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Antisperm Antibodies: How Do They Affect Fertility and What Role Do They Play in IVF Outcome?

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The presence of sperm antibodies reduces male fertility significantly, but does not usually prevent conception altogether. Rather, the effects are graduated; i.e., the larger the immunologic response (concentration of antibodies), the less likely it is that a pregnancy will occur. When the blood level rises above 40%, natural conception is highly unlikely to occur.

Like any other kind of antibody manufactured by the body, sperm antibodies are formed in response to antigens. These antigens are proteins, which appear on the outer sperm membranes as the young sperm cells develop within the male testes. In the man’s own body, his sperm are regarded as foreign invading proteins and as such would normally be targeted for attack. However, under normal conditions, direct contact between the man’s blood and sperm is prevented by a cellular structure in the testes called the blood/testis barrier. This barrier is formed by so-called, Sertoli cells, which abut very closely against each other, forming tight junctions that separate the developing sperm cells from the blood and prevent immunologic stimulation. However, the blood/ testis barrier can be broken by physical or chemical injury or by infection. When this barrier is breached, sperm antigens escape from their immunologically protected environment and come in direct contact with blood elements that launch an immunologic attack.

Once sperm and blood come in contact, whether in the male or female, specific antibodies are produced against them by specialized blood cells call T- and B-lymphocytes. The three main types of sperm antibodies produced are Immunoglobulin G (IgG), Immunoglobulin A (IgA) and Immunoglobulin M (IgM). These antibodies bind to the proteins (antigens) on the sperm’s head, midpiece or tail. The antibodies formed may be of the circulatory type (in the blood serum) or secretory type (in the tissue). This is important because high levels of antibodies in the blood serum do not invariably mean that the antibodies will find their way to the semen where they can affect the sperm. For example, the concentration of IgG is much lower in secretions of the reproductive tract than it is in the blood. Conversely, the local level of IgA is higher in the reproductive secretions than in the blood. This is an important point, which we will return to later.

Once sperm antibodies have formed, they can affect sperm in several different ways. Some antibodies will cause sperm to stick together or agglutinate. Agglutinated sperm clump together in dense masses and thus are unable to migrate through the cervix into the uterus. Other antibodies mark the sperm for attack by Natural killer (NK) cells of the body’s immune system (ie; opsonizing antibodies).

Some antibodies cause reactions between the sperm membrane and the cervical mucus preventing the sperm from swimming through the cervix (i.e., immobilizing antibodies). Antibodies can also block the sperm’s ability to bind to the zona pellucida of the egg, a prerequisite for fertilization (i.e., blocking antibodies).

Finally, there is recent evidence that the fertilized egg shares some of the same antigens that are found on the sperm. It is possible that sperm antibodies present in the mother can react with the early embryo, resulting in its destruction by phagocytic cells (ie; phagocytic antibodies).

There are a number of diagnostic tests available to detect the presence of sperm antibodies. These are performed by flow cytometry and the ELISA (enzyme-linked immunoabsorbent assay), the Franklin-Dukes sperm agglutination assay or the Immunobead Binding Test (IBT), to name a few. At SIRM, the indirect Immunobead Binding Test (IBT) is used to detect antibodies present in the blood serum, in cervical mucus or on the sperm surface.

In the male, IgA and IgG are found in the semen although there is controversy as to whether they originate locally (secreted by testicular cells) or cross over from the circulation. Antibodies of the IgM class are not found in semen.

Like the source of some antibodies, the question of the critical levels of sperm antibodies is also hotly debated among clinicians. There seems to be general agreement that blood levels above 30% by the IBT are associated with significant fertility problems.

Studies have shown that pregnancy is highly unlikely following natural intercourse or intrauterine insemination when either the woman or the man harbors significant antisperm antibodies.

While there have been isolated reports that administration of corticosteroids (eg; prednisone) will temporarily suppress antibody production, pregnancy rates are poor. Besides, corticosteroid therapy carries with it the risk of significant side effects, some of which (although infrequent) can be serious. As an example, in the man, spontaneous fractures (especially of the neck of the femur) have been reported in 2% of cases. I do not recommend this treatment.

