What do antibodies in a spermogram mean? Antisperm antibodies (ASAT)

In the vast majority of cases, it has a serious basis. Anatomical defects of the genital organs, previous or existing diseases genitourinary system, failure of the hormonal system with suppression of the function of producing male germ cells - all this can cause infertility. But in a fairly small percentage of cases, there are no obvious obstacles to a man’s inability to conceive a child... Except for his own body and its immune system, which produces antisperm antibodies - proteins against sperm.

Attack of foreign cells

Proteins produced by the body's immune system whose purpose is to reduce the fertilizing ability of sperm are called antisperm antibodies.

These proteins are produced in the bodies of both men and women, and if female antibodies do not allow male reproductive cells to fertilize the egg they protect, then male proteins behave aggressively towards their own sperm. Presence of antisperm antibodies (ACAT) male infertility provided in modern world more and more often.

Why does everything happen this way? The germ cells that the male body begins to produce during puberty are foreign objects to the immune system. Any other cell of the body has been familiar to the immune system since the period of formation of the germinal layers and the laying of organs, while sperm, when manifested, provoke it to aggression. In total, three types of ACAT are produced in the male body:

• antisperm antibodies of the IgA class;
• IgG class proteins;
• ACAT class IgM.

The IgG variety manifests itself as an increase in the volume of leukocytes in the seminal fluid, as well as an effect on reducing acidity and diluting sperm. IgA proteins are the main sign of disruption of the blood-testis barrier, which leads to damage to sperm morphology. Antibodies of the IgM variety affect germ cells, significantly reducing their motility and at the same time increasing the ability to stick together (agglutination), resulting in asthenozoospermia (that is, an abnormal decrease in the number of motile sperm). IgA antibodies in the male body are always produced more than IgG and IgM, since they are not captured during phagocytosis.

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In total, three types of ACAT are produced in the male body

In a healthy state, the reproductive system of a representative of the stronger sex is able to resist the activity of ACAT, for which they are used natural remedies protection, in particular:

• hematotesticular layer of Sertoli cells, acting as a barrier between the bloodstream and one of the membranes (spermatogenic epithelial tissue) of the testicles;
• biological substances that have a depressing effect on the immune system as a whole;
• a substance that binds immunoglobulin, contained in seminal fluid and also inhibits the immune attack on sperm;
• T-suppressor cells that act in the epididymis and suppress the immune system.

Main barrier function performs a blood-testis barrier, in which anti-sperm antibodies are practically not produced. If this cellular layer is in force various reasons is destroyed, the products of spermatogenesis (spermatocytes or already spermatozoa) enter the blood and activate the autoimmune reaction. With it, antibodies themselves appear, which bind to male germ cells and produce a number of destructive effects, including a change in their morphology, loss of the ability to penetrate the egg.

The listed protective barriers of the body are quite strong, however, they can be destroyed due to various pathological processes, which leads to the so-called autoimmune process - the production of antibodies by the immune system against its own germ cells.

Antisperm antibodies in men can begin to be produced against the background of certain diseases and lesions:

Antisperm antibodies in men can begin to be produced due to testicular injury

• with testicular trauma (and also after surgical interventions on the gonads);
• with varicocele (varicose veins of the testicles);
• in infectious processes spreading to the testicles, their appendages, seminal vesicles and prostate gland(vesiculitis, prostatitis, orchitis or epididymitis);
• with cryptorchidism (undescended testicle into the scrotum);
• obstruction (blockage or congenital obstruction) of the vas deferens.

Any of these conditions can lead to the activation of an autoimmune process, the course of which causes male infertility.

Increased production of antisperm antibodies leads to the following negative consequences:

• decreased activity and mobility of male germ cells;
• a decrease in the level of sperm viability;
• difficulty in the process of sperm passing through the cervical mucus on the way to the uterus;
• failure of the fertilization process of the egg.

Women have the same protective barriers as men, and they can also be broken due to a combination of certain circumstances. Additionally, in women, even if fertilization has taken place, sperm damaged by an attack of the immune system may carry non-viable genetic material, due to which there is a high probability of disruption of the implantation process of the fertilized egg. Also, with this problem, the vital processes of growth and development of the embryo are often suppressed.

