Antisperm immunity in assisted reproduction

Aim: Research conducted in the last 40 years has provided evidence that anti-sperm antibodies (ASA) can impair the fertilising capacity of human spermatozoa. Pathogenesis remains only partially understood, although testicular and seminal immunomodulation certainly play a role. It is established that ASA can be present at different sites and can act negatively both on the motility of the spermatozoa in the semen, on their ability to pass through female genital secretions, on the fusion of the gametes, and perhaps also on the first step of embryo development. Materials and Methods: In the past it was amply demonstrated that ASA could act negatively on sperm motility and on cervical mucus penetration. In the last year, owing to the improvement and spreading of in vitro fertilisation techniques, it has been possible to demonstrate the effect of antibody-bound sperm at the level of in vitro gamete interaction. Results: the literature demonstrates that the various previously used treatments for immunological infertility, i.e. medical therapy, AIH and IVF, were usually poor. In these cases, the primary choice of treatment in immunological infertility, especially in the most severe cases and when the sperm head is involved, is ICSI. Conclusions: ASA evaluation in all couples who undergo the various techniques of insemination or in vitro fertilisation is imperative. In fact, the presence of ASA cannot only impair the fertilising ability of the spermatozoa in vivo, but can also be a serious factor which prevents the success of the various insemination or fertilisation techniques. Only ICSI seems to be able to overcome the problem, and with this technique the fertilisation rate, embryo quality and pregnancy rate of ASA patients have been found to be in the same range as the general population of ICSI patients. However, due to the relative rarity of immunological infertility, the literature in this field is quite scarce and it is therefore necessary for more studies to be conducted in order to confirm that embryo quality is not impaired.