Immunologic infertility.

In general, the management of antibody-mediated infertility has been plagued by misdiagnosis due to the choice of assay system, therapies that may be associated with major side effects, and a failure to learn from the models of other antibody-mediated diseases. An important consideration in diagnosing antibody-mediated infertility is to use an immunoglobulin-specific technique that employs intact or living spermatozoa. Once this is done, a search should be made for what functional deficits in reproduction are associated with the presence of the antisperm antibodies. This would include postcoital testing, tests for ovum penetration (human sperm/hamster egg penetration assay), and tests for the ability of the sperm in the presence of antibody to undergo the acrosome reaction. Once the extent of the reproductive deficit is known, appropriate therapy can then be suggested. I believe that a "case" must be built to prove that antibody-mediated fertility actually exists in a particular couple, even in the presence of a positive test that is known to be highly specific. Sperm antibodies can attach to the sperm's surface without detrimentally affecting reproductive function. In a similar vein, low levels of sperm antibodies could give a positive test result, but the level may be insufficient to be a major detriment to fertility. It is hoped that in the near future isolation of specific sperm antigens will be used to identify antibodies against antigens critical to reproductive function. It may be possible to determine the minimal amount of antisperm antibody that is necessary to disturb each individual step in reproductive function. If a patient is found to have sperm antibodies whose quantity exceeds this amount, then the patient can be appropriately labeled as having antibody-mediated infertility. The array of therapies available for the couple's unique fertility problem(s) can then be described to the patient, and an appropriate therapeutic choice made.