Detecting and treating elevated ACAT counts

The detection of antisperm antibodies occurs mainly through a spermogram - this analysis of seminal fluid is prescribed by andrologist specialists to assess the basic parameters of sperm, the quantity and quality of sperm, as well as their ability and inability to carry out their fertilizing function. Additional research tools that detect the presence of ACAT include:

Among the additional research tools that detect the presence of ACAT is the MAR test of ejaculate

• MAR test (detection of antibodies on the surface of sperm);
• postcoital test (counting the number and determining the motility of sperm remaining in a woman’s cervical mucus a certain time after intercourse);
• immunobead test (analysis similar to the MAR test, differing in the spectra of the direction of antibody detection);
• enzyme immunoassay method, in which the result is obtained through the use of a specific antigen-antibody reaction.

Indications for procedures that detect the presence of antisperm antibodies in a man are:

• negative spermogram indicators;
• poor results in the postcoital test;
• preparation for IVF or unsuccessful attempts at artificial insemination;
• infertility diagnosed in a couple with normal results of a standard examination.

The body's immune reaction to its own sperm, if detected in time, can be defeated by the main measure: combating those factors that initially led to the need for excess antisperm antibodies treatment. If complex treatment of a married couple is carried out, then the following is additionally prescribed:

• six-month barrier contraception;
• completing a course of exposure to agents to reduce the viscosity of cervical fluid (in women);
• therapeutic treatment with immunosuppressive glucocorticoids (in women and men).

Men of reproductive age who have been diagnosed with immunological infertility must undergo a course of complex treatment, the ultimate goal of which is to eliminate all potential and existing factors that contribute to provoking an immune reaction. During the therapy, an impact is made on infections of the male genitourinary system, removal of problems with varicocele, and correction of obstruction of the vas deferens. Only after this can the attending physician prescribe a course of drugs to reduce the body’s production of antisperm proteins and remove proteins that have already combined with the germ cells.

If, even after taking these measures, the tests show unsatisfactory results in immunological tests, experts will most likely recommend that the couple resort to assisted reproductive technologies - artificial insemination, IVF or ICSI.

Important: certain diseases and conditions without appropriate timely treatment can cause the development of constant irritation of the immune system with a persistent antigenic reaction. For example, without receiving adequate medical care infectious prostatitis becomes a source of spread of pathogenic microflora, which irritates the immune system. During such inflammatory process a permanent autoimmune response occurs to the “host’s” own sperm. It is obvious that the prevention of various lesions of the genitourinary system is at the same time the prevention of immunological infertility.

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Blood test for antisperm antibodies (ASAT)– a laboratory test aimed at determining the level of specific immunoglobulins to sperm antigens. These antibodies reduce the likelihood of fertilization and can be considered an immunological cause of infertility. The analysis is an additional diagnostic method for infertility; it is prescribed in combination with a spermogram, with tests for antisperm antibodies in semen and antibodies to ovarian antigens. Indicated to determine the causes of infertility. The research finds application in gynecology, urology, and reproductive medicine. Blood for analysis is taken from a vein, and the determination of antisperm antibodies in it is performed using the enzyme immunoassay method. Normal values ​​range from 0 to 54.99 IU/ml. Results are prepared within 5 working days.

Antisperm antibodies are a group of specific immunoglobulins that interact with sperm antigens, preventing the onset of fertilization. They are produced by the immune system after contact with sperm. In healthy men and women, antibodies to sperm antigens are not detected either in the blood or in the semen. Their production is prevented by a number of protective mechanisms. In the male body, the effect of the immune system on sperm is limited by the blood-testis barrier - a physical barrier between blood vessels and seminiferous tubules of the testicles. When it is disrupted, the immune system triggers the production of antibodies to sperm. The cause may be testicular trauma, bacterial or viral infections, testicular cancer, surgery. After antisperm antibodies bind to sperm, the latter’s motility decreases and the ability to penetrate the cervical mucus decreases.

