The list of problems with women’s health leading to infertility is expanding every year. One of the least studied factors that impede conception processes is the presence of anti-sperm antibodies (ASAT) in the body of a potential mother. These substances significantly reduce the likelihood of pregnancy, negatively affecting the fertility processes of women. In this case, the basis is the presence of specific antibodies in the blood, which reject the seminal fluid of the partner and, accordingly, impede the fact of fertilization or the development of a viable embryo of full value. Such features are detected on average in 10% of the total number of infertile couples, and in most cases are successfully arrested by the capabilities of modern reproductive technologies.
What are anti-sperm antibodies in women, how is their presence in the body manifested and what does this feature of the body lead to? The basics of the diagnosis and treatment of immunological infertility on the part of a woman will help to understand the sensitive problem and get a chance for healthy parenthood.
Classification and features of ASAT
Anti-sperm antibodies are substances of protein origin that are able to recognize spermatozoa and have a destructive effect on them. Attaching to the sperm membranes, ACAT can cause the following cellular abnormalities:
- Sperm immobilization is the partial or complete immobilization of male germ cells in the female reproductive tract.
- Sperm agglutination – sticking of sperm with each other, macrophages, mucus of the cervical canal, cell particles and other elements contained in the female vaginal secretions.
- Epidermolysis – the total destruction of male gametes.
Any of the possible actions of anti-sperm antibodies can significantly complicate conception, leading to infertility. However, in some cases, this feature does not prevent the onset of pregnancy – according to statistics, 1-4% of married couples with children have a low concentration of AST in the mother’s blood, which she did not even suspect before the onset of pregnancy. This means that this feature is not a sentence for a woman – with proper treatment, the probability of defeating the immunological factor of infertility is very high.
Why do anti-sperm antibodies appear in the female body?
Sperm and seminal fluid that enters the reproductive system of a woman during sexual intercourse are completely alien. However, they normally do not encounter any insurmountable obstacles on the way to the egg cell, fertilizing it easily and naturally in the process of fusion. However, such an idyllic picture is not always real – in some cases, a woman’s immunity manifests pathological activity, synthesizing anti-sperm antibodies and attacking spermatozoa while still in the process of movement, completely destroying or significantly weakening them. This pathology may occur as a result of the following deviations:
- inflammation of the reproductive organs, which arose against the background of infection and activates the immune defense, which subsequently acquires hypertrophied forms;
- ingestion of defective, non-viable and abnormal sperm into a woman’s body, which automatically activates protective mechanisms, preventing a deliberately unpromising pregnancy;
- a high percentage of leukocytes in the seminal fluid of the partner, which occurs against the background of infection and is perceived by the female body as potentially dangerous;
- frequent use of chemical methods of contraception, which can cause damage to the vaginal mucosa;
- structural features of the female genital organs or the consequences of unsuccessful intrauterine insemination, as a result of which a high dose of sperm penetrates the abdominal cavity;
- atypical reaction to coagulation of erosive damage to the mucous membranes of the vagina;
- Unsuccessful in vitro fertilization attempts that caused a hormonal storm and atypical immune responses.
Any of these diseases may be complicated by the appearance of anti-sperm antibodies, which aggravate reproductive difficulties, causing immunological infertility. However, this list is far from complete – there may be infinitely many factors in one way or another affecting the reactions of female immunity, and it is almost impossible to take into account each of them. That is why the diagnosis of each reproductive problem begins with a patient’s blood test, which serves as a reliable diagnostic criterion for the presence of ASAT in a woman.
Diagnosis of immunological infertility in women
In order to detect the presence of anti-sperm antibodies in a woman, it is necessary to conduct a thorough examination, including a blood test and cervical mucus – it is in these secretions that ACAT can be detected. Such diagnostics is mandatory for couples suffering from infertility of unexplained genesis, as well as those who are going to undergo the procedure of in vitro fertilization, the outcome of which will largely depend on the characteristics of the patient’s immune protection.
