ABSTRACT
Sperm autoimmunity is an important cause of male infertility. It is present in 4% to 10% of men seen for the treatment of infertility (1-3). In some surveys of infertile men, very high proportions of positive results have been reported (4). The condition is important to recognize as a cause of asthenozoospermia, idiopathic infertility, or the unexpected failure of standard in vitro fertilization (IVF). Yet, the significance of sperm autoimmunity is disputed because early tests for the detection of sperm antibodies were not very accurate, and even recent tests, such as those based on immunofluorescence, can still be misleading (see Chapter 26) (5, 6). It has also been suggested that screening for antisperm antibodies before IVF is not cost-effective, as a positive test has a low predictive value for the failure of fertilization and the need for intracytoplasmic sperm injection (ICSI) (7,8). This is an unfortunate attitude that, if extended, would result in minimal evaluation of patients and a consequent inability to counsel patients regarding their prognosis for conception without treatment, the evaluation of ART results for different conditions, or the prompt consideration of alternative approaches to couples management.
