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 both sexes, or be in it in a small concentration. If their level is elevated, then the likelihood of pregnancy in a natural way is minimized. Currently, in vitro fertilization is considered the most effective method of treatment.
Concept
In medicine, the term "antisperm antibodies" refers to substances of protein origin. They are produced by the human body's defense system. They can be found in spermatozoa, blood serum, cervical mucus, seminal plasma. In a third of patients suffering from infertility, these substances are detected. It also happens that they are found in he althy people,but this is extremely rare.
The presence of antisperm antibodies in men is of particular clinical significance. This is explained by the fact that their presence in the ejaculate is proof of infertility of an immunological nature. If antisperm antibodies are found 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 sex these protein substances appeared. The only task of anti-sperm antibodies is to destroy spermatozoa, which prevents pregnancy in a natural way.
Causes of appearance in women
In the human body, ASAT 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 formation of antisperm antibodies starts.
Their appearance is also facilitated by the pathology of the organs of the female reproductive system. The mechanism of ACAT formation in this case is as follows: during the movement, the spermatozoa enter the focus of inflammation, where the cells of the body's defense system try to destroy pathogens. As a result, they also get hit and do not reach their goal.
Causes of antisperm antibodies in cervical mucus and blood in women:
- Violation of the integrity of the mucous membrane.
- Increased concentration of leukocytes in the partner's seminal fluid.
- Presence in the ejaculate of spermatozoa that interact with antibodies.
- The consequence of cauterization of cervical erosion.
- A large amount of "old" spermatozoa in the ejaculate, which is considered a pathological condition.
- Penetration of seminal fluid into the peritoneum. This may be the result of an incorrectly performed in vitro fertilization.
- Penetration of sperm into the gastrointestinal tract. A similar situation can occur during oral or anal sex.
- If there have been attempts to get pregnant through artificial insemination in the past. In this case, antisperm antibodies in the mucus and blood may be formed due to trauma received during the collection of oocytes (eggs). They are also often formed against the background of a pronounced hormonal surge.
Sperm components that have been destroyed are taken up by macrophage cells. The latter break them down into the smallest elements. Some of these small components form antisperm antigens on the surface of macrophage cells over time. The latter sooner or later enter the circulatory and lymphatic systems. As a result, the process of formation of antisperm antibodies starts. They spread throughout the body through liquid connective tissue, after which they penetrate the mucous membranes in search of foreign antigens. If spermatozoa are encountered on their way, ASAT immediatelystart attacking 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 sperm to eggs, 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 has occurred. In this case, constant monitoring of the expectant mother by doctors is necessary. This is due to the fact that anti-sperm antibodies can negatively affect the viability of the fetus.
Reasons for appearance in men
ASAT begin to form in adolescents during puberty. Oddly enough, but one's own spermatozoa 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 defense system. In he althy men, spermatozoa 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 men have a high concentration of antisperm antibodies in the blood and semen, the reasons may be:
- Infectious diseases.
- Narrowing of the lumen of the vas deferens.
- Significant pelvic injuries.
- Malignant neoplasms.
- Surgical intervention in the abdominal cavityor organs of the reproductive system.
- Undescended testis into the scrotum (congenital).
Spermatozoa 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 likelihood of egg fertilization to a minimum. When they are found in the biomaterial, it is customary to talk about immunological infertility.
Views
3 classes of antisperm antibodies can form in the human body:
- IgA.
- IgG.
- IgM.
The first 2 types of ASAT are of clinical importance. In the seminal fluid, antisperm IgA antibodies appear, as a rule, due to a violation of the biological barrier. The recovery process 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 features of spermatozoa.
Protein substances of the IgG class contribute to an increase in the level of leukocytes in seminal fluid, a decrease in its acidity and a reduction in its liquefaction time, which prevents the process of fertilization of the egg.
ASAT diagnostics
If you experience difficulties with conception, you should consult a doctor who will first prescribe a study of the biomaterial of both partners to determine antisperm antibodies.
There isseveral ways to detect ASAT in the body:
- Shuvarsky test.
- A blood test for antisperm antibodies by ELISA.
- Kurzrock-Miller test.
- MAR test.
Shuvarsky test (another name for the study - postcoital test) reflects the degree of immunological compatibility of partners. Biological materials are the cervical mucus of a woman, taken in the middle of the ovulation period, and male sperm, which is taken after several days of abstinence (about 5-6).
They are placed on a glass slide and mixed. Then, with the help of a microscope, they monitor whether the death of spermatozoa occurs. The duration of the study is 2 hours. It is considered normal if more than half of the spermatozoa penetrated into a drop of cervical mucus. This means that there are no antibodies in the woman's biomaterial. If most of the spermatozoa die, and the rest become less mobile, the Shuvarsky test is considered positive. In this case, we are talking about the immunological incompatibility of partners.
If abnormalities were detected during the Shuvarsky test, blood is additionally donated for antisperm antibodies. Its execution time is about 4 days. An indication for a blood test for antisperm antibodies in women is also many years of unsuccessful attempts to get pregnant. For men, analysis is prescribed in the presence of pathological changes detected in the process of spermogram.
In order for the results of the analysis to be as reliable as possible, it is necessary to excludefactors that can distort them. To do this, you must follow the following rules:
- before the last meal and the delivery of the biomaterial, at least 8 hours must pass;
- 15 minutes before blood sampling, you need to provide yourself with physical and emotional peace;
- Smoking should be eliminated within 12 hours;
- stop taking medication in a few days (if this is not possible for he alth reasons, it is important to notify your doctor);
- if the patient is a child under the age of 5 years, 30 minutes before the examination, you should offer him boiled water in a volume of 150-200 ml as often as possible.
