ETIOLOGY OF AUTOIMMUNE MALE INFERTILITY

Sperm autoimmune reactions accompanied by elaboration of anti-sperm antibodies (AsAb) are one of the causes of male infertility. Objective. To specify the role of different factors (apart from obstruction) in the etiology of immune male fertility. Subjects and methods. Clinical and laboratory examination was made in 536 men from infertile couples aged 18—45 years; a control group consisted of 82 fertile men, the wives of whom were 8-16 weeks pregnant. Their sperm was examined in accordance with the WHO requirements. AsAbs were determined in the sperm by MAR test. Oxidative stress (OS) was assessed by luminol-dependent chemiluminescence assay. Chromosome damage was evaluated from DNA fragmentation by the chromatin dispersion test in inert agarose gel with visual microscopic estimation of halo formation after acid denaturation of DNA and lysis of nuclear proteins. The blood levels of interferons (IFN) and natural and in vitro induced IFN production were determined by the Campbell method. Reproductive tract infections were diagnosed using a polymerase chain reaction assay. Results. There is a highly significant correlation between AsAb counts, on the one hand, and experienced orchitis and subclinical testicular damage, on the other hand. There is no correlation between varicocele and AsAb, but in the former, the risk of immune infertility and orchitis increases after injury; varicocelectomy contributes to a reduction in AsAb with the higher degree of varicocele and a less marked autoimmune process. AsAbs are observed in the presence of Chlamydia infection and higher IFN-γ production. Cryptorchidism and orchiopexy, parotitis, epididymitis, herniotomy, chronic bacterial prostatitis, and other potential risk factors for reduced male fertility had no significant impact on OR for the development of immune infertility. In most cases (41%) immune infertility seems idiopathic, but it is accompanied by hyperproduction of reactive oxygen species and DNA damage (fragmentation). Conclusion. Male immune infertility is polyetiologic: blood-testis barrier impairment, cross reactions with microorganisms, immunopathological reactions. Autoimmune reactions against sperm can be considered as both a cause and a consequence of its poor quality caused by genetic and different endo- and exogenous factors.

immune infertility, antisperm antibodies, oxidative stress, sperm DNA fragmentation