Relationship between an asymptomatic male genital tract exposure to Chlamydia trachomatis and an autoimmune response to spermatozoa

The relationship between a localized genital tract humoral immuneresponse to Chlamydia trachomatis and the presence of antispermantibodies on the surface of motile spermatozoa in the ejaculatewas examined in 227 asymptomatic male partners of infertilecouples with no history of exposure to C.trachomatis. Semenand serum samples were assayed for immunoglobulin (Ig) A andIgG antibodies to C.trachomatis by enzyme-linked immunosorbentassay employing a recombinant Chlamydia-specific lipopolysaccharidefragment (Medac, Hamburg, Germany), while motile spermatozoawere tested for bound autoantibodies by immunobead binding.Semen samples from 24.7 and 10.9% of the men were positive forIgA and IgG antibodies to C.trachomatis respectively. In comparison,antichlamydial IgA was less prevalent in sera (14.5%) than insemen (P = 0.01), while antichlamydial IgG was most prevalent(21.5%) in sera (P =0.003). In 75.0% of the men with antichlamydialIgA in their semen, this antibody was undetectable in sera obtainedat the time of semen collection. Conversely, 84.0% of the menwith seminal antichlamydial IgG were also IgG seropositive.Antisperm IgG and/or IgA were detected on motile spermatozoafrom 16.3% of the men; their occurrence was strongly correlatedwith the presence of antichlamydial IgA in semen (P < 0.0001).Weaker associations between antisperm antibodies and eitherseminal IgG antibodies to C.trachomatis (P = 0.01) or circulatingIgA and IgG antichlamydial antibodies (P = 0.03) were also observed.Men with antichlamydial IgA in their semen had a lower mediansperm count (82 versus 144 x 10⁶/ml) than those men without(P = 0.003); sperm morphology and motility were comparable inboth groups. These data suggest that asymptomatic male genitaltract exposure to C.trachomatis is a frequent event among thispopulation and that the presence of a humoral immune responseto this organism is correlated with the development of an autoimmuneresponse to spermatozoa.     

Immunology: Chlamydial immunoglobulin IgG and IgA antibodies in serum and semen are not associated with the presence of Chlamydia trachomatis DNA or rRNA in semen from male partners of infertile couples

The role of Chlamydia (C.) trachomatis in male infertility iscontroversial. The objective of this study was to determinethe prevalence of asymptomatic C.trachomatis infections in malepartners of infertile couples, and to compare this result withthe presence of chlamydial antibodies in serum and semen. C.trachomatiswas detected in five of 50 semen specimens (10%) by either polymerasechain reaction for C.trachomatis DNA or direct DNA probing forC.trachomatis rRNA. There was no association between the detectionof C.trachomatis in semen and the presence of chlamydial antibodiesin serum or semen. Chlamydial serum antibodies were neitherassociated with antisperm serum antibodies nor with pathologicalstandard semen parameters. These results indicate that the assessmentof chlamydial immunoglobulin IgG and IgA antibodies in serumor semen is of limited use in male infertility work-up, in contrastto its significance in female tubal infertility. The presenceof C.trachomatis in semen emphasizes the potential risk of transmissionduring artificial insemination and other assisted reproductivetechniques, and underlines the importance of sensitive directdetection methods in this group of patients.     

Oral steroid therapy for subfertile males with antisperm antibodies in the semen: prediction of the responders

