Editing Infertility: Diagnosis and Evaluation (section)

===== Anti-sperm antibodies =====
* '''Can result in sperm agglutination in the semen'''
**Anti-sperm antibodies may be present without sperm agglutination and, conversely, agglutination may be present due to other factors, such as the presence of E.coli in the semen
* '''Can impair sperm-ova penetration'''
*'''Associated with events such as trauma, mumps orchitis, testis malignancy, vasal obstruction, vasectomy that disrupts the blood-testis barrier, or the patency of the male genital tract allowing sperm antigens or genital tract infections to generate anti-sperm antibodies.'''
** Vasectomy disrupts the blood-testis barrier, resulting in detectable levels of serum antisperm antibodies in 60% to 80% of men.
* IgA and IgG antibodies are the predominant antibodies found in semen, while IgM is rarely found[https://pubmed.ncbi.nlm.nih.gov/33295257/]
*Tests used (2):
**Mixed antiglobulin reaction test
**Immunobead (IB) test
***Gives information about the type and presence of the immunoglobulins and their localization specifically on the sperm head, midpiece or tail or covering the entire sperm
*'''Indications'''
**'''Should not be done in the initial evaluation of male infertility'''
**'''Should only be considered if it will affect management of the patient.''' 
***'''For couples planning on ICSI, ASA testing should not be performed since it will not change management.'''
*'''Management'''
**'''IUI after specific semen processing or ICSI'''
***Some have reported improved IUI pregnancy rates with specific semen processing protocols for couples with anti-sperm antibodies compared to standard sperm washing, although the data are limited
***In those with anti-sperm antibodies, ICSI yields higher pregnancy rates per cycle than IUI with semen processing designed to disrupt the bound antibodies.