In Vitro Fertilization (IVF) with Intracytoplasmic Sperm Injection (ICSI) is the best option for conception in the presence of significant antisperm antibodies. Here, each egg is injected with a single sperm, so whether or not there are antibodies attached to the outer surface of the sperm becomes irrelevant.. In fact, pregnancy and birth rates are the same as in cases where IVF is performed for reasons other than male factor infertility. IVF/ICSI success rates are also unaffected by the concentration of antisperm antibodies.

*Intrauterine insemination (IUI – sometimes referred to as artificial insemination) of processed sperm is contraindicated in cases of moderate or severe male immunologic infertility because it does NOT improve pregnancy rates over NO TREATMENT AT ALL.

Tags: anti-sperm antibodies, Immunologic Infertility, In Vitro Fertilization (IVF), intracytoplasmic sperm injection, Intracytoplasmic Sperm Injection (ICSI), IVF Authority

23 Responses to “Antisperm Antibodies: How Do They Affect Fertility and What Role Do They Play in IVF Outcome?”

Carol says:

November 12, 2009 at 1:52 am

Interesting post. It is nice to have information that is relevant to the situation we are in i.e. antibodies from a vasectomy / reversal.

Carol
http://www.theivfclub.com

Reply
Geoffrey Sher, MD says:

November 12, 2009 at 11:37 am

Thank you!

Geof Sher

Reply
C. says:

November 19, 2009 at 11:43 am

I'm going in for egg collection tomorrow, I hope you can answer this question in time! This will be my second IVF. In the first round, antibodies were found in my husband's sperm. As I had a lot of eggs, we decided to split 15 for ICSI and 7 for regular IVF to test the sperm's viability. 4 of the 7 eggs fertilized with IVF, vs. 12 out of 15 for ICSI. Would this imply that in all future rounds of IVF we can avoid ICSI and just go for regular IVF (preferable due to natural selection of the "winning" sperm), as his sperm has been proven viable? Or are there other factors to consider?

Thank you!

Reply
Geoffrey Sher, MD says:

March 8, 2010 at 10:30 pm

ICSI is/was mandatory here in my opinion.

Geoff Sher

Reply
Mrs. H says:

September 20, 2011 at 1:09 pm

Thank you for your blog. My husband and I are just now beginning our research and journey into IF. All of our lab work and analysis led to a diagnosis of "unexplained' IF. However after reading this I wonder if antibodies may play a role since my husband's semen analysis came back with a score of 37% IgA Binding.

Reply
Geoffrey Sher, MD says:

September 20, 2011 at 2:43 pm

It absolutely could be the problem. Feel free to call 800-780-7437 if you wish to have a free telephone consultation with me to discuss!

Geoff Sher

Reply
Jen Parker says:

July 4, 2012 at 5:17 pm

Good Morning,

I was wondering if you or any one else had looked into the posibility of repairing the Sertoli Cells in the Blood Testis Barrier, as if this were possible, then natural conception would again be possible. It seems that all the medical research I read looks for a way around the problem rather than a solution to it. I would be very interested to hear your opinion on this or maybe a referral to someone who would be able to help my husband and I.

Thank you in advance for your help.
Jennifer Parker

Reply
Geetha says:

November 6, 2012 at 8:44 am

Hi sir,

I want to clarify my doubts about my problem. I am not that much fluency in English. Please manage it. Two years completed in my marriage life, 6 month before only we had to know about this problem. My husband’s sperm count is nil. So we tested sperm test 3 times and finally seem sperm count inside through biopsy but when it will come out all cells are killed(Antisperm- I dnt know exact name). Pls suggest me what I want to do get pregnancy

Reply
- Geoffrey Sher says:
  
  November 6, 2012 at 11:08 am
  
  Hi Geetha,
  
  I would need to know your husbands blood levels of FSH, LH, Testosterone and Prolactin before I could begin to comment.
  
  Can you get these and post them here.
  
  Alternatively, once you have these test results, call 800-780-7437 or 702-699-7437and set up a Skype or telephone consultation with me.
  
  Geoff Sher
  
  Reply
Mrs Hicks says:

November 9, 2012 at 4:01 pm

Hi,

My husband got his semen analysis back and the count is low overall in all areas but it also states he has 80% antisperm antibodies. Our Doctor doesn’t know what this means so he is avoiding questions about it and says we still have anywhere from a 25-50% chance of conceiving naturally. I think he is just telling us this as a guess. I’m not confident he knows what it means. Hes told us to come back in a year. My question is how much will these antibodies effect natural conception?

