Elsevier

Clinica Chimica Acta

Volume 444, 15 April 2015, Pages 29-36
Clinica Chimica Acta

Antisperm antibodies in infertile men and their effect on semen parameters: A systematic review and meta-analysis

https://doi.org/10.1016/j.cca.2015.01.033Get rights and content

Highlights

  • The literature searches of our article were including five databases. Literature retrieval was comprehensive.

  • The inclusion criteria and exclusion criteria we formulate was strict.

  • Our study illustrates that ASA have a negative effect on semen parameters. The result is different from present studies.

  • Our studies suggests that ASA may not the main factor of male unexplained infertility

Abstract

Background

Antisperm antibodies (ASA) in males cause the autoimmune disease ‘immune infertility’. The mechanism of ASA cause male infertility is not clear. Present studies have investigated the effect of ASA and their incidence in men with unexplained infertility, as well as to evaluate the correlation between the ASA and semen parameter alterations but have shown inconsistent results. We performed a systematic literature review and meta-analysis to assess the association between ASA and basic semen parameters in infertility men.

Methods

Systematic literature searches were conducted with PubMed, EMBASE, Science Direct/Elsevier, CNKI and the Cochrane Library up to October 2014 for case–control studies that involved the impact of ASA on semen parameters. Meta-analysis was performed with Review Manager. Standard mean differences (SMD) of semen parameters were identified with 95% CI in a random or fixed effects model.

Results

Eight studies were identified, including 238 cases of ASA positive infertility male and 929 ASA negative controls. Our results illustrated that the sperm concentration and sperm motility (a+b) from ASA positive patients were significantly lower than ASA negative controls (SMD (95% CI) − 23.64 [− 43.47, − 3.81], − 16.40 [− 27.92, − 4.88], respectively). However, semen liquefaction time in the ASA positive group was significantly longer than the control group (SMD (95% CI) 4.19 [1.72, 6.66]). There was no significant effect of ASA on the sperm volume, sperm viability, sperm progressive motility, sperm normal morphology and sperm abnormal morphology.

Conclusions

The present study illustrates that there was a significant negative effect of ASA on sperm concentration, sperm motility (a+b) and sperm liquefaction.

Introduction

The presence of antisperm antibody in infertile male was first reported by Rumke [1] and Wilson [2] in 1954. Since then, antisperm antibodies (ASA) have been considered by several authors as a possible causative factor in infertility, with significant levels of ASA detected in the semen of 5–15% [3] of infertile men but in only 1–2% [4], [5] of fertile men. In male, ASA have been found in serum, seminal plasma, bind to sperm [6], [7]. High levels of ASA are present in patients with a clinical history of testicular torsion, testicular carcinoma, epididymis orchitis, bilateral orchitis with extensive destruction of seminiferous tubules, seminal infections, varicocele and inflammation induced by genital infection and vasectomy [8], [9], [10], [11], [12], [13], [14].

Sperm ASA are believed to have an adverse impact on male fertility by influencing the quality of sperm. Several studies have evaluated the effect of ASA on sperm parameters, but the subject has not been evaluated in a systematic fashion. Studies of ASA on sperm parameters have reported contradictory results, with some studies showing statistically significant alterations of basic semen parameters due to ASA, but not others [15], [16], [17], [18], [19], [20], [21], [22].

Section snippets

Literature search

This meta-analysis was restricted to published studies that investigated the effect of ASA on semen parameters. Two independent reviewers (HQW and SYG) searched PubMed, Embase, Science Direct/Elsevier, CNKI and the Cochrane Library from inception to October 2014, without restrictions on language or study type. The search terms combined text words and MeSH terms. For example, the search terms for ASA were: antisperm antibodies, sperm antibodies, antibodies, ASA and semen antibodies. While those

Inclusion criteria

All patients presenting for infertility evaluation had a minimum of one year of unprotected intercourse, and the patient exclusion of other disorders of the urogenital system. The female partners of selected did not present hormonal dysfunctions, tuba obstruction and reproductive system infection. ASA is detected in semen, by using sperm antisperm antibody test [mixed agglutination reaction (MAR), immunobead test (IBT), or ELISA]. Experiment case is ASA positive patients. Control case is ASA

Study selection and validity assessment

Two independent reviewers (HQW and SYG) screened titles and abstracts of all citations from the literature search. All relevant studies that appeared to meet the eligibility criteria were retrieved. Full texts were needed to analyze if an ambiguous decision was made based on the title and abstract. The final decision of eligible studies was made by reviewing articles. Disagreements were resolved by consensus or a third reviewer (LCC). Two reviewers (LCC and XLB) completed the quality assessment

Data extraction and statistical analysis

Data, including demographic data (authors, year of publication, country, number and mean age of participants, abstinence time, assay method) and outcome data of semen parameters (semen volume, sperm liquefaction, sperm concentration, sperm progressive motility, sperm total motility, sperm viability, sperm normal morphology and sperm abnormal percent), were extracted from the studies by 3 reviewers (TX, SYG and LCC). Disagreements were resolved by consensus. Quantitative meta-analysis was

Characteristics of the included studies

Fig. 1 shows a detailed review process. A total of 1053 nonduplicate studies were identified, 8 studies were ultimately selected according to eligibility criteria, after group discussion, all reviewers were in agreement to include all 8 papers.

