A clinically significant indicator in the diagnosis of infertility is the amount of antisperm antibodies (ASAT) in women and men. Normally, they either should not be present in the biological material of persons of both sexes, or be in a small concentration in it. If their level is increased, then the likelihood of pregnancy in a natural way is minimized. Currently, in vitro fertilization is considered the most effective treatment.
The concept
In medicine, the term "sperm antibodies" refers to substances of protein origin. They are produced by the protective system of the human body. They can be found in sperm, blood serum, cervical mucus, and seminal plasma. In a third of patients suffering from infertility, these substances are detected. It also happens that they are found in healthy people, but this is extremely rare.
The presence of antisperm antibodies in men is of particular clinical significance. This is because their presence in the ejaculate is evidence of immunological infertility. If antisperm antibodies are detected in women, it is customary to talk about the incompatibility of partners. In principle, it is not so important in the body of a person of what gender these protein substances appeared. The only task of antisperm antibodies is the destruction of sperm, which prevents the onset of pregnancy in a natural way.
Reasons for the appearance of women
In the human body, ASATs are biologically active substances that are components of liquid connective tissue. The process of their formation starts only if any foreign agents enter the bloodstream.
It is customary to talk about the immunological incompatibility of partners if the female body rejects the components of the seminal fluid of a man. If they enter the bloodstream through the mucous membrane, the process of formation of antisperm antibodies is started.
Pathologies of the organs of the female reproductive system also contribute to their appearance. The mechanism of formation of ASAT in this case is as follows: during movement, spermatozoa fall into the focus of inflammation, where the cells of the body's defense system try to destroy pathogens. As a result, they fall under attack and do not achieve their goal.
Causes of the appearance of sperm antibodies in cervical mucus and blood in women:
- Violation of the integrity of the mucous membrane.
- An increased concentration of leukocytes in the partner's seminal fluid.
- The presence of sperm in the ejaculate that interacts with antibodies.
- The consequence of cauterization of cervical erosion.
- A large number in the ejaculate of "old" sperm, which is considered a pathological condition.
- Penetration of seminal fluid into the peritoneum. This may be the result of incorrectly performed in vitro fertilization.
- The penetration of sperm into the gastrointestinal tract. A similar situation can occur during oral or anal sex.
- If in the past there were attempts to get pregnant with the help of artificial insemination. In this case, antisperm antibodies in mucus and blood can form due to trauma received during oocyte (egg) collection. Also, they are often formed against a background of pronounced hormonal burst.
The components of the sperm that have been destroyed are absorbed by macrophage cells. The latter split them into the smallest elements. Some of these small components form antispermal antigens on the surface of macrophage cells over time. The latter sooner or later fall into the circulatory and lymphatic systems. As a result, the process of formation of antisperm antibodies is started. They spread throughout the body through fluid connective tissue, after which they penetrate the mucous membranes in search of foreign antigens. If sperm cells meet on their way, ASAT immediately begin to attack them.
Thus, if protein substances have already appeared in the blood, the mucous membrane of the female genital organs becomes a kind of barrier. Instead of promoting the movement of sperm to the ovum, it prevents this process.
It also happens that the level of ASAT in the biological material of a woman is increased, but at the same time pregnancy occurs. In this case, constant monitoring of the expectant mother by doctors is necessary. This is due to the fact that sperm antibodies can negatively affect the viability of the fetus.
Reasons for the appearance in men
ASAT begin to form in adolescents during puberty. Oddly enough, but your own sperm can also be considered foreign in the male body. Normally, they should not come into contact with blood components, since the antigens of the seminal fluid are immediately destroyed by the protective system. In healthy men, sperm are in an isolated state. But under the influence of adverse factors, the biological barrier between the blood vessels and the vas deferens is broken.
If a high concentration of antisperm antibodies in the blood and semen is detected in men, the causes may be:
- Infectious diseases.
- Narrowing the lumen of the vas deferens.
- Significant pelvic injuries.
- Malignant neoplasms.
- Surgical intervention in the abdominal cavity or organs of the reproductive system.
- Undescended testicle in the scrotum (congenital pathology).
Sperm, entering the bloodstream, are perceived by the immune system as foreign cells. The body's defenses begin to attack them, as a result of which they are destroyed. The presence of antisperm antibodies in semen and blood reduces the probability of egg fertilization to a minimum. When they are found in biomaterial, it is customary to talk about immunological infertility.
