Antisperm antibodies in infertile men and their effect on semen parameters: A systematic review and meta-analysis
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
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2022, Fertility and SterilityCitation 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).
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2022, Seminars in Cell and Developmental BiologyCitation 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.