Kay D J, Hosken B, Boettcher B, Clark L
Department of Biological Sciences, University of Newcastle, Australia.
Am J Reprod Immunol Microbiol. 1988 Jun;17(2):48-52. doi: 10.1111/j.1600-0897.1988.tb00201.x.
Men presenting with azoospermia due to aplasia of the vas deferens have commonly been considered to be infertile without hope of treatment. With improved methods of artificial insemination however, and more particularly with the advent of in vitro fertilization, it has been suggested that unusable spermatozoa may be able to be drawn from the epididymes of such men so that fertilization is achieved. The clinical situation of such men is analogous to that of long term vasectomised patients, 60% of whom are known to produce antibodies to spermatozoa which would interfere with the fertilization process. It was therefore decided to attempt to draw fluid from the epididymes of three such patients and at the same time conduct immunological studies on their sera, seminal fluid and, where available, epididymal fluid. Unfortunately, the spermatozoa obtained from all three men lacked sufficient progressive motility for use in in vitro fertilization. In addition, all men had antispermatozoal antibodies in their sera. Two of them also had antispermatozoal antibodies in their epididymal fluid and on their sperm, one at the same titer as in his serum. Since it is known that antibodies coating sperm reduce the changes of fertilization it is suggested that their presence should be assessed in all such men being considered for treatment. In addition, these studies demonstrate that antispermatozoal antibodies can enter the male tract at the level of the epididymis or higher and there were strong suggestions of local antibody production at this level in the tract.
因输精管发育不全而导致无精子症的男性通常被认为不育且无治疗希望。然而，随着人工授精方法的改进，尤其是体外受精技术的出现，有人提出或许可以从这类男性的附睾中获取可用的精子以实现受精。这类男性的临床情况与长期输精管结扎患者类似，已知60%的长期输精管结扎患者会产生抗精子抗体，这会干扰受精过程。因此，决定尝试从三名此类患者的附睾中抽取液体，同时对他们的血清、精液以及（如有）附睾液进行免疫学研究。不幸的是，从所有三名男性身上获取的精子均缺乏足够的前进运动能力以供体外受精使用。此外，所有男性的血清中都有抗精子抗体。其中两人的附睾液和精子上也有抗精子抗体，其中一人的抗体滴度与血清中的相同。由于已知覆盖精子的抗体会降低受精几率，因此建议在考虑对所有此类男性进行治疗时评估抗体的存在情况。此外，这些研究表明抗精子抗体可在附睾或更高水平进入男性生殖道，并且有强烈迹象表明在生殖道的这个水平存在局部抗体产生。