In the female body, the production of antisperm antibodies can be triggered by infections and inflammations in the genitourinary system, and autoimmune diseases. When sperm approach the site of inflammation, they are perceived by the cells of the immune system as foreign and are destroyed. The macrophages that phagocytize them retain protein fragments of sperm - antigens - on their surface. Circulating in the blood, these cells provoke the production of ASAT in the female body. During and after sexual intercourse, antibodies interfere with the advancement of sperm; during pregnancy, they disrupt the synthesis of cytokines that promote implantation ovum, formation of trophoblast and placenta. This leads to miscarriage, gestosis, and intrauterine growth retardation.

The severity of the pathological effect of antisperm antibodies depends on the titer and activity against sperm antigens. Their presence in the blood does not always lead to infertility, but the likelihood of pregnancy is reduced by 40%. Typically, antisperm antibodies are considered a cause of infertility if other disorders are excluded. To conduct the study, blood is taken from a vein. The most informative method for recognizing antibodies is enzyme immunoassay. The main areas of application of the research are reproductive medicine, gynecology and urology.

Indications

A blood test for antisperm antibodies is prescribed for a comprehensive study of the causes of infertility, in particular if a violation of immunological tolerance is suspected. The test is an addition to sperm testing. It is indicated in cases where the results of a spermogram indicate a decrease in motility, increased aggregation and agglutination of sperm, as well as when deviations in the results of a postcoital test, a mixed antiglobulin test or a latex agglutination test in women are detected.

When screening men, more accurate results from the antisperm antibody test can be obtained through semen analysis. A blood test is prescribed as an additional test in cases of absence or deficiency of sperm in the ejaculate. Limitations of the blood test for ASAT include distortion of results in poly- and monoclonal gammopathies, autoimmune diseases, changes in immune status, for example, against the background of long-term infections.

Preparation for analysis and collection of material

When performing an analysis for antisperm antibodies in the blood, biomaterial is taken from a vein. The use of the enzyme immunoassay method requires compliance with some recommendations for preparing for blood donation. Firstly, the day before the analysis it is necessary to exclude physical and psycho-emotional stress. Secondly, it is forbidden to drink alcohol the day before, it is advisable to avoid fatty foods. Blood is taken on an empty stomach - in the morning on an empty stomach or 4 hours after eating. 30 minutes before the procedure you need to stop smoking and spend this time in a calm environment. For patients taking medicines, it is worth discussing their impact on the test result with your doctor. The blood sampling procedure is performed using the puncture method. The biomaterial is placed in a sealed tube and delivered to the laboratory.

The level of antisperm antibodies is determined in the blood serum. Therefore, before the study, the test tube is placed in a centrifuge, and coagulation factors, in particular fibrinogen, are removed from the resulting plasma. The serum is subjected to enzyme immunoassay. In general terms, it can be thought of as a two-step procedure. At the first stage, antigens are introduced into the sample, which form complexes with ACAT. An enzyme is then added to color these complexes. Optical density is measured using a photometer, and the concentration of antibodies in the blood is calculated from the obtained indicators. Preparation of results takes up to 5 working days.

Normal values

The absolute norm is the absence of antisperm antibodies in the blood. Reference values ​​for the analysis are from 0 to 54.99 IU/ml. They are the same for men and women. When interpreting the results, it is taken into account that the presence of antisperm antibodies in the blood of spouses will not necessarily be accompanied by infertility, but the likelihood of conception is reduced. The opposite is also true - normal results of the ACAT test do not exclude infertility. This disease is multifactorial; diagnosis of the causes involves the use of a complex of laboratory and instrumental methods. According to statistics, only about 20% of unexplained infertility is caused by immunological reasons.

