Male immune infertility: a million dollar question in medically assisted reproduction

Male factor infertility accounts for approximately 30–50% of all infertility cases. The primary causes include genetic abnormalities, sexually transmitted infections, physical or anatomical issues, hormonal imbalances, lifestyle factors, and environmental influences. Despite significant advances in diagnostic techniques, an identifiable cause remains elusive in nearly 40% of cases. One less commonly recognized factor is male immune infertility, which results from the presence of antisperm antibodies (ASA) in semen. These antibodies are typically identified through an extended semen analysis. Under normal physiological conditions, spermatogenesis and sperm transport occur within an immune-privileged environment. However, when the blood-testis barrier is compromised due to trauma, infection, or surgery, ASA may form. The effects of ASA on fertility can vary, but evidence indicates that ASA presence may impair sperm motility and capacitation, promote sperm agglutination, and be associated with DNA fragmentation. To address these challenges, assisted reproductive technologies (ART), including intrauterine insemination (IUI), in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI), are commonly used. These methods have proven to be effective in overcoming ASA-related infertility and improving reproductive outcomes. Given the ongoing debate and uncertainty surrounding the clinical relevance of ASA, this paper aims to review existing literature, explore the concept of male immune infertility, identify its risk factors, outline current methods for ASA detection, evaluate the role of ASA in ART, highlight both the strengths and limitations of current research, and contribute to a clearer understanding of this complex condition. After our literature review, we could confirm that multicentric studies with large groups of patients related to this topic are rarely found, and that there are many uncertainties regarding the clinical significance of ASA. The complete system of diagnosing male immune infertility lacks precise guidelines that infertility clinics could use in their routine male infertility check-ups.

Male infertility; Male immune infertility; Antisperm antibodies; The mixed antiglobulin reaction (MAR) test; Assisted reproductive technology

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