Evaluation on Antisperm Antibody in Infertile Men with Oligoasthenoteratozoospermia

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1 Journal of Reproduction & Contraception doi: /j.issn Mar.; 25(1): Evaluation on Antisperm Antibody in Infertile Men with Oligoasthenoteratozoospermia Yi-chao XU 1, Jing LI 2, Wei-bao LIANG 1, Wei-jie ZHU 3 1. Department of Urology, the First Affiliated Hospital, Jinan University, Guangzhou , China 2. Department of Pathophysiology, Medical College, Jinan University, Guangzhou , China 3. Department of Developmental and Regenerative Biology, College of Life Science and Technology, Jinan University, Guangzhou , China Objective To evaluate the level of antisperm antibody (ASA) in infertile men with oligoasthenoteratozoospermia (OAT). Methods Forty-six infertile men with OAT were enrolled into this study. Sperm samples were screened by the direct immunobead test for ASA type IgG and IgA according to the WHO laboratory manual. Results Of the 46 patients with OAT assessed for ASA-IgG, 2 had immunobead binding which were 22% and 27%, respectively, and the sub-positive rate was 4.3%. No case had the clinical positive level according to the WHO criteria ( 50% of the motile sperm with immunobead binding). ASA-IgA was not detected in all cases. Conclusion A significant incidence or high level of ASA could not be found in infertile men with OAT, which suggests that ASA is not associated with the pathogenesis of infertile men with OAT. Key words: antisperm antibody (ASA); sperm; oligoasthenoteratozoospermia (OAT); infertility Infertility has become a public health problem since last decades in most countries, which affects approximately 10% to 15% of married couples. In particular, the male factor is reportedly up to 50% of infertile couples [1-3]. Male infertility may be caused by complex and multiple causes, which are associated with disturbance or defects of anatomy, physiology, endocrinology or genetics, etc. Oligoasthenoteratozoospermia (OAT) is common severe abnormalities of semen Corresponding author: Wei-jie ZHU; Tel: ; tzhuwj@jun.edu.cn Jing LI; Tel: ; tlijing62@126.com 49

2 quality [4]. For infertile men with OAT, sperm parameters show very low sperm number, poor motility, and high sperm abnormal morphology. These abnormal sperm parameters reflect aberrant alternations of functions in both testes and epididymides, which demonstrates that infertile men with OAT have complicated etiology [5-8]. Recently, Pelliccione et al. [9] reported that an activation of the immune system was associated with idiopathic OAT in infertile men. In addition, sperm from OAT-patients showed increased expression of secretory actin-binding protein [10]. However, sperm auto-immunity whether related to the etiology of OAT has not been fully understood. In the present study, the antisperm antibody (ASA) level in infertile men with OAT was determined by means of the immunobead test (IBT), aiming to elucidate the role of ASA in the pathogenesis of OAT. Materials & Methods Subjects and semen samples A total of 46 infertile men with OAT, aged years, who had applied for treatment of primary infertility at the First Affiliated Hospital of Jinan University were included in the study. OAT samples were selected according to the criteria described by the WHO manual (WHO, 2010) [11] : 1) total sperm number < per ejaculate; 2) progressive motility <32%; 3) ratio of sperm normal forms <4%. Semen samples were produced by mastrubation after 3-7 d of sexual abstinence. Semen examination was performed according to the WHO manual. Sperm morphology was assessed after slide staining with the Papanicolaou-staining method. ASA assay The direct immunobead test was used to determine the ASA level of sperm samples according to the WHO manual and as previously described [11-14]. In brief, a volume of 5 µl washed sperm suspension was mixed thoroughly with 5 µl drops of each type of immunobead (IgG and IgA; Irvine Scientific, Calif., USA) on a glass microscope slide and was examined with a phase-contrast microscope. Motile sperm which had one or more adherent immunobeads were scored wherever the beads were binding. Sperm samples from males predetected to be ASA-positive and ASA-negative were set as positive controls and negative controls, respectively. A threshold value of 50% was adopted to indicate a significant ASA positivity according to the WHO criteria, 20%-50% motile sperm that had adherent particles were deemed to be sub-positive. Results 50 Of the 46 patients with OAT assessed for ASA-IgG, 2 patients had immunobead