This study was performed to examine the effectiveness of steroidtherapy in subfertile men with antisperm antibodies and infertilitylasting > 1 year, to predict those who would respond positively,and to evaluate the effect of the therapy on semen parametersand antisperm antibodies. The patients included 48 subfertilecouples in whom the male partner had 20% motile spermatozoawith bound antibodies of immunoglobulin (Ig)G, IgA or a combinationof both, and were treated with prednisolone, 40 mg a day, forthe first 10 days, then 5 mg on days 11 and 12 of the partner'scycle for 9 months. Twelve couples became pregnant; a cumulativeconception rate of 30.2% was achieved at 9 months. The pregnantgroup started with significantly higher concentrations of IgG(tail) and grade I motility (P = 0.03 and P = 0.02 respectively).Multi-covariate discrete logistic regression analysis on theinitial screening semen samples predicted a higher chance ofconception for those with high levels of IgG (tail) (P = 0.006,sensitivity = 33%, specificity = 93%, correct = 75%, false positive= 33% and false negative = 24%). In the pregnant group, prednisolonecaused a significant increase in grade I motility (P = 0.03).In the non-pregnant group, there was a significant increasein grade I motility (P = 0.0002), amplitude of lateral headdisplacement (P = 0.03), curvilinear velocity (P = 0.02) anddecrease in grade IV motility (P = 0.03) following prednisolonetreatment. In both groups there was suppression of the totalantisperm antibody concentrations. Comparison of semen parametersin the last semen samples between the two groups showed thatthe pregnant group had significantly higher progressive motility(P = 0.008) and lower grade IV motility (P = 0.02). It was concludedthat steroid treatment is effective in treating subfertile menwith antisperm antibodies; it suppresses certain isotypes ondifferent locations and improves motility. The isotype IgG againstthe tails of spermatozoa is a specific predictor for pregnancyfor men to be treated with prednisolone.     

Chlamydial serology in 1303 asymptomatic subfertile couples

The clinical significance of antichlamydial antibodies (Chlam Ab) was determined in a total of 1303 subfertile couples consulting for infertility investigation and treatment. Median age of the women was 30 (range 22-44) years and of the men 33 (range 21-53) years. The median duration of infertility was 4 (range 1-21) years. All patients were asymptomatic for genital tract infection. A comprehensive infertility investigation included examination of the endocrine, cervical, and tubal factor, and semen analysis, antisperm antibody (ASA) testing, sperm-mucus interaction testing in vitro using a standardized protocol, and post-coital testing (PCT). Screening for Chlam IgG Ab was performed in serum of both partners, obtained at the same time. Simultaneous microbial cultures in genital secretions of both partners included a broad spectrum of potentially pathogenic bacteria. Elevated titres of Chlam IgG Ab as seromarker for previous infection were found in 20.8% of all women, and in 12.6% of men. Chlam Ab were significantly more frequent in partners of seropositive patients (in 51.8% of women with a Chlam Ab positive partner, compared to 15.8% of the other women). Microbial screening outcome was not significantly related to results of chlamydial serology in both partners. In women, elevated titres of Chlam Ab were significantly associated with a tubal factor, but were not related to reduced quality of the endocervical mucus (CM), including the in-vitro penetrability of the CM (using partners' or donors' spermatozoa). In males, Chlam Ab were not significantly related to the outcome of semen analysis, including screening for ASA (IgG and/or IgA) in semen, and several parameters of sperm functional capacity. After exclusion of couples with tubal disease, subsequent male fertility did not significantly differ in males with or without Chlam Ab. The results suggest that during basic infertility investigation, positive chlamydial serology as an easy screening procedure indicates a higher risk for a tubal infertility factor. However, in asymptomatic patients, Chlam IgG Ab in serum are not associated with a cervical factor or with the male factor, using several determinants for evaluation of semen quality including subsequent fertilizing capacity.      

Immunology: Formation of antisperm antibodies in women treated with Fallopian tube sperm perfusion

