability established pregnancy by timed intercourse (TI) or intrauterine insemination (IUI). In such patients with ASA having normal hemizona index, TI or IUI can be selected based on the PCT result. Therefore, the treatment strategy for males with ASA is similar to that for infertile males with oligozoospermia or asthenozoospermia.In conclusion, it should be emphasized that a diversity of ASA exists and their effects on fertility in infertile males. Although there is an argument that routine testing for ASA in males is not always necessary, one should be aware that in some cases of failed IUI or IVF, ICSI is selected afterward because of the diagnosis of ASA.

Diagnosis and treatment of immunologically infertile women with sperm-immobilizing antibodies in their sera

Detection of sperm-immobilizing antibodies in women may have relevance for diagnosis of immunological infertility. Infertile women in whom sperm-immobilizing antibodies are detected can be refractory to conventional treatments such as timed intercourse or intrauterine insemination (IUI) because the antibodies secreted in the female reproductive tract might impair sperm passage, inhibit fertilization, and prevent normal post-fertilization processes. Hence, manipulation of gametes and embryos from patients with sperm-immobilizing antibodies should be carried out with additional care to avoid fertilization failure resulting from the presence of antibodies during in vitro fertilization (IVF). Moreover, the reasons for the why majority of women do not develop sperm-immobilizing antibodies on exposure to sperm is not clear. The production of sperm-immobilizing antibodies is likely to occur in women with particular HLA haplotypes after repeated exposure to sperm. Characterization of sperm-immobilizing antibodies may help in the identification and characterization of sperm specific antigens that can be used as candidate antigens for the development of sperm based contraceptive vaccines.

Incidence of antisperm antibodies in males with systemic autoimmune diseases.

Problem  To investigate if systemic autoimmune diseases could be one of the risk factors for developing antisperm antibodies (ASA) in males.

ORIGINAL ARTICLE: Incidence of Antisperm Antibodies in Males with Systemic Autoimmune Diseases

Problem  To investigate if systemic autoimmune diseases could be one of the risk factors for developing antisperm antibodies (ASA) in males.

Relationship Between Level of Serum Sperm Immobilizing Antibody and Its Inhibitory Effect on Sperm Migration through Cervical Mucus in Immunologically Infertile Women

Sperm immobilizing antibodies often interfere with the penetration of sperm through the cervical mucus. However, the relationship between sperm immobilizing antibody titer and the result of the post‐coital test (PCT) has not yet been clarified. The aim of this study was to investigate whether the 50% sperm immobilization unit (SI50) titer, a quantitative measure of sperm immobilizing antibody, in patients’ sera was correlated with the result of PCT.

Effects ofin vivo exposure to eggs with sperm-immobilizing antibodies in follicular fluid on subsequent fertilization and embryo developmentin vitro

AimsIt has been shown that supplementation of patients’ sera that contains sperm-immobilizing antibodies results in failure of fertilization and embryo developmentin vitro. The present study was carried out to investigate if exposing retrieved eggs to a high number of sperm-immobilizing antibodies in the follicular fluid (FF)in vivo affected subsequent fertilization and embryo developmentin vitro, even if they were washed with an antibody-free culture medium.MethodsPatients’ sera and their FF were collected in 15in vitro fertilization-embryo transfer (IVF-ET) or intracytoplasmic sperm injection-embryo transfer (ICSI-ET) treatment cycles from 11 infertile women with sperm-immobilizing antibodies in their sera. Quantitative sperm-immobilizing antibody titers (SI50 titers) in the sera and FF were evaluated. The fertilization rate, good-quality embryo rate and implantation rate by IVF-ET were compared between infertile patients having higher (10≤) SI50 titers and lower (< 10) SI50 titers in their FF.ResultsThere was a significant correlation in the SI50 titers between the patients’ sera and their FF (P < 0.0001). After thoroughly washing the collected eggs in culture medium without the patient’s serum before IVF, there was no difference in the fertilization rate in the patients with high (10≤) and low (< 10) SI50 titers in their FF (P = 0.62). However, the good-quality embryo rate in the patients with a high SI50 titer was significantly lower than patients with a low antibody titer (P < 0.05). There was no significant difference in the implantation rate between the two groups (P = 0.33).ConclusionsSimilar amounts of sperm-immobilizing antibodies existed in the patients’ FF and in their sera. ICSI did not seem to be necessary in patients having the antibodies if their sera were not supplemented in the culture media. Even with careful manipulation of eggs, it might be suggested that the harmful effects of sperm-immobilizing antibodies on embryo development cannot be completely avoided, especially in patients with high SI50 titers in the FF.

Infertile women without sensitization to an appropriate amount of sperm do not produce sperm-immobilizing antibodies in their sera

Background and AimThe factors that affect sperm immobilizing antibody production in some women are not fully understood. This study was performed to investigate if production of sperm immobilizing antibodies in women is associated with their husbands’ sperm count.MethodsThe sperm immobilization test (SIT) was performed on 221 infertile women whose husbands had normal semen characteristics according to the criteria by WHO; 160 patients were treated by intracytoplasmic sperm injection (ICSI) because of poor semen characteristics, and 1013 virgin female children acted as the controls.ResultsA significant difference of the incidence in SIT was observed between the virgin female children and the women whose husbands had a normal sperm count (P < 0.0001). There was also a significant difference of the incidence in SIT between the women treated by intracytoplasmic sperm injection (ICSI) because of a severe male factor and those whose husbands had a normal sperm count (P < 0.05).ConclusionsThese results indicate that production of sperm immobilizing antibodies in women begins after they have been exposed to a large enough amount of sperm. However, the precise amount of sperm required to produce the antibodies is not clarified by the present study.

ORIGINAL ARTICLE: Incidence of Antisperm Antibodies in Males with Systemic Autoimmune Diseases: ANTISPERM ANTIBODIES IN MEN

Problem  To investigate if systemic autoimmune diseases could be one of the risk factors for developing antisperm antibodies (ASA) in males.

Effects ofin vivoexposure to eggs with sperm-immobilizing antibodies in follicular fluid on subsequent fertilization and embryo developmentin vitro: Effect of ASA in follicle on IVF and embryo

Aims:  It has been shown that supplementation of patients’ sera that contains sperm‐immobilizing antibodies results in failure of fertilization and embryo development in vitro. The present study was carried out to investigate if exposing retrieved eggs to a high number of sperm‐immobilizing antibodies in the follicular fluid (FF) in vivo affected subsequent fertilization and embryo development in vitro, even if they were washed with an antibody‐free culture medium.