Most diagnostic tests are based on the detection of antibodies against sperm membrane antigens. Among them, the following studies are highly informative and reliable:
- MAR test. This type of research is considered the world standard for the diagnosis of anti-sperm antibodies, both for women and men. The results of the study are the total number of male germ cells associated with antibodies of immunoglobulins A and G, as well as the titer of ACAT in the mucous discharge of the cervix and blood plasma of the patient.
- Postcoital test. This study is based on the analysis of the interaction of sperm with the mucous membrane of the cervix. Despite the high accuracy of the results, the negative effect cannot be differentiated by gender, which, of course, is the key drawback of this kind of diagnosis and allows for post-coital research only in conjunction with other procedures. A negative result of the interaction, in this case, may be caused by the presence of anti-sperm antibodies in a woman, her partner, or both spouses.
- Latex agglutination. Modern, high-tech, but not yet fully understood the method, through which you can recognize anti-sperm antibodies in the biological fluids of the female body, in particular, in the blood and mucous secretions from the reproductive organs. Despite its high sensitivity, at this stage, it is used as an auxiliary study in combination with other tests to assess their reliability and differentiate the problem.
- ELISA method or ELISA. Such diagnostics are carried out to detect anti-sperm antibodies in a woman’s blood plasma. Like latex agglutination, it is considered auxiliary and serves to confirm the diagnosis.
As a rule, if there is evidence, the reproductologist is not limited to any particular method, using all the tests in the complex. This approach allows you to get the most accurate clinical picture that reflects the state of health of the woman, and therefore, assign the correct and most effective treatment.
Rules for preparing for diagnostic events
If your doctor has prescribed a blood test for the determination of anti-sperm antibodies, you should prepare for it in advance – this will significantly increase the information content and reliability of the test. To exclude factors that somehow affect the outcome of the study, it is necessary:
- do not eat at least 8-10 hours prior to analysis;
- immediately before the selection of venous blood, provide a full 15-minute rest – sit quietly or lie on the couch, relax and distract from worries about the upcoming test;
- do not take any medications a day before the analysis, and if this is not possible, inform the attending physician and laboratory technician about drug therapy;
- 12 hours before the study, do not drink alcohol, fatty, fried, spicy foods, do not smoke, and also limit physical activity.
By following these rules, you will be able to significantly increase the reliability of plasma screening for the presence of anti-sperm antibodies. As for mucus from the cervical canal, it is selected before ovulation, that is, somewhere in the middle of the menstrual cycle (a reproductologist will determine the exact date individually). Since the preparation for the study also takes place at home, a woman should remember that one day before the analysis no medication should be taken, especially of local importance (that is, vaginal suppositories). On the morning of the day of delivery, you can not carry out hygienic procedures of the external genital organs, as well as go to the toilet for at least 2 hours. In addition, in order to avoid distortion of the result, you should refrain from intimacy for at least 2-3 days.
Treatment
In the presence of anti-sperm antibodies in a woman’s body, primary therapy is directed solely at the successful conception and subsequent birth of a healthy child. The initial treatment for this abnormality is condom therapy, which eliminates any possible contact of the female reproductive system with the partner’s germ cells. For this, barrier contraceptives have been used for several months – during this time the woman’s immunity can adapt and the amount of anti-sperm antibodies will drop to an insignificant level. At the same time, a woman may be prescribed drug therapy to reduce the viscosity of cervical mucus and suppress an active immunological reaction, in which a large amount of ACAT is produced.
If after half a year, conservative therapy does not bring the desired result, the fertility specialist may recommend an in vitro fertilization procedure for the couple using ICSI. This technique involves the introduction of sperm into the cytoplasm of the egg, bypassing the other stages at which anti-sperm antibodies can occur. This approach greatly increases the chances of IVF success, allowing spouses to become parents, despite the presence of anti-sperm antibodies and diagnosed infertility!