Fallopian tube sperm perfusion (FSP) is a combination of ovarianstimulation and intra-uterine insemination using a large volume(4 ml) of inseminate containing 10⁷–10⁸ spermatozoa. Theinseminate will flush the Fallopian tubes and some of it willend up in the pouch of Douglas. In the present study, we haveinvestigated whether the FSP method will result in the formationof serum antisperm antibodies in the female. A total of 184treatment cycles were given to 128 women. The indications fortreatment were: unexplained infertility (n = 35), various infertilitydiagnoses (n = 28) and donor insemination (n = 65). Prior totreatment, 11 (8.6%) women had a positive tray-agglutinationtest (Friberg) and/or a positive immunobead test. After completingone to four treatment cycles, another six (4.7%) women had developedserum antisperm antibodies. The antibodies induced by the treatmentwere of isotype IgM and directed against the tailtip of thespermatozoa. Two of the women, who prior to the treatment hadantisperm antibodies, showed an increase in antibody titre duringtreatment. There was no statistically significant differencein the pregnancy rate between the women with antisperm antibodiesand the women without. In our opinion, the small risk of developingantisperm antibodies is no contra-indication for treating infertilecouples with FSP.     

Autoantibodies and antisperm antibodies in sera and follicular fluids of infertile patients; relation to reproductive outcome after in-vitro fertilization

Immune reactions have effects at various concentrations in thereproductive process and autoantibodies may have an impact onfertility and the outcome of assisted conception. We measuredthe prevalence of and relation between antibodies to smoothmuscle, nuclear, phospholipid and sperm antigens, and concentrationsof immunoglobulins G, M and A and complement components C3 andC4, in the sera and follicular fluids of women with unexplainedinfertility (n = 30), endometriosis (n = 20), tubal infertility(n = 50) and the sera of 20 normal non-pregnant women. We assessedfertilization and successful pregnancy rates in relation toantibody status of infertile women after in vitro fertilization.All antibodies had a higher prevalence in infertile women comparedwith controls and this was significant for smooth muscle antibodyin endometriosis (P < 0.05); anticardiolipin antibody intubal infertility P < 0.05); and antisperm antibody in alltypes of infertility (P < 0.001). There was no relation betweenpresence of specific antibodies in serum or between serum andfollicular fluids. Total biochemical pregnancy rate was higherwith endometriosis (P = 0.05) but clinical pregnancy and livebirth rates did not differ between groups or in relation toantibody status. Significant differences in immunoglobulin andcomplement components occurred in women with and without successfulbiochemical pregnancy.     

Immunology: Autoimmunity to spermatozoa, asymptomatic Chlamydia trachomatis genital tract infection and {gamma}{delta} T lymphocytes in seminal fluid from the male partners of couples with unexplained infertility

The relationship between an undetected, asymptomatic Chlamydiatrachomatis genital tract infection, the concentration of andb T cells in semen and sperm autoimmunity was examined in 48male partners of couples with unexplained infertility. ImmunoglobulinA (IgA) antibodies to C.trachomatis were detected in seminalfluids from 14 (29.2%) of the men. Only four of these were positivefor circulating anti-chlamydial IgA, suggesting that the stimulusfor antibody production was within the genital tract. In contrast,four men were positive for anti-chlamydial IgG in their semen;all were also seropositive for anti-chlamydial IgG. T lymphocytesbearing the and antigen receptors were present in every semensample. Men with seminal anti-chlamydial IgA, however, had significantly(P = 0.035) elevated semen T cell concentrations (median 3100cells/ml) than did men lacking this antibody (median 1400 cells/ml);concentrations of T cells were comparable in both groups. Genitaltract sperm autoimmunity, as shown by antibodies bound to motileejaculated spermatozoa, was detected in 13 (27.1%) men. Thepresence of these antibodies was associated with elevated concentrationsof both (median 4200 versus 700 cells/ml) and (median 5000versus 850 cells/ml) T cells (P = 0.0002 and 0.0001 respectively).Men with antisperm antibodies only in their serum had seminalT cell concentrations comparable with men testing negative forantisperm antibodies. Anti-chlamydial IgA was identified insemen from four of 10 men with IgA bound to their spermatozoaand in none of the men with only spermatozoabound IgG. Therewas no relationship between sperm quality and the occurrenceof seminal IgA antibodies to either C.trachomatis or spermatozoa.An asymptomatic C.trachomatis infection activates T cells withinthe male genital tract, which may lead to antisperm antibodyformation and immune-mediated infertility.     