Kinds
In the human body, 3 classes of antisperm antibodies can form:
- IgA
- IgG
- IgM
The first 2 types of ASAT are of clinical importance. IgA antisperm antibodies appear in the seminal fluid , usually due to a violation of the biological barrier. The process of its restoration takes several weeks. After successful treatment, the concentration of protein substances of the IgA class decreases. The damaging effect of this type of ASAT is to change the morphological characteristics of sperm.
Protein substances of the IgG class contribute to an increase in the level of leukocytes in the seminal fluid, a decrease in its acidity and a reduction in the time of its liquefaction, which impedes the process of egg fertilization.
Diagnosis of ASAT
If you have difficulty conceiving, you must consult a doctor who will primarily prescribe a study of the biomaterial of both partners for the determination of antisperm antibodies.
There are several ways to detect ASAT in the body:
- Sample Shuvarsky.
- Blood test for antisperm antibodies by ELISA.
- Kurzrock-Miller test.
- MAR test.
The Shuvarsky test (another name for the study is the postcoital test) reflects the degree of immunological compatibility of partners. Biological materials are cervical mucus of a woman taken in the middle of the ovulation period, and male sperm, which is collected after several days of abstinence (about 5-6).
They are placed on a glass slide and mixed. Then, with a microscope, they monitor whether sperm death occurs. The duration of the study is 2 hours. The norm is considered if more than half of the sperm penetrated into a drop of cervical mucus. This means that there are no antibodies in the biomaterial of a woman. If the majority of sperm cells die, and the remaining become less mobile, the Shuvarsky test is considered to be positive. In this case, we are talking about the immunological incompatibility of partners.
If during the Shuvarsky test abnormalities were detected, blood is additionally donated for antisperm antibodies. Its execution time is about 4 days. The indication for a blood test for antisperm antibodies in women is also many years of unsuccessful attempts to become pregnant. For men, an analysis is prescribed in the presence of pathological changes identified in the spermogram process.
In order for the analysis results to be as reliable as possible, it is necessary to exclude factors that can distort them. To do this, observe the following rules:
- at least 8 hours should pass before the last meal and delivery of the biomaterial;
- 15 minutes before blood sampling, it is necessary to ensure physical and emotional peace;
- smoking should be excluded in 12 hours;
- stop taking medication in a few days (if for health reasons this is not possible, it is important to notify the attending physician);
- if the patient is a child under the age of 5 years, 30 minutes before the study, it is necessary to offer him boiled water in a volume of 150-200 ml as often as possible.
The norm of antisperm antibodies is less than 60 units / l. When the result is greater than this value, it is considered positive. If it is doubtful (the indicator is 60 units / l), additional studies are indicated.
The Kurzrock-Miller test is a test by the results of which it is possible to determine which of the partners is the cause of the childless union. In a woman in the middle of ovulation, cervical mucus is taken, in a man - sperm after several days of abstinence.
The test can be performed in one of the following ways:
- Direct. A combination of biological materials is carried out and sperm motility is assessed upon contact with cervical mucus.
- Cross The partners' biomaterial is combined with donor samples taken from people with children.
Options for the result of the study:
- Positive. Means that upon contact with mucus, sperm do not lose mobility, that is, conception in a natural way is possible.
- Weakly positive. During the study, mobility was preserved in some spermatozoa, while the other did not. Conception in this case can occur, but after the course of treatment.
- Negative. Means that sperm cannot penetrate the mucus. In this case, it is customary to talk about infertility.
If in the process of conducting a cross-test the sperm of the subject penetrate into the mucus of the donor, the cause of the childless union is a woman. If someone else's seminal fluid easily enters the patient’s sample, a man is considered infertile.
Antisperm antibody MAR test is a comprehensive study. It allows you to identify the degree of a man’s ability to bear children. After sampling the biomaterial, sperm is assessed by external signs. It should be white and transmit light. If it is opaque, this may indicate the presence of a pathology of an infectious nature. Also, the ejaculate should have a pH of at least 7.2.
Then a sample of biomaterial is placed under a microscope. With its help, the number, morphology and degree of sperm motility are estimated. It is also possible to monitor the change in the quality of seminal fluid over time, to identify the presence of pathogens in it.
The main stage of the mar-test for sperm antibodies is the mixing of biomaterial with a special substance. Its distinguishing feature is that it can only come into contact with seminal fluid, the cells of which are associated with antibodies.
During the study, the level of IgA and IgG is detected. The result is expressed as a percentage. If the number of sperm that are associated with antibodies does not exceed 10%, the chance of having a baby in a natural way is high. Currently, WHO has not defined specific indicators of the norm. But it is believed that 50% of sperm antibodies associated with antibodies significantly affect fertility. The higher this indicator, the lower the ability to conceive.
