Antisperm Immunity and Infertility

Jin-Chun Lu; Yu-Feng Huang; Nian-Qing Lu

Disclosures

Expert Rev Clin Immunol. 2008;4(1):113-126. 

In This Article

Expert Commentary & Five-year View

It is difficult to delineate the appropriate fertility-related antigens. Although ASAs were found in the sera of infertile couples, and reportedly have correlation with poor fertility rates, ASAs may also occur in men proven fertile. Further exploration on screening of appropriate fertility-related antigens is necessary in the future. The identification of specific sperm-antigen epitopes and recombinant proteins should be the main direction in the field.

There is wide variability among individuals. This may be the reason why the detection of ASAs has low predictive value and its clinical significance in infertility is uncertain,[92] and does not influence the fertility prognosis. Moreover, ASAs have been shown to be directed against several different antigens, and each have different effects on sperm function, with some even having no effect on sperm function. Are there some common fertility-related antigens among individuals? Their identification may be very important for the diagnosis of immunoinfertility.

The mechanism by which infertility is generated was unclear. Although various factors influenced fertility and possible mechanisms of action have been reported, it is difficult to explain why some antigens could block in vitro fertilization but not fertility in vivo. Every mechanism may play a small role in infertility, or one mechanism may operate in a small proportion of infertile couples. Therefore, the exact mechanism causing infertility remains unknown. The characterization of sperm antigens relevant to fertility will help to clarify the mechanism of ASA-induced infertility.

There is no standardized ASA assay. Although the WHO recommended IBT and MAR as the standard methods for ASA assay, these two methods are actually rarely used in clinical andrology laboratories, and were challenged by many other methods. Moreover, there were widely variable results among different methods. Recently, specific sperm epitopes have been identified with a phage display technique. Mixed epitopes as specific antigens used for ASA assay may be a choice for establishing a standard method for ASA assays, since the antigens are not altered during analysis.

The availability of effective treatment means depends on the extent of our understanding of ASA-associated infertility. Thus, in the study of immunoinfertility, the most important field may be its treatment of immunoinfertility. This should be the focus of research in the future.

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