Immunological assessment of infertility by estimation of antisperm antibodies in infertile couples.

160 clinical samples were collected from 40 infertile couples with unexplained infertility. The samples collected included serum and seminal plasma of the male partners and serum and cervical mucus samples of the female partners. 25 fertile healthy couples were investigated as controls. All the samples collected were then tested for class-specific antisperm antibodies by an Enzyme linked immunosorbent assay (ELISA). Antisperm antibodies were detected in 30% of the infertile couples which included 25% female and 10% male partners. Amongst the cases positive for antisperm antibodies, antibodies were detected most frequently in female sera 58.4% followed by male sera 33% and 25% in cervical mucus. The isotyping of antisperm antibodies in various samples showed IgG to be the most frequent type specific antibody followed by IgM & IgA types of antibodies. ELISA has provided a relatively simple, reliable and highly reproducible method of detection of antisperm antibodies. Thus application of antisperm antibody testing especially in cervical mucus should become an integral part of the investigation of immunologic infertility.     

The predominance of IgG1 and IgG3 subclass antisperm antibodies in infertile patients with serum antisperm antibodies.

Mouse monoclonal antibodies (MAb) specific for each of the four human IgG subclasses and immunofluorescence flow cytometry were used to evaluate the subclass of the IgG antibody response to sperm in serum samples from 13 men and 6 women with a high titer (greater than 1:15,625) of IgG antisperm antibodies (ASA] determined by an indirect immunobead test. Five sera without ASA were also studied as a control. All 19 (100%) of the ASA-positive sera contained immunoglobulin (Ig)G ASA of the IgG1 and IgG3 subclasses. A 1:1 correlation was observed between the presence of IgG1 and IgG3 ASA. IgG2 was essentially undetectable, while IgG4 reactivity, although less intense than IgG1 and IgG3, was more prominent in the sera from the five vasectomized men. The ability of the IgG1 and IgG3 ASA-positive sera to deposit complement (C) on sperm was demonstrated by the concomitant binding to antibody-laden sperm of polyclonal antibodies to the membrane attack complex (C5b-9) of C. Both C-fixing and non-C-fixing ASA-positive sera were found to possess IgG1 and IgG3 antisperm antibodies. The predominance of IgG1 and IgG3 subclasses suggested a T-cell dependent immune response to sperm antigens.     

The occurrence of Chlamydia trachomatis in the semen of men participating in an IVF programme

Chlamydia trachomatis is one of the most common causative agentsof sexually transmitted diseases. The authors studied the occurrenceof C.trachomatis in the semen of 184 asymptomatic men participatingin the IVF programme. Twenty-six (14.1%) of the 184 tested werepositive for C.trachomatis, these patients and their wives receivingdoxycycline capsules twice, 100 mg on the first day and 100mg/day for the following 13 days. This treatment was effectivein 88.5% of the cases and in the rest, treatment continued witherithromycin 250 mg four times/day for 2 weeks. The authorscompared the semen parameters (cell count, motility, morphology,bovine mucus penetration and hypo-osmotic swelling test) inthe infected and non-infected groups and observed no significantdifference between these two groups     

Value of flow cytometric assay for the detection of antisperm antibodies in women with a history of recurrent abortion

