Condition & Treatments
Antisperm antibodies
Antisperm antibodies: when the immune system targets sperm
The body normally keeps sperm hidden from the immune system. If that barrier is broken, by surgery, injury or infection, the immune system can make antibodies that coat sperm. Coated sperm may clump together, swim poorly or struggle to fertilise an egg. Antisperm antibodies are uncommon, found in around 2–4% of men from infertile couples [1], and there are effective ways around them.
I N S H O R T
They are more common after vasectomy or vasectomy reversal, testicular injury or surgery, and infection.
They are found with a simple test on a semen sample.
ICSI bypasses the antibodies, and treating the cause can help.
Common questions
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Vasectomy and vasectomy reversal. Antisperm antibodies are found in most men after vasectomy [1], and can persist after reversal.
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Testicular injury, torsion or surgery, including testicular biopsy.
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Infection or inflammation of the prostate, seminal vesicles or epididymis.
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Blockages in the tubes that carry sperm, and sometimes varicocele [2].
When testing is worth doing
Antisperm antibody testing is not a routine first test [1]. Prof Raheem recommends it when the result will change your treatment, for example:
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Sperm clumping together (agglutination) on a semen analysis.
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Poor sperm movement without another clear cause.
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Disappointing results after vasectomy reversal.
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Unexplained failure of IUI or IVF.
If ICSI is already planned, testing is usually not needed, as ICSI works around the antibodies [1].
Tests
MAR test, which shows the percentage of sperm coated with antibodies. Above 50% is usually considered significant; lower levels are less certain [3].
Immunobead test, which also shows where on the sperm the antibodies bind.
Semen culture and microbiome, to look for an infection driving the antibodies.
Treatment options
Treating the cause, such as an infection or a varicocele.
Sperm washing and IUI, for milder cases.
ICSI, where a single sperm is injected directly into each egg. This bypasses the antibodies and is the most reliable option [1].
Steroid tablets, which can lower antibody levels in some men, but the evidence is limited and side effects are significant [2], so they are used only in carefully selected cases.
Why this matters to your care
Prof Raheem performs vasectomy reversal and microsurgery, so he understands why antibodies develop and how to plan around them. He orders the test only when it will change your treatment, and chooses the most direct route to a pregnancy.
Common questions
Will the antibodies go away?
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They can fall after the cause is treated, but often persist. ICSI works regardless.
Do they harm a baby?
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There is no evidence that antisperm antibodies affect the health of a baby.
I had a vasectomy reversal. Do I need this test?
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Only if results are disappointing. Many men with antibodies after reversal still conceive naturally.
References
1. Gupta S, et al. Antisperm antibody testing: a comprehensive review of its role in the management of immunological male infertility and results of a global survey of clinical practices. World Journal of Men's Health, 2022;40(3):380–398. Link
2. Antisperm antibodies: screening and applications in 2011, from male infertility check-up to immunocontraceptive vaccine. Basic and Clinical Andrology, 2012;22:20–28. Link
3. World Health Organization. WHO laboratory manual for the examination and processing of human semen, 6th edition, 2021. Link