Immunological Infertility in Men

First stage in treatment of immunological infertility in men is elimination of all possible causative factors of autoimmune process development in reproductive system such as urogenital infections, varicocele, seminiferous path blocking, etc.

However, blood circulation normalization, absence of sexually transmitted diseases, repair of seminiferous paths (when is possible), elimination of production harms do not provide elimination of antisperm antibodies when they already started to reproduce themselves.

Therefore, second stage requires usage of one or complex of additional treatments:

• medication therapy (systemic enzyme therapy, hormonal therapy)
• special washings with further intrauterine or intratubal insertion of spermal cells
• extracorporal fertilization including fertilization with single spermal cell using method of microinjection in plasma

Remember that any stimulating therapy is contraindicated to patients with aspartate transaminase. When patient or/and his partner have antispermal antibodies and no other pathologies, then the diagnosis of isolated immune infertility is made.

In isolated immune infertility the nonsurgical empiric treatment is ineffective. The only real alternative here is assisted reproductive treatment.

Antisperm Antibody Testing

Investigation of immunological factor of infertility is based on making tests on presence of antisperm antibodies in semen and in blood plasma in patient and his partner. Standard tests are performed:

• MAR is standard test for detecting percentage of spermatozoids with antisperm antibodies (positive result is 50% of spermatozoids with antibodies);
• IFA (immunofluorescent assay) detects level of antisperm antibodies in blood plasma in patient and his sexual partner.

Positive results of test prove the immune factor of infertility. When another pathologies are not found, the diagnosis of isolated immune infertility, which is found in 10% of marriages, is made. At this stage may be diagnosed varicocele, obstructive azoospermia, and may be detected group of patients with reduced fertility without specification of ethiology at this stage or immunologic factor of infertility. Results obtained at this stage help to narrow diagnostic algorithm of second stage.

On second stage next tests are performed:

• identification of hormonal level is required in patients with azoospermia. It detects the rate of testosterone, follicle-stimulating hormones interstitial cell-stimulating hormone and also sex-hormone that binds globulin which shows not only the amount of testosterone but also its biological activity.
• ultrasound investigation of scrotum organs helps to find structural changes and pathologic growths in testes, adnexas, prostate gland. This test shows changes in seminal vesicles in case of seminiferous paths distal sections blocking or no changes in innate agnesia of spermoduct. Chromatic doppler investigation helps to detect venous hyperemia in the system of spermatic veins and also detects subclinical varicocele.
• identification of urogenital infections agents is made to see if infertility is caused by infection. Indications for this test are: undetermined character of fertility reduction, recurrent pregnancy loss, and also preparation for additional reproductive techniques. Diagnostics of sexually transmitted infections must be made using immunofluorescent assay together with PCR (polymerase chain reaction).
• genetic investigations are made in azoospermia. Karyotyping detects abnormalities in chromosome set. Today becomes popular test which investigates AZF-segment of Y-chromosome. Around 10% of non-obstructive azoospermia cases are connected with dropping of one or several locuses in Y-chromosome on AZT-segment. Genetic investigations provide not only data about genes, but also about the chances that the disease may be transmitted to masculine descents.
• investigations of centrifuged semen and post-orgasmic urine helps to define causes of azoospermia. Investigation of post-orgasmic urine is made in case of retrograde ejaculation.
• seeding of semen is made in pyospermia, and also in case of bad results of spermogram.

Types of Male Infertility

Male infertility is male inability to conceive a child during 12 months of regular tries without using contraception. Contrary to common belief, male infertility occurs as frequently as female infertility and is 35% of total number of infertility cases.

Types of male infertility
1) Obstruction
In this form the normal maturation of spermatozoids in testicles is not broken but there is a barrier on the way of spermatozoids movement from testicles in urethra. This may be caused by inherent absence or narrowing of a portion of seminiferous tubules, commissures left after inflammation, scar left after surgery, cyst, growth in genitalia or in near-by organs. Anatomical defects of penis (phimosis, penile curvature) may also cause obstructive infertility in males.

2) Secretory problem
In this form of infertility testicles cannot produce healthy spermatozoids in counts enough to fertilize ovule. Causes of this problem:

• genetic factors
• hormonal dysregulations
• severe chronic diseases (diabetes)
• past inflammatory diseases of genitalia (orchitis, parotitis, etc) including sexually transmitted diseases

Factors provoking disease:

• protein deprivation
• avitaminosis
• testicles trauma
• occupational hazards (ionizing radiation, high temperatures, contact with various toxins, etc)

3) Immunological problem
This form of infertility develops after testicles trauma. Normally, testicles tissues are separated from blood stream with a special barrier. When testicles traumas occur, this barrier may get damaged which may put into contact testicles tissues with blood immune cells. Body starts to accept testicles as foreign formation and as a result develops immune reaction with formation of antibodies against testicles tissues. Antibodies may be developed also against apermatozoids. Antisperm antibodies may block spermatogenesis, break sperm motility, prevent spermatozoids from entering cervical canal of uterus, aggravate fertilization, interrupt fission and even contribute to termination of early pregnancy.

Diagnosis
First stage of examination includes accurate history taking (past fertilizations and urological diseases). Must be performed spermogram analysis, detection of immunologic infertility factor.