PROBLEM: To verify the proposed relationship between recurrent spontaneous abortions and the presence of maternal antisperm antibodies (ASA) in women as detected by a sensitive and reliable method. METHOD OF STUDY: The presence of maternal antipaternal immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies were determined against three different paternal antigens comprising T, B lymphocytes and semen cells by a sensitive flow cytometric crossmatch method to examine their possible correlation with pregnancy outcome. Group 1 consisted of sera obtained from 24 women with a history of abortion, and lymphocytes and semen samples collected from their husbands at the same time of visiting the in vitro fertilization (IVF) Clinic at King Faisal Specialist Hospital and Research Center. Sera, lymphocytes and semen samples were also collected from six couples with no history of abortion who served as controls (Group 2). RESULTS: Using a sensitive flow cytometric assay to analyse the samples, without knowledge of clinical status, elevated levels of both IgG and IgM were detected in Group 1. However, no significant association was found when compared with normal females who had healthy pregnancies. CONCLUSION: Flow cytometry is a highly sensitive and specific tool for the detection of alloantibodies in human sera from patients with rejected transplanted organs. Our findings suggest that maternal antipaternal antibodies with respect to IgG and IgM classes do not play a major role in women with a history of recurrent abortions, despite the presence of increased levels of antibodies against three different sources of paternal antigens.     

The Value of the Mixed Antiglobulin Reaction (MAR Test) as an Addition to Routine Seminal Analysis in the Evaluation of the Subfertile Couple

ABSTRACT: A mixed erythrocyte-spermatozoa antiglobulin reaction (MAR test) for IgG antibodies has been done on semen specimens supplied by the male partners in 720 subfertile couples during a two-year period. The test was possible in all except 69 patients (9.5%). Antisperm antibodies were detected in 48 (10%) of 484 men with normal sperm counts, 18 (23%) of 78 with low sperm motility, and 19 (15%) of 128 with low counts. In 204 patients, antisperm antibodies were also measured by serum sperm-agglutination tests: The results showed a highly significant correlation with the results of MAR testing. It is concluded that the MAR test should be a routine part of seminal analysis, since the presence of IgG antisperm antibodies can be established in about 10% of men who might otherwise be passed as normal, and such antibodies can be positively excluded in a further 78% of the male partners of infertile marriages.     

Intra-uterine insemination versus cyclic, low-dose prednisolone in couples with male antisperm antibodies

A total of 46 couples with male immunological infertility enteredthe trial at the infertility clinic of the Family Federationof Finland. The men all showed a positive mixed antiglobulinreaction to immunoglobulin G in their semen; 31 men were alsotested for sperm-bound IgA immunoglobulins by flow cytometry.Serum antisperm antibodies were checked in a tray agglutinationtest. The women showed normal reproductive endocrinology andat least one patent Fallopian tube. The couples were randomizedto undergo either up to three intra-uterine inseminations (IUI),or timed intercourse with cyclic, low-dose (20 mg) prednisolonetherapy of the men. Cross-over was carried out if no pregnancyoccurred in the first stage. Timing of ovulation was based onurinary luteinizing hormone assay and transvaginal ultrasonographicmeasurements. In all, 40 couples either completed the studyor the female partner conceived. IUI was significantly better(P = 0.04) with nine pregnancies than timed intercourse withprednisolone (one pregnancy). There were no significant associationsbetween antibody levels, sperm count or motility versus theincidence of pregnancy. In male immunological infertility, well-timedIUI is an effective treatment method: results are obtained rapidlyand steroidal side-effects can be avoided.     

Possible role of Chlamydia trachomatis in the male partner of infertile couples

Chlamydia trachomatis is the most prevalent sexually transmitted bacterial infection, with an estimated 92 million new cases occurring each year worldwide. The aim of the present study was to detect the microorganism from semen samples of asymptomatic male partners of infertile couples using polymerase chain reaction (PCR) and enzyme-linked immunosorbent assays (ELISA). Semen and blood specimens were obtained from 93 infertile and 93 fertile men attending an infertility center by our diagnostic laboratory for the detection of C. trachomatis. The presence of C. trachomatis was examined by PCR assay. Serum IgG and IgA antibodies to C. trachomatis were also monitored using ELISA in all samples. The rates of C. trachomatis infection by PCR were 19.4% and 7.5% in infertile and fertile men, correspondingly, which was significantly different using χ ² test (p?=?0.01). The prevalence of IgG and IgA antibody levels were 4.3% and 2.2% (in infertile) and 3.2% and 1.1% (in fertile men), respectively. The present study showed a remarkable correlation between infections caused by C. trachomatis and infertility in men. Our data revealed that C. trachomatis caused a persistent infection among infertile couples.     

