Anti-sperm Antibodies (ASA): Common Q & A
Q. Is there a name for this process?
A. Yes. Production of anti-sperm antibodies (ASA) is a form of "auto-immunity". Although anti-sperm antibodies are harmless to the individual who has them, other types of auto-antibodies can be dangerous. There is a whole category of diseases called "auto-immune diseases", which can be very harmful. Anti-sperm antibodies are NOT included among these illnesses and are NOT related to the development of such diseases whatsoever.
Q. Do normal men ever have anti-sperm antibodies?
A. You bet. About 10% of normal healthy men have them. Many of these men have no history of vasectomy, infection, or other known causes. The existence of such antibodies in these men is a bit of a mystery. Most of these men are perfectly fertile.
Q. How do such antibodies cause infertility in men?
A. There are several known mechanisms. It is known that antibody-coated sperm have a difficult time passing through the cervical mucus of females. This usually occurs only when more than 50% of the sperm are coated. The cervical mucus contact test (CMT) is an assay which checks for this problem. When the test is positive, sperm within the cervical mucus lose their ability to swim forward and take on a shaking motion. This shaking motion is not effective for mucus penetration.
Q. What else can happen?
A. Antibody coated sperm can be gobbled up in the uterus by immune cells of the female. Interaction of sperm and egg can be disturbed by antibodies. In some cases, it appears that the sperm are unable to bind to the zona pellucida (ZP) of the egg. In others, the sperm can bind to the ZP, but can't penetrate it.
Q. What are anti-sperm antibodies (ASA)?
A. Anti-sperm antibodies are protein molecules created by the body as an immunological response to the presence of sperm. Antibodies are also called immunoglobulins.
Q. Why would the body create antibodies to sperm?
A. During the development of the immune system, a man's body has no sperm. They don't exist until puberty, whereupon they are made and stored within the testes. The immune system never gets to "see" them. When a man has a vasectomy, his immune system is exposed to his sperm, possibly as a result of leakage or obstruction. The immune system does not recognize them and mistakenly perceives them as foreign. It then creates anti-bodies to protect the individual from what it believes is an invader. This is the same response that the body manifests regularly to protect against bacteria and viruses. Antibodies also can develop against foreign tissue and are part of the reason for rejection in transplant patients.
Q. Is vasectomy the only cause of anti-sperm antibodies?
A. No. Anti-sperm antibody production can also be stimulated by severe trauma to the testicle and infections of the testicle or prostate gland. Other causes are listed inside this brochure.
Q. Does everybody who has had a vasectomy develop such antibodies?
A. No, but it seems that about 70% of men will develop them after vasectomy. They peak in number a year after vasectomy, and start to decrease after 2 years. In most cases, they eventually disappear. However, they have been demonstrated more than 20 years after a vasectomy in some individuals.
Q. Where do these antibodies exist?
A. They can be present in a man's semen and/or blood.
Q. Can women have them?
A. Yes. Some women develop antibodies to their husband's sperm. They can be found in the cervical mucus of such women.
Q. How can a person be tested for ASA?
A. It is widely believed that ASA in the semen are responsible for infertility rather than ASA in the blood. Therefore, it is the semen that is tested. Of the ASA present in the semen, only the ones actually bound to sperm cells are measured.
There are a number of different methods employed for such testing. The most widely used is the immunobead test.
Q. Do you ever test the blood for ASA?
A. Rarely. The blood is only tested when the semen contains no sperm, a condition called azoospermia.
Q. Does every person who wants to have a vasectomy reversal need testing for ASA?
A. Absolutely not. The vast majority of men should have their reversal without being checked for ASA.
Q. Do ASA always interfere with fertility?
A. No. In most cases they will have no effect.
Q. How do I know if I need to be tested?
A. Establishing the need for testing is difficult in men who have had vasectomies that haven't been reversed. Since there are no sperm in their semen, it is not practical to assess antibody binding, motility, cervical mucus interaction, ZP binding/penetration, etc. If required, testing is sometimes done after reversal.
Q. I've had a reversal. How do I know if I need ASA testing?
A..Some relative indications may include clumping of the sperm, impairment of motility when other causes have been eliminated, and demonstration of "shaking" motion by sperm in cervical mucus.
Q. Do ASA decrease sperm count or viability?
Q. Is there anything definite that can show up in my sperm count after reversal which can alert my urologist to the presence of ASA?
A. No. There is no single finding which will irrefutably demonstrate the presence of ASA. To establish their existence, specific tests must be done.
Q. So, if I want to have a reversal to restore my fertility, I don't need to be concerned about the possible presence or occurrence of ASA?
A. That is correct. There is no need for concern.
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