Level Up

Main reason higher level antisperm antibodies in the blood - autoimmune infertility in men and immunological incompatibility with a partner in women. The disease is provoked by damage or surgery to the testicles, testicular tumors, infections and inflammation in the organs of the reproductive system. If the test results are elevated, the patient may be prescribed additional testing for inflammatory diseases genitourinary system. If the diagnosis is confirmed, then two weeks after the end of the course of treatment, the ASAT test is repeated. The reason for the increase in the level of antisperm antibodies in the blood may be a distortion of the results due to an autoimmune disease, polyclonal or monoclonal gammopathy, or immunodeficiency. Therefore, before the analysis, a medical history is taken, and, if necessary, a study of the immune status is prescribed.

Level reduction

If there are no antisperm antibodies in the blood or their level is low, then the cause of infertility is not an immunological conflict. In such cases, the doctor decides on the need for further examination - diagnosis of chromosomal pathologies, incompatibility of blood systems, etc. In men, the reason for the decrease in the level of antisperm antibodies in the blood with initially elevated levels is the success of the therapy.

Treatment of abnormalities

A blood test for antisperm antibodies is used to diagnose immunological causes of infertility. It is prescribed as part of a comprehensive examination, including a spermogram, MAR test or test for antiovarian antibodies. With elevated levels in men, the diagnosis of autoimmune infertility is confirmed; in women, immunological incompatibility with a partner is determined. With the results of the analysis, you need to consult your doctor - a reproductive specialist, urologist, or gynecologist. The specialist will determine the need for further examination, select adequate therapy, and decide on the advisability of using assisted reproductive technologies.

Antisperm antibodies are antibodies to antigens found in the sperm membrane. Can be detected antisperm antibodies in cervical mucus, blood serum, on the surface of sperm and in seminal plasma.

Their presence is diagnosed in the body of infertile men or women in 10-35% of cases. They can also be observed in completely healthy people. The examination of a couple diagnosed with infertility must necessarily include an ACAT test. This study is especially important for men because antisperm antibodies in ejaculate- This is evidence of immune infertility.

Antisperm antibodies are proteins produced by the human body's immune system. It doesn’t matter whether they occur in a male or female body, their task is one – the destruction of sperm. The presence of antibodies to sperm in the male body causes autoimmune infertility, and in women in this case immunological incompatibility of partners is diagnosed. These diagnoses are identified by WHO as a separate disease.

Antisperm antibodies in women

Antibodies in human body are biologically active ingredients blood disorders that appear when foreign substances enter the bloodstream. Therefore, in cases where components of sperm that are foreign to the female body for some reason come into contact with the blood through the mucous membrane, antisperm antibodies begin to form. A forum on this topic can be found by entering a query in the search bar.

The formation of antibodies to sperm occurs under certain circumstances. Antisperm antibodies, the causes of which lie in inflammation of the female genitourinary system, have a rather complex mechanism. Spermatozoa, moving in the genital tract, encounter a focus of inflammation, where, with the help of immunocompetent cells, an active process of destruction of foreign infectious objects occurs. Thus, spermatozoa also come under attack from protective cells.

The components of destroyed sperm are absorbed by special macrophage cells, which then disassemble them into smaller elements. Separate parts of disassembled sperm will subsequently form antisperm antigens on the surface of macrophages. After the macrophage enters the bloodstream, and then into the lymph nodes, antisperm antibodies begin to form there, previously not characteristic of the body. They spread through the blood, penetrate the mucous membranes in search of enemy antigens - sperm, which are immediately attacked. It turns out that after antisperm antibodies appear in women, the mucous membrane of their genital organs, which should facilitate the movement of sperm to the egg, on the contrary, becomes a difficult barrier to their path.

If antisperm antibodies are elevated, but despite this, pregnancy occurs, there is a risk of their negative impact on the viability of the fetus.

A healthy mucous membrane will not allow sperm to come into contact with blood cells, thereby avoiding the described pathological process. Antibodies will be produced no matter how the antigens entered the bloodstream. That is, the phenomenon can be initiated by swallowing ejaculate during oral sex, and by unsuccessful attempts ECO.