3 binding which were 22% and 28%, respectively, and the sub-positive rate was 4.3%(2/ 46). No case had the clinical positive level according to the WHO criteria (50% or more of the motile sperm with immunobead binding). ASA-IgA was not detected in all cases. Discussion OAT is the most frequently seen phenotype in male infertility, and has a variety of etiologies, including age, non-inflammatory functional alterations in post-testicular organs, infective agents, alterations in gamete genome, mitochondrial alterations, environmental pollutants [4-8,15-18]. In addition, varicocele, oxidative stress, subtle hormonal alterations and nutritional factors could contribute to defective spermatogenesis and sperm maturation, which lead to poor quality of sperm and even OAT [19-23]. Male infertility and ASA are often related [24-26]. In certain pathological situations such as reproductive tract obstruction, infection, or trauma, testicular blood-testis barrier or/and epididymal blood-epididymis barrier could be damaged, which lead to disturbance of autoimmune system and production of ASA [27-30]. It is generally accepted that ASA may contribute to decrease male fertility [31-33]. However, the present study failed to demonstrate a significant incidence of ASA in the infertile men with OAT. Besides, those 2 cases with sub-positivity did not reach the clinical positive level according to the WHO criteria [11]. These data indicate that ASA is not associated with the pathogenesis of OTA-related infertility. Probably, disordered spermatogenesis and abnormal epididymal function result in poor sperm parameters, leading to OAT. On the other hand, 2 cases had ASA sub-positive levels in this study, which meaned that an immune response against sperm antigens could be still developed although OAT-patients had very low spermatogenesis. In conclusion, this study revealed that a high incidence or high levels of ASA could not be found in infertile men with OAT, which excluded the possibility that sperm auto-immunity was responsible for the OAT etiology. On the other hand, as a screening test for the etiology of male infertility, the detection of ASA should be still performed in OAT population even if the etiologic factor for OAT is not related to ASA. References 1. Fisch H, Goluboff ET. Geographic variation in sperm counts: a potential cause of bias in studies of semen quality. Fertil Steril, 1996, 65(5): Rowe PJ, Comhaire FH, Hargreave TB, et al. WHO manual for the standardized investigation, diagnosis and management of the infertile male. UK: Cambridge University Press, Baccetti B, Capitani S, Collodel G, et al. Recent advances in human sperm pathology. Contraception, 2002, 65(4):

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6 Conference Information 9th Gynaecological & Early Pregnancy Ultrasound Workshop & 10th ISUOG Outreach Pre-Conference Workshop May 3rd Singapore / Singapore Obstetrics/Gynecology, Radiology / Imaging Contact: Ms Jessica Leong, Postgraduate Medical Institute, Singapore General Hospital Phone: Fax: pgmi.courses@sgh.com.sg Website: 23rd European Congress of Obstetrics & Gynaecology May 7th to 10th United Kingdom / Glasgow Obstetrics / Gynecology Contact: Anna Botto or Stefano Ricco, Organizing Secretariat, M.A.F. Servizi SRL - Part of GL Events Group Phone: Fax: ebcog2014@mafservizi.it Website: MRCOG Final Preparation: Intensive OSCE May 8th to 9th United Kingdom / London Obstetrics / Gynecology Contact: Royal College of Obstetricians & Gynaecologists Phone: events@rcog.org.uk Website: 46th Annual Society for Obstetric Anesthesia & Perinatology (SOAP) Meeting May 14th to 18th Ontario / Toronto Anesthesiology, Obstetrics / Gynecology Contact: SOAP Phone: Fax: soap@soap.org Website: Clinical Directors Forum May 15th United Kingdom / London Obstetrics / Gynecology Contact: Kim Helm, Royal College of Obstetricians & Gynaecologists Phone: khelm@rcog.org.uk Website: 54