title: Immunological infertility among Nigerian men: incidence of circulating antisperm auto-antibodies and some clinical observations: a preliminary report.
abstract: OBJECTIVE
  To (i) establish the incidence of circulating antisperm auto-antibodies among infertile men; (ii) relate this incidence to the high prevalence of sexually-transmitted diseases (STDs) in sub-Saharan Africa and; (iii) elucidate the effect of steroid and other therapy on semen quality and subsequent fertility of the patients.
  
  
  METHODS
  Serum samples from 50 infertile men and 50 age-matched controls were assayed by two agglutination techniques for anti-sperm antibodies. Mean sperm concentrations were determined before and after steroid treatment of patients having antibody titres of 1:64 or above. Serum levels of follicle-stimulating hormone, luteinizing hormone, testosterone and prolactin were also determined by radioimmunoassay in 38 patients. Seminal fluid analysis and culture were performed in 35 patients and testicular histology determined in 21.
  
  
  RESULTS
  Agglutination was demonstrated in 22 of 50 sera (44%), whilst non-agglutinating cytotoxic antibodies were detected in two. Only two of the 50 control sera (4%) were positive. After steroid therapy, antibody titres were significantly decreased and there was a sixfold improvement in mean sperm concentration and a threefold improvement in motility and morphological characteristics. Bacterial (46%) and non-bacterial (17%) infection were recorded in 22 of 35 patients, 13 of whom showed the presence of antisperm antibodies in their sera. Staphylococcus aureus was the commonest single bacterial isolate. Overall, 13 of 29 patients (45%) improved, nine accounting for 12 pregnancies. Pregnancies and/or improvements in semen quality were observed only among patients with mild histological changes. Low testosterone and prolactinaemia occurred in 29% and 21% of the patients, respectively. Among these, anti-sperm antibodies were also recorded in 18% and 13%, respectively.
  
  
  CONCLUSIONS
  The incidence of antisperm antibodies among infertile men is high in Nigeria and may be related to high prevalence of STDs. Immunologically infertile men can be treated successfully with steroids. Concomitant antibiotic and hormone therapy may also be essential in appropriate cases. Clinicians are advised to adopt a multimodal approach to the treatment of male infertility in sub-Saharan Africa. The presence of non-agglutinating cytotoxic antibodies calls for further investigation of the role of complement in the pathogenesis of immunological infertility.
authors.affiliation: University Department of Surgery, College of Medical Sciences, University of Calabar, Nigeria.
authors.forename: P D
authors.initials: PD
authors.lastname: Ekwere
mesh_terms: D000328:Adult; D000372:Agglutination Tests; D001323:Autoantibodies / Q000032:analysis*; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D007248:Infertility, Male / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology*; D008297:Male; D009549:Nigeria / Q000453:epidemiology; D011239:Prednisolone / Q000627:therapeutic use; D011388:Prolactin / Q000097:blood; D013076:Sperm Count; D013094:Spermatozoa / Q000276:immunology*; D013739:Testosterone / Q000097:blood
chemical_list: D001323:Autoantibodies; D005938:Glucocorticoids; D013739:Testosterone; D011388:Prolactin; D011239:Prednisolone