title: Value of serum antisperm antibodies in diagnosing obstructive azoospermia.
abstract: OBJECTIVE
  The requisite presence of active spermatogenesis for antisperm antibody production may be useful in identifying obstructive azoospermia. The diagnostic performance of serum antisperm antibody was evaluated as a test for obstructive azoospermia.
  
  
  METHODS
  A total of 484 men with male infertility who had undergone antisperm antibody testing were evaluated. Demographic data, patient history, and followup were recorded. Obstruction was confirmed by surgical exploration. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated to quantify diagnostic performance. ROC curves were calculated and compared.
  
  
  RESULTS
  Of 484 men 272 possessed documented obstruction of the vas or epididymis and 212 had documented infertility without azoospermia. The obstructed group had significantly increased antisperm antibody levels compared to the nonobstructed group. IgG, IgA, and IgM were analyzed as diagnostic tests for obstruction. The AUC for IgG, IgA and IgM ROC curves was 0.92, 0.85 and 0.67, respectively. The AUC for serum IgG against sperm tails was 0.92, 0.87 against sperm heads and 0.79 against sperm midpieces. IgG demonstrated the highest sensitivity (85%) with a specificity of 97% (chi-square test p <0.01). IgA possessed the highest specificity (99%), positive predictive value (99%) and positive likelihood ratio (70.0).
  
  
  CONCLUSIONS
  The presence of serum antisperm antibody was highly accurate in predicting obstructive azoospermia, particularly after vasectomy. It can obviate the need for testis biopsy, the current but more invasive and costly gold standard of detection. This allows the surgeon to proceed directly to surgical reconstruction or sperm retrieval after a simple blood test.
authors.affiliation: The Center for Male Reproductive Medicine and Microsurgery, Department of Urology and Cornell Institute for Reproductive Medicine, New York, New York, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Lee
authors.forename: Marc
authors.initials: M
authors.lastname: Goldstein
authors.forename: Brant W
authors.initials: BW
authors.lastname: Ullery
authors.forename: Joshua
authors.initials: J
authors.lastname: Ehrlich
authors.forename: Marc
authors.initials: M
authors.lastname: Soares
authors.forename: Renee A
authors.initials: RA
authors.lastname: Razzano
authors.forename: Michael P
authors.initials: MP
authors.lastname: Herman
authors.forename: Mark A
authors.initials: MA
authors.lastname: Callahan
authors.forename: Philip S
authors.initials: PS
authors.lastname: Li
authors.forename: Peter N
authors.initials: PN
authors.lastname: Schlegel
authors.forename: Steven S
authors.initials: SS
authors.lastname: Witkin
mesh_terms: D000328:Adult; D001323:Autoantibodies / Q000097:blood*; D053713:Azoospermia / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D013094:Spermatozoa / Q000276:immunology*
chemical_list: D001323:Autoantibodies