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Objective: Here we compared the results of a prospective study systematically screening for antisperm antibodies in a cohort of subfertile males to the results of a previous retrospective study in equally subfertile patients where screening for antisperm antibodies was performed solely if semen presented spontaneous agglutinates of sperm. Methods: The prospective study was conducted on 317 semen analyses between 1 September 2014 and 9 December 2015 and the retrospective study investigated 2823 semen analyses performed between 1 April 2004 and 31 March 2014. Sperm parameter analysis used exactly the same techniques across patients in both studies. Screening for IgG and IgA class antisperm antibodies was performed by using the direct (in-semen) MAR test with immunobeads. Results: Retrospectively, 76 (2.69%) of the 2823 patients in the cohort had a positive MAR test after presenting semen showing sperm agglutination. Compared to this group, the prospective study found a significantly higher number of patients presenting antisperm antibodies (positive MAR test in 25 patients, i.e. 7.88%). Of these 25 patients, IgA and mixed (IgG and IgA) class antisperm antibodies were significantly higher in the prospective group than those in the retrospective group. Conclusion: Given how antisperm antibodies can damagingly block or hamper different prefertilization and possibly postfertilization events, screening for antisperm antibodies solely on the basis of sperm agglutinates does not look adequate. This study advocates making screening for autoimmunity to sperm a routine part of the basic workup for male subfertility.

Is Absence of Spontaneous Agglutinates of Spermatozoa in Semen a Reliable Indicator of Non-Autosensization against Human Sperm Antigens?