Table 1 summarizes general data from the 8 studies. All retrieved studies involved 238 cases and 929 controls. The mean ages of patient and control groups were in the ranges of 29.3–33.9 years and 28.9–32.2 years, respectively. The mean ages of patient and

Meta-analysis

Data of sperm concentration, sperm motility (a+b), sperm progressive motility, sperm normal morphology, sperm abnormal morphology and sperm viability were respectively analyzed in a random-effects model to estimate the effect of ASA on each parameters. Data of sperm liquefaction and semen volume was respectively analyzed in a fixed-effects model. The results suggested that sperm concentration and sperm motility (a+b) from ASA positive patients were significantly lower than ASA negative controls

Discussion

In this study, 8 available published articles were reviewed and analyzed statistically to investigate the effect of ASA on 8 semen parameters. Our results suggest that the presence of ASA in semen significantly reduced the sperm concentration and sperm motility (a+b) of the ASA positive infertility male. While, the ASA can significantly increase the sperm liquefaction time. The effect of ASA on sperm normal morphology, sperm viability, semen volume, sperm progressive motility and sperm abnormal

References (62)

  • R.K. Naz et al.

    Antisperm antibodies: origin, regu-lation, and sperm reactivity in human infertility

    Fertil Steril

    (1994)
  • J. Dor et al.

    Antisperm antibodies: their effect on the process of fertilization studied in vitro

    Fertil Steril

    (1981)
  • F. Comhaire et al.

    Methodological aspects of sperm morphology evaluation: comparison between strict and liberal criteria

    Fertil Steril

    (1994)
  • D.A. Ohl et al.

    Infertility due to antisperm antibodies

    Urology

    (1995)
  • S. Harrison et al.

    Sperm acrosome status and sperm antibodies in infertility

    J Urol

    (1998)
  • P. Rumke

    The presence of sperm antibodies in the serum of two patients with oligospermia

    Vox Sang

    (1954)
  • L. Wilson

    Sperm agglutinins in human semen and blood

    Proc Soc Exp Biol Med

    (1954)
  • J.H. Adeghe

    Male subfertility due to sperm antibodies: a clinical overview

    Obstet Gynecol Surv

    (1993)
  • C.A. Bates

    Antisperm antibodies and male subfertility

    Br J Urol

    (1997)
  • R.K. Naz

    Antisperm contraceptive vaccines: where we are and where we are going

    Am J Reprod Immunol

    (2011)
  • S.Y. Oliveros et al.

    Anticuerpos antiespermatozoidesen pare-jascon infertilidad de causes no explicada

    Rev Cubana Endocrinol

    (2000)
  • A.M. Mahmound et al.

    Clinical and biological aspects of male immune infertility: a case-controlled study of 86 cases

    Andrology

    (1996)
  • J.G. Rivera et al.

    Fenomenos inmunológicos en la infer-tilidad

    Rev Clin Esp

    (1971)
  • Fenomenos inmunológicos en la infer-tilidad

    Rev Clin Esp

    (1971)
  • S.C. Esteves et al.

    Influence of antisperm antibodies in the semen on intracyto-plasmic sperm injection outcome

    Int Braz J Urol

    (2007)
  • I.S. Henao et al.

    Autoanticuerpos antiespermatozoides e infertilidad

    Iatreia

    (1997)
  • A. Zini et al.

    Antisperm antibodies are not associated with pregnancy rates after IVF and ICSI: systematic review and meta-analysis

    Hum Reprod

    (2011)
  • Yafeng Liu et al.

    The effect of seminal plasma antisperm on infertility male, and their semen parameters analysis

    J China Healthy Birth Genet

    (2005)
  • Chao Deng

    Discuss the seminal plasma antisperm antibody, and the association between semen parameters and sperm morphology

    Asia Pac Tradit Med

    (NOV.2011)
  • Yaling Chu et al.

    Antisperm antibody in sperm surface, and clinical analysis of semen parameters in infertility male

    J Fam Plann

    (2004)
  • Patricia C. Garcia et al.

    Antisperm antibodies in infertile men and their correlation with seminal parameters

    Reprod Med Biol

    (2007)
  • Cited by (77)

    • Immune infertility in men

      2022, Fertility and Sterility
      Citation Excerpt :

      Recent studies using the MAR test with the previously WHO-recommended threshold of 50% report a prevalence of 2.6%–6.6% in infertile men and 0.9% in fertile men. Meta-analyses including older studies with lower thresholds have reported rates of 5%–16% in infertile men and 1%–2% in fertile men (28, 29). Detected prevalence is generally higher with the use of microarray chips or enzyme-linked immunoassays; however, the clinical implications of these remain understudied (26, 30).

    • Intracytoplasmic sperm injection

      2022, Management of Infertility: A Practical Approach
    • Toxicology of reproduction process and problems of male infertility

      2022, Reproductive and Developmental Toxicology
    • Effect of varicoceles on spermatogenesis

      2022, Seminars in Cell and Developmental Biology
      Citation Excerpt :

      Breakdown of the BTB may allow for the production of ASA, and there is evidence that infertile men have a higher incidence of ASA than fertile men [78,81]. Although the link between ASA and male infertility is controversial, the WHO recommends testing for ASA in the presence of sperm agglutination, and there is some evidence that the presence of ASA may result in negative effects on semen parameters [31,82]. More research is needed to determine whether decreased BTB integrity results in decreased spermatogenesis.

    View all citing articles on Scopus
    View full text