男性不妊における抗精子抗体に関する臨床的研究

Abstract

The relationship between male infertility and sperm immunity was studied on 237 patients of male infertility; 159 oligozoospermia, 33 functional azoospermia, 13 obstructive azoospermia and 32 men from unexplained infertile couples. Twelve vasectomized and 52 fathered men were also studied as controls. For detection of antibodies, their sera were tested by tube-slide agglutination test, sperm immobilization test, indirect immunofluorescent antibody technique, and in some cases gelatin agglutination test. Seminal plasma was tested by sperm immobilization test and agglutination tests in some cases. Kremer's in vitro sperm penetration test was done on cases with positive antisperm antibodies. The results are as follows: 1) The proportion of positive antisperm antibodies in serum showed significantly high value in the patients of obstructive azoospermia and post-vasectomy compared with normal controls. Indirect immunofluorescent antibody technique particularly showed high positive rate as in the obstructive azoospermia group being the highest as 92.3%. Accordingly, this method seemed to be helpful for diagnosis of obstructive azoospermia. On the other hand, in the cases of functional azoospermia the positiveness was particularly low. 2) There was no significant difference in the positive rate between the group with impaired function of sperm production and the group with normal sperm counts. In obstructive azoospermia, the function of sperm production remained normal on testicular biopsy despite antisperm antibodies in serum. There seemed to be a little possibility that antisperm autoimmunity caused impairment of sperm production. 3) Sperm autoagglutination correlated with the results of tube-slide agglutination test. But more definite correlation was shown with gelatin agglutination test according to the fact that all the 10 cases with sperm autoagglutination were positive and their antibody titers showed relatively good correlation with the degree of sperm autoagglutination. It was suggested that sperm autoagglutination was caused by sperm agglutination antibodies. 4) No correlation was seen between impaired sperm motility rate and sperm immobilizing antibody. There were found cases with normal sperm motility in spite of their high titered sperm immobilizing antibodies. 5) According to the data of Kremer's test with semen of men with antisperm antibodies, sperm agglutinating and immobilizing antibodies were confirmed to impair sperm penetration through the cervical mucus. Therefore these antibodies can be the cause of infertility. On the other hand, antibody which could be detected by indirect immunofluorescent antibody technique did not impair sperm penetration. 6) In summary, an6sperm antibodies may not cause the disturbance of function of sperm production, but can be a cause of infertility in some patients with them. It can be concluded that detection of antisperm antibodies is necessary for clarifying the cause of male infertility clinically even though the semen findings are normal.