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  • Anticors anti-spermatozoïdes
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Indications de la recherche des anticorps anti-spermatozoïdes

Indications for antisperm antibody testing

Andrologie volume 13, pages 70–80 (2003)Cite this article

Resume

Les causes immunologiques de l’infertilité du couple sont souvent évoquées mais sont à l’heure actuelle toujours contestées. La prévalence des anticorps anti-spermatozoïdes chez l’homme varie de 2,8 à 26% et de 0,2 à 1,6% chez la femme. Les antigènes spermatiques n’apparaissant qu’à la puberté, toute pathologie mettant en contact ces antigènes avec le système immunitaire peut entraîner une immunisation. II existe des mécanismes anatomiques et physiologiques actifs pour éviter cette réponse immunitaire chez l’homme et la femme. De nombreux effets défavorables des anticorps anti-spermatozoïdes sur la fertilité ont été décrits: altérations des paramètres spermatiques, non-pénétration des spermatozoïdes dans le mucus cervical, interactions ovocyte-spermatozoïdes perturbées. Les indications de la recherche des anticorps chez l’homme et la femme sont basées sur des signes d’appel cliniques et biologiques.

Chez l’homme, tout antécédent de chirurgie urogénitale, d’obstruction congénitale ou acquise sur le tractus génital, et de pathologie du tractus notamment les infections et/ou inflammations, sont une indication de la recherche des anticorps antispermatozoïdes (ASA). Souvent les patients porteurs d’ASA n’ont pas d’antécédents pathologiques retrouvés, et seules les anomalies du spermogramme, les résultats négatifs ou “pauvres” des tests dans la glaire et les échecs de fécondationin vitro (FIV) classique, incitent à les rechercher.

Chez la femme, la pathogenèse de cette immunisation est moins claire que chez l’homme. Ont été incriminées les infections pelviennes hautes, l’endométriose, les fausses couches à répétition, les pratiques sexuelles et les interventions au niveau du col utérin. Comme chez l’homme, les tests dans la glaire sont négatifs ou déficients et on retrouve des échecs de FIV inexpliqués.

La conséquence du succès de l’ICSI dans cette indication est la diminution de la recherche sur les anticorps anti-spermatozoïdes. Avoir un diagnostic exact, une explication probable de l’infertilité du couple est indispensable car elle peut aider à la progression de la connaissance sur l’histoire naturelle de l’apparition des ces anticorps, sur l’identification des antigènes impliqués dans ce processus, et ainsi permettre le développement de tests de plus en plus spécifiques afin d’engager une stratégie de prise en charge plus rapide du couple à l’aide de la procréation médicalement assistée la plus adaptée.

Abstract

The clinical significance of antisperm antibodies (ASA) is highly controversial. A significant percentage of infertile men and women present immunity to spermatozoa, suggesting that ASA may interfere with the fertilizing capacity. ASA can act negatively on sperm parameters, sperm-cervical mucus interaction, gamete fusion and possibly also on the first step of embryonic development. ASA are present in approximately 2.8% to 26% of the male population and 0.2% to 1.6% of women. The pathogenesis of immunity to spermatozoa had not been fully elucidated: breakdown of normal protective mechanisms, i.e. blood-testis barrier, or epithelial barrier in women, and other mechanisms of immunological sperm tolerance, such as regulation of suppressor T lymphocytes.

The indication for antisperm antibody testing is based on clinical and laboratory findings of infertile patients. In men, indictions for ASA testing include a history of genital disease, surgery for genital abnormalities, vasectomy, obstruction or injuries of the male genital tract, infection of accessory glands, long-standing infertility, alteration of semen parameters (agglutination, motility), mucus penetration, and reduced fertilizing capacity in IVF. In many cases, no etiological cause of autoimmunity is found and a genetic predisposition has been suggested. A majority of women do not develop antisperm antibodies, despite repeated contact with spermatozoa during their sexual life. Upper genital tract infection is the main cause of isoimmunization in females, although sexual practices, endometriosis, surgery for cervical neoplasia, recurrent spontaneous abortion and long-term infertility may also be involved. Sperm-cervical mucus impairment is the most obvious effect of immunization in women associated with IVF failure. Autoantibodies are frequently associated with antisperm antibodies.

One of the consequences of the success of ICSI has been a decreased research effort to further the understanding of the origin and relevance of antisperm antibodies and specific antibody-antigen interactions. A better understanding of the natural history of immunological infertility would be useful for patient conseiling and to develop the most effective, efficient and safest management strategies. Such data could also be useful for the development of new tests and immunological methods of male contraception.

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  1. Biologie de la Reproduction, CECOS TOURS, CHU Bretonneau, 2 Bis Boulevard Tonnellé, 37044, Tours cedex

    Claire Barthélémy

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  1. Claire Barthélémy
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Correspondence to Claire Barthélémy.

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Barthélémy, C. Indications de la recherche des anticorps anti-spermatozoïdes. Androl. 13, 70–80 (2003). https://doi.org/10.1007/BF03034413

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  • DOI: https://doi.org/10.1007/BF03034413

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Basic and Clinical Andrology

ISSN: 2051-4190