|
|
If varicoceles are controversial, immune sperm problems are even more so. However, while the controversy surrounding varicoceles is now quite old, the immune problem is a relatively newer area, which means we have even more questions about this, and even fewer answers!
In one of Nature's quirks, men can develop antibodies to their own sperm; or the wife can develop these against the husband's sperm. What happens is that the body's defense mechanism destroys its own sperm; or the wife's hostile cervical mucus does so, as though the sperm were enemy bacteria or virus. This can happen after problems of inflammation, injury to the testes, surgery, infection or blockage.
Problems start with making a diagnosis. Antisperm antibodies are suspected when the sperm clump to one another (agglutinate) on a sperm test. A poor postcoital test, which shows all immotile sperm in the mucus is also a tip-off, because one of the reasons for this is cervical mucus hostility because of antibodies.
There are many tests available to detect sperm antibodies. Blood tests for antisperm antibodies can be done for both the wife and husband using ELISA methods. This is an easy test to do but interpreting it is hard what does a postive test mean? Could it be responsible for infertility? Most doctors don't think so, because they argue that the presence of these antibodies in the blood is of little clinical importance - but the debate goes on! These older tests are now considered to be obsolete. The newer antibody tests which are more reliable, are done on the sperm itself, using immunobead testing, and these can tell the doctor whether the antibodies are on the sperm head or tail. However, interpreting the significance of a positive result remains a vexed issue!
Treatment is equally confusing - and included testosterone injections in the past in order to suppress sperm production - the rationale being that if there are no sperm there will be no further formation of the battling antibodies! Corticosteroids have also been used successfully to stop a person from making antibodies, but these drugs can have significant side effects, as a result of which they are not considered standard therapy today. Today, washing the sperm in the lab to clean away the seminal fluid which contains the antibodies, along with timed intrauterine insemination (IUI), is the first-line treatment. For more difficult patients, where the antibodies are tightly bound to the sperm head, IVF and even ICSI may be needed.
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