Detection of seminal antibodies to human immunodeficiency virus in vaginal secretions after sexual intercourse: Possible means of preventing the risk of human immunodeficiency virus transmission in a rape victim

Detection of semen anti-human immunodeficiency virus (HIV) antibodies within the cervico-vaginal secretions from a non-HIV-infected woman who has had a recent sexual intercourse with an HIV-infected man is theoretically possible since the seminal fluid from all HIV-infected men contains a high titer of IgG antibodies to HIV. We report the case of an HIV-seronegative African woman whose cervico-vaginal secretions contained IgG antibodies to HIV, including antibodies to HIV-env-encoded glycoproteins. This woman had also detectable prostatic specific antigens and acid phosphatase in her cervico-vaginal secretions, establishing the persistence of semen. In order to confirm whether anti-HIV antibodies in seminal fluid could be detected in vitro when mixed with cervico-vaginal secretions, 10^?1 to 10^?6 10-fold dilutions of seminal fluid from HIV-1-seropositive donors were realized with a pool of HIV-negative cervico-vaginal secretions as diluent. Six commercial enzyme immunoassays or rapid tests were compared for semen anti-HIV detection in the secretions. At a 10^?1 dilution of the mixture, all assays were markedly positive for all tested semens and the greatest dilutions of seminal fluid showing positivity ranged from 10^?3 to 10^?5. The IgG immunocapture assay appeared to be the most sensitive test. The rapid tests permitted the detection of semen IgG antibodies to HIV at dilutions ranging from 10^?1 to 10^?3 suggesting their potential value in emergency situations. © 1995 Wiley-Liss, Inc.     

Endometriosis: Expression of the 60 kDa heat shock protein in peritoneal fluids from women with endometriosis: implications for endometriosis-associated infertility

Proinflammatory cytokines and activated macrophages and T lymphocyteshave been detected in peritoneal fluids of women with endometriosisand may impair fertility. Expression of the 60 kDa heat shockprotein (hsp60) is one mechanism leading to a localized activationof macrophages and T lymphocytes and cytokine release. Peritonealfluids, obtained from 68 women undergoing a diagnostic laparos-copy,were assayed for hsp60. As independent evidence of local immuneactivation, the fluids were analysed for interferon (IFN).Fluids were also tested for antibodies to Chlamydia trachomatisbecause a chronic asymptomatic infection by this organism mayalso release hsp60. At laparoscopy, 26 women were diagnosedwith pelvic adhesions, 19 had endometriosis, 16 had a visiblynormal pelvis, four had ovarian cysts while three had myomas.The prevalence of hsp60 was higher in peritoneal fluids fromthe women with endometriosis than in the other subjects (P =0.005). Hsp60 was detected in seven (36.8%) of the endometriosispatients and in only one each of the women with adhesions, anormal pelvis or an ovarian cyst; all women with myomas werenegative. Detection of IFN in peritoneal fluids was highly correlatedwith the presence of hsp60 (P = 0.0003). IFN was present inseven of nine (77.8%) women with hsp60 and in only five of 40(12.5%) women lacking hsp60. Women with pelvic adhesions hadan increased prevalence of immunoglobulin G antibodies to C.trachomatiscompared with the other women (P = 0.01). There was no relationshipbetween evidence of exposure to C.trachomatis and hsp60 in peritonealfluids. These data suggest that hsp60 may be released into theperitoneal fluid as a consequence of implanted ectopic endometrium.Hsp60-mediated immune activation may be one mechanism leadingto endometriosis-associated infertility.     

