By Dr. Ethan Grober
I get a fair number of questions regarding anti-sperm antibodies and their influence on vasectomy reversal outcomes. They seem to cause patients and their partners a great deal of anxiety so I felt it would be a good idea to specifically address this issue in my blog.
Antibodies are produced by your body's immune system in response to unfamiliar and often unwanted contact with the body. Common triggers (antigens) for antibody formation include the presence of bacteria, viruses or cancer cells in the blood. The antibodies formed by the body's immune system serve to help the body target and fight-off theses unwanted cells.
With respect to sperm, the human body developed in a way that normally protects sperm from being targeted and influenced by antibodies. Sperm are physically prevented from interacting directly with the blood stream via the blood–testis barrier. The blood-testis barrier can be compromised however under certain circumstances – surgery, trauma, cancer and/or abnormal development or descent of the testis. When compromised, theoretically sperm may become susceptible to antibody detection and the antibodies can possibly influence the way sperm function.
A vasectomy (and vasectomy reversal) can disrupt the blood testis barrier and research suggests that between 70% to 100% of men have detectable antibodies following a vasectomy. The influence of these antibodies, in previously fertile men following vasectomy reversal, is not well established.
Antibodies are produced by your body's immune system in response to unfamiliar and often unwanted contact with the body. Common triggers (antigens) for antibody formation include the presence of bacteria, viruses or cancer cells in the blood. The antibodies formed by the body's immune system serve to help the body target and fight-off theses unwanted cells.
With respect to sperm, the human body developed in a way that normally protects sperm from being targeted and influenced by antibodies. Sperm are physically prevented from interacting directly with the blood stream via the blood–testis barrier. The blood-testis barrier can be compromised however under certain circumstances – surgery, trauma, cancer and/or abnormal development or descent of the testis. When compromised, theoretically sperm may become susceptible to antibody detection and the antibodies can possibly influence the way sperm function.
A vasectomy (and vasectomy reversal) can disrupt the blood testis barrier and research suggests that between 70% to 100% of men have detectable antibodies following a vasectomy. The influence of these antibodies, in previously fertile men following vasectomy reversal, is not well established.
This is why:
"Overall postoperative conception rate (following vasectomy reversal) is relatively high (50% to 70%) and the presence of antisperm antibodies does not correlate closely with postoperative fecundability. Consequently, the value of preoperative antisperm antibody testing remains controversial and unproven."
Unfortunately, many couples with otherwise excellent fertility potential following vasectomy reversal, are encouraged to undergo in-vitro fertilization (IVF) simply based on the presence of antibodies.
References:
1. Thomas AJ. Microsurgical vasovasostomy: immunologic consequences and subsequent fertility. Fertil Steril 1981;35:447–50.
2. Belker AM. Microsurgical vasectomy reversal. In: Advances in urology. Chicago: Year Book Medical, 1988:193–230.
3. Meinertz H. Antisperm antibodies and fertility after vasovasostomy: a follow-up study of 216 men. Fertil Steril 1990;54:315–21.
4. Vrijhof HJ. Vasovasostomy results in 66 patients related to obstructive intervals and serum agglutinin titres. Urol Int 1994;53:143–6.
5. Eggert-Kruse W. Circulating antisperm antibodies and fertility prognosis: a prospective study. Hum Reprod 1989;4:513–20.
6. Witkin. Effect of sperm antibodies on pregnancy outcome in a subfertile population. Am J Obstet Gynecol 1988;158:59–62.
7. Parslow JM. The effects of sperm antibodies on fertility after vasectomy reversal. Am J Reprod Immunol. 1983;3(1):28-31.
8. Carbone DR Jr. Partial obstruction, not antisperm antibodies, causing infertility after vasovasostomy. J Urol. 1998;159(3):827-30.
9. Zhonghua Nan Ke Xue. The relationship between changes of serum antisperm antibodies before and post vasovasostomy and pregnancy rate. 2006;12(1):32-5, 38.
10. Ninz S. Effect of obesity on sex hormone levels, antisperm antibodies, and fertility after vasectomy reversal. Urology. 2010;76(4):851-6.
- Despite the high percentage of men who develop antibodies following vasectomy, still the majority of couples - about 60-70% - are successful in achieving a pregnancy following vasectomy reversal.
- According to published research, the presence or absence of antibodies identified following vasectomy reversal inconsistently predicts what couples will be successful in achieving a pregnancy.
- Testing for sperm antibodies is variable and not well standardized. Antibodies identified in the blood are not the same as those identified on sperm. There are different types of antibodies and different locations on the sperm where antibodies may/many not influence sperm function. What antibodies are important? On what location on the sperm? Measured by what particular test? All this remains unclear.
- Most of the research on anti-sperm antibodies and their influence on fertility potential come from studies of infertile men. However, most men who have had a vasectomy and vasectomy reversal were fertile prior to their vasectomy with no significant problems having children. It appears that antisperm antibodies associated with vasectomy reversal may differ fundamentally from those occurring in naturally infertile males. The two populations - fertile men vs. infertile men - are not the same.
"Overall postoperative conception rate (following vasectomy reversal) is relatively high (50% to 70%) and the presence of antisperm antibodies does not correlate closely with postoperative fecundability. Consequently, the value of preoperative antisperm antibody testing remains controversial and unproven."
Unfortunately, many couples with otherwise excellent fertility potential following vasectomy reversal, are encouraged to undergo in-vitro fertilization (IVF) simply based on the presence of antibodies.
References:
1. Thomas AJ. Microsurgical vasovasostomy: immunologic consequences and subsequent fertility. Fertil Steril 1981;35:447–50.
2. Belker AM. Microsurgical vasectomy reversal. In: Advances in urology. Chicago: Year Book Medical, 1988:193–230.
3. Meinertz H. Antisperm antibodies and fertility after vasovasostomy: a follow-up study of 216 men. Fertil Steril 1990;54:315–21.
4. Vrijhof HJ. Vasovasostomy results in 66 patients related to obstructive intervals and serum agglutinin titres. Urol Int 1994;53:143–6.
5. Eggert-Kruse W. Circulating antisperm antibodies and fertility prognosis: a prospective study. Hum Reprod 1989;4:513–20.
6. Witkin. Effect of sperm antibodies on pregnancy outcome in a subfertile population. Am J Obstet Gynecol 1988;158:59–62.
7. Parslow JM. The effects of sperm antibodies on fertility after vasectomy reversal. Am J Reprod Immunol. 1983;3(1):28-31.
8. Carbone DR Jr. Partial obstruction, not antisperm antibodies, causing infertility after vasovasostomy. J Urol. 1998;159(3):827-30.
9. Zhonghua Nan Ke Xue. The relationship between changes of serum antisperm antibodies before and post vasovasostomy and pregnancy rate. 2006;12(1):32-5, 38.
10. Ninz S. Effect of obesity on sex hormone levels, antisperm antibodies, and fertility after vasectomy reversal. Urology. 2010;76(4):851-6.