Conservative treatments
If one of the partners has a small amount of antisperm antibodies, drug therapy and condom use are indicated for 6 months.
It is allowed to have sex without resorting to the barrier method of contraception, but only on days favorable for conception. The need to use a condom is explained by the fact that the less sperm enters the body of a woman, the more significantly the production of ASAT will decrease.
Currently, many treatment regimens for antisperm antibodies have been developed. The most popular includes the following steps:
- Droppers. As a rule, Reosorbilak and Glutargin are administered one after the other. The course is 3 days.
- Injection Immediately after completing the dropper course, intramuscularly administered: human immunoglobulin (only 3 times, every other day), Diprospan (once), Erbisol (10 days).
- The second stage of the injection course. Three times a day, “Galavit” is administered.
Throughout the course of treatment, the patient also needs to take Claritin.
It is important to understand that all medications should be prescribed by a doctor, their dosage is also calculated individually on the basis of the results of all studies and taking into account the particular course of the disease in each individual person.
Folk methods
Alternative treatment should not be considered as the only way to get rid of the disease. The use of traditional medicine recipes is not prohibited, but first you need to get permission from your doctor. This is due to the fact that medicinal plants can weaken the effect of prescribed drugs.
The following recipes are most effective in the treatment of immunological infertility:
- Take a pinch of red geranium, pour 200 ml of boiling water over it. Let it brew for 10 minutes. After the specified time, the product can be taken orally 30 minutes after the completion of any meal - a tablespoon for both man and woman.
- Take 2 tbsp. l cinquefoil goose. Pour the plant 400 ml of boiling water. Insist for 1 hour. Means to use on an empty stomach daily.
- Prepare 2 tbsp. l calendula and 1 tbsp. l daisies. Mix the components, pour them with 200 ml of boiling water. Insist at least 12 hours. Then the product must be filtered and douched.
- Mix tincture of calendula and propolis extract (alcohol) in a ratio of 1: 1. Then 1 tbsp. l the resulting funds must be diluted in warm boiled water. This solution is also intended for douching.
Regular use of the above recipes will allow to reduce the concentration of antisperm antibodies in the biological materials of both partners.
Intrauterine Insemination
This term refers to reproductive technology. Its essence is as follows: a sperm is taken from a man, after which it is transferred to the woman directly into the uterus, that is, there is no sexual contact. Samples of both the partner and the donor can sit down.
In addition to the presence of a high level of sperm, the following diseases and conditions are indications for insemination:
- Erectile disfunction.
- Malignant neoplasms in men.
- Low sperm activity.
- An abnormally developed genital organ in a man.
- High viscosity in plasma semen.
- Vaginismus in a woman.
- Allergic reaction to sperm.
- Lack of ovulation.
The procedure is not performed if a woman is diagnosed with obstruction of the fallopian tubes. In addition, contraindications for persons of this gender are: oncological diseases, infectious pathologies of the reproductive system, myoma, polyps. After obtaining the results of all studies (blood test, spermogram, ultrasound), the question of the advisability of insemination is resolved.
The procedure is carried out according to the following algorithm:
- Stimulation of ovulation (if necessary).
- Monitoring its onset.
- A man’s fence of biomaterial, its preparation.
- The introduction of sperm using a catheter into the uterine cavity through the cervical canal.
According to statistics, the success rate is 12%. It is allowed to carry out the procedure for intrauterine insemination up to 4 times. If all attempts are unsuccessful, doctors recommend in vitro fertilization.
ECO
If the analysis for antisperm antibodies revealed a high level, experts most often advise patients to turn to this method.
In vitro fertilization is a reproductive technology, the essence of which is as follows: the partners collect biomaterial (eggs and sperm), after which the samples are placed in a special environment where they are connected. Then, the fertilized oocyte moves to the uterine cavity, where the process of pregnancy development starts.
45 % . , . - , . . , .
Finally
Antisperm antibodies are protein substances that are produced by the body’s immune system. Normally, they either should not be detected, or they may be present in the biomaterial, but in small quantities. If their level is significantly increased, it is customary to talk about immunological infertility. In order to determine the treatment tactics, the doctor draws up a comprehensive diagnosis for both partners. According to its results, it becomes clear which of them is barren. In severe cases, conservative treatment is ineffective. In such situations, for many couples, the only opportunity to become parents is IVF.