Antisperm antibodies cause infertility; immunosuppression and traditional Chinese medicine treatment.
Antisperm antibodies reduce the number of sperm entering the fertilization site, which is only one aspect. They also interfere with sperm metabolic activation, disrupt fertilization, and inhibit zygote cell division. The mechanism by which sperm antibodies affect fertility is as follows:
Sperm autoimmunity can cause spermatogenesis disorders, leading to oligospermia or azoospermia. This condition often results from pathological damage to the testes, epididymis, or accessory glands, or from reproductive tract obstruction. The main manifestations are:
1. The effect of sperm antibodies on sperm motility. If antisperm antibodies are located at the top of the sperm, the sperm heads will stick together, forming clumps, as if chained together; if the antibody site is at the tail, the sperm tails will stick together, resulting in agglutination and affecting motility.
2. Inhibits sperm transport in the female reproductive tract. Because the Fc segment of sperm antibodies binds to cervical mucus glycoprotein molecules, sperm motility is impaired when penetrating cervical mucus, thus reducing the sperm's ability to penetrate the mucus.
3. Interference with sperm capacitation or acrosome reaction. Antisperm antibodies affect the rearrangement of sperm surface molecules and particles on the acrosome and plasma membranes, thus affecting sperm capacitation and inhibiting fertilization by blocking the release of hyaluronidase. They can also affect fertilization by affecting sperm penetration of the zona pellucida, sperm-egg fusion, or by acting directly as a spatial barrier.
Treatment for this disease should primarily consider: first, eliminating factors that cause sperm to come into contact with the autoimmune system; second, regulating the immune mechanism to prevent the production of antisperm antibodies. If new antibodies are no longer produced, the existing antisperm antibodies may gradually decrease; and third, improving sperm function as much as possible to reduce the damage caused by antibodies.
Identifying the underlying cause and treating accordingly is the most effective treatment method. If a history of reproductive tract infection is found, and symptoms and signs are present, adequate doses of antibiotics should be used depending on the specific source of infection. For example, some patients with prostatitis, seminal vesiculitis, epididymitis, or vas deferens inflammation may produce antisperm antibodies. It is generally believed that these antibodies will disappear naturally after the infection is cured. For severe testicular injury, testicular torsion, testicular tumors, epididymal cysts, hydrocele, etc., surgery is necessary, and active surgical treatment can help reduce antibody production and promote antibody disappearance. Varicocele infertility may also be related to antibodies. As the severity of varicocele increases, the antibody positivity rate rises significantly. Treatment with medication, embolization, and surgery will also help the antibodies disappear.
High doses of testosterone can inhibit sperm production, causing azoospermia. Clinically, a two-week course of 250 mg testosterone resulted in azoospermia. During the 6-12 months of treatment, antibody titers decreased. After treatment was stopped, antibody and sperm counts returned to therapeutic levels. Some patients conceived without developing antibodies for a period, but antibodies reappeared a year later. Another possible treatment is 250 mg testosterone intramuscularly every two weeks until azoospermia is achieved and maintained for two months, followed by 16 mg methylprednisolone daily for one month, then 8 mg methylprednisolone daily for one month. However, this method can sometimes cause testicular tissue damage, leading to permanent azoospermia.
Side effects from these treatments are unavoidable, and some are quite serious. Patients can use a combination of traditional Chinese and Western medicine, employing holistic conditioning and syndrome differentiation to reduce side effects and significantly improve efficacy, aiming for a cure. Traditional Chinese medicine believes that the appearance of antisperm antibodies is related to internal disturbances by pathogenic factors, leading to impaired sperm and blood flow, weakened sperm motility in the uterus, poor blood circulation, difficulty in sperm transport, and difficulty in fertilization, or even gestational distension. Patients can take a decoction to regulate immunity and promote fertility (containing Cuscuta chinensis, Lycium barbarum, Ligustrum lucidum, Cornus officinalis, Epimedium, Salvia miltiorrhiza, Paeonia lactiflora, Angelica sinensis, Leonurus japonicus, Rehmannia glutinosa, Polygonum cuspidatum, Citrus aurantium, and Hedyotis diffusa) to tonify the kidneys, replenish qi and essence, promote blood circulation, remove blood stasis, clear heat, and eliminate dampness. They can also take some proprietary Chinese medicines, such as Jingtailai granules, Jingmiankang, Kangmian capsules, Kangmianling liquid, Kangmiancuyu pills, and immune-regulating agents. In addition, acupoint embedding therapy is also widely used in clinical practice. This therapy boasts a high cure rate and minimal side effects for patients with positive antisperm antibodies. It also functions as a form of heterologous tissue therapy in modern medicine, regulating physiological functions, accelerating metabolism, and enhancing immunity and resistance. The catgut used in the thread embedding therapy, a foreign protein, is implanted into acupoints, inducing biophysical or biochemical changes that produce a slow, gentle, and lasting stimulation, clearing the meridians, harmonizing yin and yang, and strengthening the body's resistance to pathogens, thereby achieving the therapeutic goal.
Specifically, the following are some methods for treating immunological infertility:
1. Immunosuppressive therapy: using glucocorticoids. Some patients may conceive after 1-3 courses of treatment, depending on their partner's menstrual cycle. However, nearly two-thirds of patients experience side effects with high-dose hormone therapy, such as weight gain, irritability, mood changes, acne, edema, and rashes.
2. Testicular rebound therapy: In a small number of men with autoimmune infertility, sperm count is not reduced, and in some cases it is even high, leading to a surge in the number of antisperm antibodies. High-dose testosterone treatment can be used to significantly reduce or eliminate the titer of antisperm antibodies in the body. Once treatment is stopped and sperm count returns to normal, some patients' antisperm antibody levels do not increase again, potentially allowing their partners to conceive.
3. Etiological Treatment: In cases of reproductive system infection, edema and obstruction of the vas deferens, as well as damage to the blood-testis barrier by microorganisms, can induce antibody production, leading to infertility. Therefore, male reproductive tract inflammation should be treated aggressively, with earlier and more timely anti-infective treatment being better. The general treatment period is 6–12 months. For infertility caused by testicular tissue damage and epididymal lesions resulting in autoantibodies against sperm, surgical treatment should be performed to eliminate the lesions causing the immune response, potentially improving fertility.
4. Sperm washing and intrauterine artificial insemination.
5. Traditional Chinese Medicine Treatment: Some researchers have used a pure Chinese herbal decoction, supplemented with a small dose of prednisone, to treat patients with positive serum antisperm antibodies. The results showed that the disappearance rate of antisperm antibodies reached 95%. Numerous reports have confirmed that after treatment with Chinese herbal medicines that warm the yang and tonify the kidneys, replenish essence and marrow, promote blood circulation and remove blood stasis, and clear heat and detoxify, the average forward motility speed of motile sperm increased, and the detection rate of pus cells in semen decreased.