The indicator of 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.
Kurzrock-Miller test - a test, according to the results of which it is possible to determine which of the partners is the cause of a childless union. In a woman, cervical mucus is collected in the middle of ovulation, in a man, sperm is collected after several days of abstinence.
The test can be done in one of the following ways:
- Straight. Biological materials are combined and sperm motility is assessed upon contact with cervical mucus.
- Cross. Partners' biomaterial is combined with donor samples taken from people who have children.
Research result options:
- Positive. Means that upon contact with mucusspermatozoa do not lose mobility, that is, conception is possible naturally.
- Weakly positive. During the study, some of the spermatozoa retained motility, while the other did not. Conception in this case may occur, but after the course of treatment.
- Negative. Means that spermatozoa cannot penetrate the mucus. In this case, it is customary to talk about infertility.
If, during the crossover test, the spermatozoa of the subject penetrate into the mucus of the donor, the reason for the childless union is a woman. If foreign seminal fluid easily enters the patient's sample, the male is considered infertile.
MAR-test for antisperm antibodies is a comprehensive study. It allows you to determine the degree of a man's ability to bear children. After taking the biomaterial, the sperm is evaluated by external signs. It should be white and let in light. If it is opaque, this may indicate the presence of an infectious pathology. Also, the ejaculate must have a pH of at least 7.2.
Then the biomaterial sample is placed under the microscope. With its help, the number, morphology and degree of sperm motility are assessed. It is also possible to track the change in the quality of the seminal fluid over time, to identify the presence of pathogens in it.
The main stage of the mar-test for antisperm antibodies is mixing the 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 withantibodies.
During the study, the level of IgA and IgG is detected. The result is expressed as a percentage. If the amount of sperm that is associated with antibodies does not exceed 10%, the chance of conceiving a child naturally is high. At present, WHO has not defined specific indicators of the norm. But it is believed that 50% of antibody-bound spermatozoa 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 the use of a condom for 6 months are indicated.
It is allowed to have sex without resorting to a barrier method of contraception, but only on fertile days. The need to use a condom is explained by the fact that the less sperm enters the woman's body, the more significantly the production of ASAT will decrease.
Currently, many antisperm antibody treatment regimens have been developed. The most popular includes the following steps:
- Droppers. As a rule, Rheosorbilac and Glutargin are administered one after the other. Course - 3 days.
- Injections. Immediately after completion of the course of droppers, the following are injected intramuscularly: human immunoglobulin (only 3 times, every other day), Diprospan (once), Erbisol (10 days).
- The second stage of the course of injections. Three times a day they introduce "Galavit".
Throughout the course of treatmentthe patient also needs to take Claritin.
It is important to understand that all drugs must be prescribed by a doctor, their dosage is also calculated individually based on the results of all studies and taking into account the characteristics of the course of the disease in each individual.
Folk methods
Unconventional 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 you must first obtain permission from your doctor. This is due to the fact that medicinal plants can weaken the effect of prescribed drugs.
The most effective in the treatment of immunological infertility are the following recipes:
- 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 remedy can be taken orally 30 minutes after the completion of any meal - a tablespoon for both a man and a woman.
- Take 2 tbsp. l. goose cinquefoil. Pour the plant with 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. chamomile. Mix the components, pour them with 200 ml of boiling water. Infuse for at least 12 hours. Then the remedy 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 product must be diluted in warm boiled water. This solution is also intended for douching.
Regular use of the aboveprescriptions will 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 man takes sperm, after which it is transferred to the woman directly into the uterus, that is, there is no sexual contact. Both partner and donor samples can be implanted.
In addition to the presence of a high level of antisperm bodies, the following diseases and conditions are indications for insemination:
- Erectile dysfunction.
- Malignant neoplasms in men.
- Low sperm activity.
- Abnormally developed penis in a man.
- High viscosity in plasma semen.
- Vaginismus in a woman.
- Allergic reaction to semen.
- No ovulation.
The procedure is not performed if the woman is diagnosed with obstruction of the fallopian tubes. In addition, contraindications for persons of this gender are: oncological diseases, infectious pathologies of the organs of the reproductive system, fibroids, polyps. After receiving the results of all studies (blood test, spermogram, ultrasound), the issue of the advisability of insemination is decided.
The procedure is carried out according to the following algorithm:
- Ovulation stimulation (if necessary).
- Monitoring its onset.
- Fence from a manbiomaterial, its preparation.
- Introducing sperm with 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 of intrauterine insemination up to 4 times. If all attempts fail, doctors recommend in vitro fertilization.
ECO
If the analysis for antisperm antibodies revealed a high level, most often experts advise patients to turn to this method.
In vitro fertilization is a reproductive technology, the essence of which is as follows: biomaterial (eggs and sperm) is taken from partners, after which the samples are placed in a special environment where they are combined. Then the fertilized oocyte moves to the uterine cavity, where the process of pregnancy development starts.
In about 45% of patients, the first attempt is successful. It is important to understand that there are many factors that affect performance. For many childless couples, IVF is the only way to become parents, but it is not always possible to get pregnant after the first one. This is a complex and lengthy process. As practice shows, after the second attempt, pregnancy occurs in most cases.
In closing
Anti-sperm antibodies are protein substances that are produced by the body's immune system. Normally, they either should not be detected, or they canbe present in the biomaterial, but in a small amount. If their level is significantly increased, it is customary to talk about immunological infertility. In order to determine the tactics of treatment, the doctor draws up a referral to both partners for a comprehensive diagnosis. According to its results, it becomes clear which of them is infertile. In severe cases, conservative treatment is ineffective. In situations like this, for many couples, IVF is the only way to become parents.