Many thanks.

Reply
- Geoffrey Sher says:
  
  November 9, 2012 at 5:56 pm
  
  Frankly, you need IVF with ICSI. Without this you are highly unlikely to conceive.
  
  Please go to http://www.IVFauthority.com and when you get to the home page find the “search bar” in the right hand column. Type in the following subjects into the bar and it will take you to all the relevant articles I posted there.
   “Male Infertility”
   “Antisperm Antibodies”
   “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted 3/21/2012)
   “A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
   “IVF success: Factors that influence outcome”
   “Intracytoplasmic sperm injection (ICSI)”
  
  Please call 800-780-7437 vand set up a telephone consultation with me so we can discuss!
  
  Geoff Sher
  
  Reply
Karen says:

February 27, 2013 at 12:51 pm

My husband has been found to have 95% antibodies on his semen; he had a vasectomy reversal in 2011. We have tried unsuccessfully to get pregnant naturally, and have now been recommended to have insemination, which we went for once unsuccessfully. I am 40 so I don’t want to waste anymore unnecessary time. Is insemination the course of action we should be following at the moment, or is IVF the only route we should be considering?

Reply
- Geoffrey Sher says:
  
  February 27, 2013 at 2:43 pm
  
  IUI will not work in the presence of sperm antibodies of this magnitude. IVF with ICSI is the only option.
  
  Please go to http://www.IVFauthority.com . When you get to home page, look for a “search bar” in the upper right hand corner. Type the following subjects into the bar, click on it and it will take you to all the relevant articles posted there.
  
  1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
  
  2. “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
  
  3. “Agonist/Antagonist Conversion Protocol”
  
  4. “Intrauterine Insemination”
  
  5. “Antisperm Antibodies and IVF”
  
  6. “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
  
  7.“A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
  
  8. “ICSI”
  
  Consider calling 800-780-7437 or 702-699-7437 to arrange a telephone or Skype consultation (free of charge to those who reside in the United States or Canada) with me so we can discuss your case in detail.. While an audiovisual (Skype) interaction is much more personable and preferable than a discussion by telephone, either will suffice.
  
  Geoff Sher
  
  Reply
Jennifer says:

March 23, 2013 at 1:47 am

Just received husband’s SA. Background – He had an unsuccessful surgery in childhood to correct an undescended testicle.

Sperm concentration was 69 million with 69% motility. However, 30% antisperm antibody affecting the head of the sperm. Doctor recommended IVF/ICSI. She said it is possible for us to conceive naturally, but couldn’t really tell us just HOW possible.

We are older 37 & 38 and have been actively trying for 10 cycles. My tests are normal for my age, but I’m waiting for a lap to check for endo or tube issues to rule them out. My question is – just how much does my husband’s antibody numbers change our chances of natural conception? Can the antibody % fluctuate on a day-to-day basis?

Reply
- Geoffrey Sher says:
  
  March 24, 2013 at 12:54 pm
  
  I would respectfully disagree. The chance of a naturally conceived pregnancy is very small. You need ICSI. However, there is also the issue of the endometriosis. Frankly, unless you have signs and symptoms from the condition that need surgical treatment and given that you need ICSI anyway, a laparoscopy won’t help at all in my opinion (see below). Finally since 30% of women who have endometriosis also have an immunologic implantation dysfunction (IID) that would prevent normal implantation, this should in my opinion, be thoroughly investigated prior to ICSI.
  
  Please go to the home page of this blog, (www.IVFauthority.com). When you get there look for a “search bar” in the upper right hand column. Then type in the following subjects into the bar, click and this will take you to all the relevant articles I posted there.
  
  1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
  
  2. “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
  
  3. “Agonist/Antagonist Conversion Protocol”
  
  4. “Immunologic Implantation Dysfunction” (posted on May, 10th and on May 16th respectively.
  
  5. “Embryo Implantation………” (Part-1 and Part- 2—-Posted August 2012)
  
  6. “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
  
  7.“A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
  
  8. “Endometriosis”
  
  Feel free to call 800-780-7437 or 702-699-7437 to arrange a Skype consultation (free of charge to those who reside in the United States or Canada) with me so we can discuss your case in detail.
  