Seroprevalence of Chlamydia trachomatis in women with bad obstetric history and infertility

50 sera each from women with infertility, bad obstetric history and healthy pregnant women were tested for the presence of antichlamydial IgG antibodies. Antichlamydial IgG antibodies were present in 68% of women with infertility, 50% of women with bad obstetric history and 10% in healthy pregnant women. As culture methods are cumbersome so diagnosis can be made by serological tests, which are sensitive, specific and non invasive. Chlamydia trachohmatis is one of the most common bacterial sexually transmitted disease and most infections caused by Chlamydia trachomatis being asymptomatic, result in a large reservoir of unrecognized, infected individuals capable of transmitting the infection to sexual partners. Chlamydia trachomatis if detected earlier and given proper treatment, can minimize the complications in these patients.     

Andrology: Results of 55 intracytoplasmic sperm injection cycles in the treatment of male-immunological infertility

Antisperm antibodies present in the semen can be a primary causeof infertility. If the proportion of spermatozoa carrying antispermantibodies is very high, then usually a poor result ensues instandard in-vitro fertilization. We therefore employed intracytoplasmicsperm injection (ICSI) in 55 cycles (37 patients) where theproportion of antisperm antibody-bound spermatozoa was 80% orhigher, as determined by the mixed antiglobulin reaction (MAR)test. The type and location of antisperm antibodies were determinedby the immunobead test in 30 of the 37 patients. The mean normalfertilization rate was 75.7% in these 55 cycles, which was significantlyhigher than the fertilization rate in another 1767 ICSI cycles(69.2%) performed over the same period and where MAR-negativesemen (the level of antisperm antibodies was <80%) was usedfor microinjection. Embryonic development was comparable, buta higher proportion of poor-quality embryos was obtained withMAR-positive than with MAR-negative semen samples. Out of the55 patients, 53 had embryos replaced (96.4%) and a fetal sacwas detected by ultrasonography in 14 patients (26.4%). Thedata indicate that fertilization, embryo development and pregnancyrates after ICSI are not influenced significantly by the proportionof antisperm antibody-bound spermatozoa, nor by the dominanttype of antibodies present, nor by the location of the antispermantibody on the spermatozoa. The conclusion of this study isthat ICSI should be the primary choice for patients who havehigh numbers of antisperm antibodies present in their semen.     

Multivariant Analysis of Men from Infertile Couples With and Without Antisperm Antibodies

PROBLEM: Research studies in animal and human systems have demonstrated conclusively that antisperm antibodies can interfere with fertilization. In the male, autoantibodies to sperm can be detected both in the sera and seminal plasma. METHOD OF STUDY: Ninety-seven men who were tested for antisperm antibodies as a part of an infertility evaluation were identified. Complete medical history was obtained, including information related to events suspected of being associated with antisperm antibodies. History of surgery (varicocele repair, hernia repair, and vas reversal) and infection (epididymitis, sexually transmitted disease, and orchitis) were compared with semen parameters (motility less than 60%, concentration less than 20 times 10⁶, and volume less than 2 cc). These were compared to antisperm antibody results of mixed agglutination reaction (MAR) and direct immunobead binding test (IBT) for immunoglobulin G (IgG). Statistical analysis was performed using Fishers exact two-tailed test. RESULTS: As expected, prior vas reversal was significantly associated with the presence of antisperm antibodies (P = 0.0002) by MAR or IBT with a fivefold increased relative risk (95% confidence interval, 1.97-12.38). Other surgeries manipulating the cord structures independent of vas reversal were not associated with antisperm antibodies (P = 0.09). Prior infections, independent of vas reversal, were significantly associated with antisperm antibodies by MAR (P = 0.04) with a 3.8-fold increased relative risk (95% confidence interval, 1.06–13.87) but not by IBT. Sperm concentration less than 20 times 10⁶, motility less than 60%, and a volume less than 2 cc were not associated with antisperm antibodies by MAR or IBT. CONCLUSION: These findings suggest that manipulation of the cord structures excluding the vas were not associated with antisperm antibodies; however, vas reversal and prior infection are significant risk factors for the development of antisperm antibodies.