title: The Epidemiology of Anti-Sperm Antibodies Among Couples with Unexplained Infertility in North West Bank, Palestine.
abstract: BACKGROUND
  Anti sperm antibodies (ASA) can present in serum and semen and they may lead to impair the sperms function leading to infertility. The precise mechanism of generation of these antibodies is yet to be discovered.
  
  
  OBJECTIVE
  This study was performed to determine the prevalence of anti-sperm antibodies (ASA) in patients with unexplained infertility. The study was initiated also to explore the possible factors that may associate with ASA formation and how ASA status is associated with pregnancy rates after going with in vitro fertilization - intracytoplasmic sperm injection (IVF-ICSI).
  
  
  METHODS
  A cross-sectional study was conducted on 42 normal infertile couples consulting Razan Medical Center for Infertility & I.V.F. in Nablus, Palestine, from December 2012 - March 2013. Serum levels of immunoglobulins G (IgG) ASA were measured in participants (males and females) using enzyme-linked immunosorbent assay (ELISA). In addition, participants also filled a questionnaire about the presence of previous varicocele repair, inguinal hernia repair, orchitis, testicular trauma and vasectomy reversal among males and severe coitus bleeding and coitus during menses or puerperium among females. Couples were also asked about previous IVF-ICSI procedures and the outcome of the procedure in terms of either they got pregnant or not. Data was analysed using SPSS software.
  
  
  RESULTS
  The prevalence of ASA was 14.3% (6/42) among all couples, 9.5% (4/42) among males and 4.8% (2/42) among females. There was no significant relationship between previous varicocele repair, previous inguinal hernia repair, or orchitis and formation of ASA (p value =0.64, 0.56, and 0.26 respectively). Previous trauma, vasovasostomy, severe coitus bleeding and coitus during menses or puerperium were not observed in any of the study sample. ASA did not seem to affect the outcome of IVF-ICSI (p-value =0.54).
  
  
  CONCLUSIONS
  Prevalence of ASA in infertile couples in the north part of Palestine is similar to that obtained worldwide. ASA formation does not relate to any of the studied risk factors and does not seem to associate with pregnancy rate after IVF-ICSI. We recommend further studies using a larger sample size and including all parts of Palestine in order to generalize the obtained results.
authors.affiliation: Research and Teaching Assistant, Faculty of Medicine and Health Sciences, An-Najah National University , Nablus, Palestine .
authors.forename: Anas Lotfi
authors.initials: AL
authors.lastname: Yasin
authors.affiliation: Intern Doctor, Ministry Of Health, Nablus, Palestine .
authors.forename: Ahmad Lotfi
authors.initials: AL
authors.lastname: Yasin
authors.affiliation: Professor and Head, Department of Biomedical Sciences-Faculty of Medicne and Health Sciences, An-Najah National University , Nablus, Palestine .
authors.forename: Walid Salim
authors.initials: WS
authors.lastname: Basha
keywords: Immune response; Intracytoplasmic sperm injection; Invitro fertilization; Pregnancy; Prevalence