Antibodies to sperm in men

Oddly enough, sperm can be considered foreign in the male body. Antisperm antibodies in men are formed during puberty, that is, when sperm begins to be produced in the body. Semen antigens appearing in boys in adolescence, are considered “newcomers” in the body. And therefore, accordingly, they must be destroyed by the immune system. And it would have been so, but nature had thought out everything to the smallest detail. Sperm are isolated and can only enter the bloodstream in emergency situations. These are infections, injuries, operations, after which the biological barrier between the seminal tract and blood vessels is broken. Sperm that enter the blood are perceived as foreign cells, after which the defense mechanism is activated.

Antisperm antibodies in sperm and blood serum negatively affect the formation, motility, viability and transportation of sperm, and, accordingly, the ability to fertilize an egg.

Testing for the presence of antisperm antibodies

There is far more than one test for antisperm bodies. The choice of research method depends on the patient's indications. According to WHO recommendations, a test for antisperm antibodies in the ejaculate must be performed with each sperm analysis. But before that, the couple must also undergo a post-coital test (Shuvarsky test). If the result is negative, the determination of antisperm antibodies in women and men will be mandatory. Depending on what class of antisperm antibodies (IgG, IgM or IgA) are present in the body, blood, ejaculate or cervical discharge will be examined.

An in vitro test for antisperm antibodies (Kurzrock-Miller test) can also be performed. In this case, the couple needs to come for research on the eve of ovulation and have cervical mucus and sperm taken for analysis. The materials are placed in a test tube, after which their interaction outside the woman’s body is assessed. The test result is considered negative if the sperm become less mobile in the mucus.

Regarding the test for antisperm antibodies, how to take it depends on the research method. Blood sampling is done on an empty stomach; smoking is not recommended an hour before. Testing for antisperm antibodies, the price of which depends on the laboratory and method chosen, is carried out in the following ways:

• MAR test for antisperm antibodies, the results of which indicate the presence of ACAT on sperm membranes. In this test, sperm is mixed with latex particles that are coated with antibodies and antiserum to the antibodies. If sperm stick to these particles, this means that there are anti-sperm antibodies on their surface. If they move freely, there are no ASATs;
• latex agglutination method. Similar to the previous method. But it is used to determine antisperm antibodies in cervical fluid and identify sedentary sperm. Latex particles are combined with prepared liquid samples. The results of the analysis are based on the absence or presence of sperm agglutination;
• solid-phase indirect immunoenzyme blood test for antisperm bodies.

Less common diagnostic methods include flow cytometry, immunofluorescence, radioimmunoassay and others, which help determine the amount of antisperm antibodies present in the body. The norm is different for men and women, but it is better if the ASAT level is low. IN healthy body they are not detected. Antibodies to sperm antigens can be elevated only in certain pathologies of the reproductive system. Although their presence does not mean that the couple is infertile, they can halve the likelihood of conception. Infertility cannot be ruled out even if antisperm antibodies are absent.

Tests for antisperm antibodies and antiphospholipid antibodies are mandatory before the in vitro fertilization procedure.

Antisperm antibodies: how to treat?

Treatment of antisperm antibodies in women and men is carried out only if it is necessary to conceive and bear a child and it depends on the results of the research. Today, it is almost impossible to completely suppress ASAT in the female body. There are several ways to reduce antisperm antibodies:

• in women, the concentration of ASAT can be reduced by prolonged use of barrier contraception (up to six months), which is excluded only on days favorable for conception;
• in men, first of all, it is necessary to conduct additional research to find out the reason why antisperm antibodies appeared. Treatment of the disease that led to the formation of ASAT will solve the problem.

Among other things, both spouses may be assigned drug treatment, the purpose of which is to reduce the production of antisperm antibodies.

Antisperm antibodies in men are specific proteins (immunoglobulins) produced by the immune system. The autoimmune process is directed against one’s own germ cells (sperm).

Their presence in a couple leads to infertility, since women can also have ASAT. What causes this, how to treat it, this is what our article is about.

What's happened

ASAT are cells of the immune system that protect the human body from various infections and foreign substances. In a healthy man, sperm are protected from cells of the immune system by a special barrier. Why is this happening?

It should be noted that sperm are formed during the maturation of a guy, the immune system is established from birth. She perceives the germ cell as foreign.