  Geoff Sher
  
  Reply
Luke says:

April 8, 2013 at 9:29 pm

I am 22 years old and previously “apparently” got two Seperated girls pregnant wen i was a teenager one twice and one a miscarriage.currently I am trying to have have a baby with my partner
After having difficulties we went to a fertility doctor who told us my partner doesn’t ovulate and I have 100% sperm anti bodies..medication has since helped her ovulate so is there any chance of me being able to naturally have a baby with her or if not is it even possible for ivf with the anti bodies my sperm count was high so there’s no trouble there..any insight would be much appreciated

Reply
- Geoffrey Sher says:
  
  April 9, 2013 at 11:21 am
  
  Unfortunately, with 100% sperm antibodies the chance of a natural pregnancy is close to zero percent. The only way you are likely to achieve a baby is through ICSI.
  
  Go to the home page of this blog , http://www.IVFauthority.com and then to the search bar in the upper right hand corner of that page. Then type in “Male sperm antibodies” and read thart article.
  
  Geoff Sher
  
  Reply
Teresa says:

April 30, 2013 at 1:24 pm

Hi
These results are 5 post vasectomy reversal.
Volume -3.5
Viscosity – normal
Ph- 7.9
Who score 1%,36
Who score 2% 23
Progressive motility 59
Who score 3% 12
Who score 4% 29
Motile sperm conc(who 1+2)m/ml27.3
Sperm concentration m/ml 46.2
Total sperm no per ejaculate 161.17

Are these results bad? The doctor said he has100% antibodies .where does it this on these results please.

Thanks for your help in advance

Reply
- Geoffrey Sher says:
  
  April 30, 2013 at 3:04 pm
  
  The 100% antisperm antibodies virtually totally negates achieving a pregnancy by any other means than through IVF with intracytoplasmic sperm injection (ICSI).
  
  Please go to the home page of this blog, http://www.IVFauthority.com . When you get there, look for a “search bar” in the upper right hand corner. Type the following subjects into the bar, click on it and it will take you to all the relevant articles posted there.
  
  1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
  
  2. “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
  
  3.“A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
  
  4. “Male Factor Infertility”
  
  5. ” Male sperm Antibodies”
  
  6. “Intracytoplasmic Sperm injection (ICSI)”
  
  Consider calling 800-780-7437 or 702-699-7437 to arrange a Skype consultation (free of charge to those who reside in the United States or Canada) with me so we can discuss your case in detail
  
  Geoff Sher
  
  Reply
Teresa says:

May 1, 2013 at 4:13 am

Thanks. Just wondered if it was just because he was only 5 months post vasectomy reversal .
Will they disappear ?

Reply
- Geoffrey Sher says:
  
  May 1, 2013 at 6:44 am
  
  Unfortunately the antibodies are permanent.
  
  Geoff Sher
  
  Reply
David says:

June 11, 2013 at 8:07 pm

There is hope. I had a vasectomy reversal and was told that I had significant sperm antibodies. Our specialist said IVF was the way to go. So we had 2 unsuccessful attempts with IVF with ISCI injections. However the amazing thing is my wife became pregnant the month after the treatments. the 1st unfortunately resulted in a miscarriage. The second resulted in a successful pregnancy. Now we have a son.

Reply
- Geoffrey Sher says:
  
  June 11, 2013 at 8:15 pm
  
  Goes to show……
  
  “MAN PROPOSES AND G-D DISPOSES”!
  
  Geoff Sher
  
  Reply

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This is the 13th in a series of answers to common questions about failed IVF. Virtually everyone recognizes that pregnancy with multiples (especially triplets or greater) is associated with a high incidence of premature delivery that has serious cons... more

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My IVF Cycle Failed – What Went Wrong? Question #12: Might the Timing of Embryo Transfer – Day 2-3 (Cleaved) vs. Day 5-6 (Blastocyst) Play a Role?

This is the 12th in a series of answers to common questions about failed IVF. (Note: I’ll be hosting a live video chat on Aug. 2 on the topic of Failed IVF where I’ll discuss the issues addressed in this series of posts and take your ques... more

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