For this purpose, a man’s organs have created a whole barrier to protect sperm from immune cells found in the blood plasma.

1. Physical "Blood-testisbarrier", BTB, when the blood vessels connect to the seminiferous tubules.
2. Hematotesticular – interferes with the formation of AT and sperm sensitivity.
3. Processes occurring in the testicles for protection.

When a malfunction occurs, immune cells begin to produce antibodies in the ejaculate. This can happen when live bait penetrates the blood, then the biological barrier between the seminal tract and blood vessels disappears, and specific proteins take on their destructive action.

Reasons:

1. Inflammations, infections of the sexual system.
2. The formation of venous nodes in the scrotum - varicocele.
3. Surgical intervention on the genital organs.
4. Non-descent of the testicle (identicality).
5. Malignant neoplasms.
6. Blockage of the seminal canals.

Specific protein compounds in blood plasma and ejaculate negatively affect the morphology, mobility, vitality of germ cells, and the ability to fertilize an egg.

Diagnosis of ASAT in men

In case of infertility, an analysis is prescribed to detect antisperm antibodies. It is performed on the basis of a spermogram. If the ejaculate contains immunoglobulins, this leads to a change in its composition:

• Spermatozoa become inactive.
• Leukocytes are elevated, the norm is not more than (1 million).
• Gluing of gametes (agglutination).
• Violation of the composition of seminal plasma.

When deviations from the normal ejaculate occur, a postcoital test for AS antibodies is prescribed. It is done 12 hours after sexual intercourse. It is necessary to determine whether there are antisperm antibodies in the cervical mucus.

The cervical canal is the first stage that sperm must pass on their way to the egg. If the mucus contains antibodies, fertilization is almost impossible. This test does not always give an accurate result; more research is needed.

The antibody test is done repeatedly, it is necessary to determine what class of antibodies, and depending on the result, additional ones are produced. ASAT, which acts on ejaculate, is determined by three classes IgG, IgM, IgA.

• IgG, IgM - a large amount affects the seminal plasma, makes it thick, and increases the level of leukocytes. Gametes die in the epididymis during sexual development. Asthenozoospermia (cell immobility) may develop.
• IgA– affect the morphology of gametes, the maturation process is disrupted, and deformation occurs.

Depending on the class, an analysis is prescribed for AS antibodies in the blood, ejaculate, and cervical secretions.

The material taken for ASAT is taken from a vein, the presence of immune cells that influence the maturation of reproductive cells of the same class as in the seed is determined.

A blood test for antibodies is taken in the morning before meals. It is advisable not to smoke in front of him. Presence different types antibodies, their quantity can indicate various pathologies.

An indirect ELISA test that helps determine the class of immune cells. Plasma is taken and tests are done for various proteins.

MAR test - detection of sperm antibodies on a latex basis. How is it done? Immune cells are applied to pieces of thin rubber, mixed with gametes; if they stick, it means they have antibodies. When there are antisperm drugs, the test is positive.

It is noteworthy that their norm is different for men and women. When a couple wants to have children, all tests are done in parallel, the doctor selects adequate treatment for both spouses.

For fertilization to occur, there must be as few immune cells as possible. Their presence reduces the chances of having children. But it often happens that a couple, after living for several years, will be able to conceive a baby.

Treatment

The reasons for the appearance of antibodies in men and women are different.

• In the weaker sex, their number varies depending on the maturation cycle of the egg. If you temporarily restrict the access of sperm to the female body, the less antibodies will be produced. Condoms are used for this. Contact is possible only on days favorable for conception.
• At the same time, antihistamines are prescribed to reduce the production of antibodies, and drugs to reduce the viscosity of the cervical mucosa.
• In men, the appearance of ASAT is caused by reasons that require special treatment. Unlike women, in rare cases they can be treated.
• When both spouses have a large amount of ASAT, drug rehabilitation has not yielded results, intrauterine insemination husband's sperm, or artificial insemination IVF, ICSI.

An ASAT test is the first thing a couple should do if they are infertile. Modern techniques make it possible to successfully combat this pathology. Visit our website, new articles are waiting for you.