Effects of antisperm antibodies post vasectomy reversal on pregnancy rates

Tamer A. Abouelgreed; Mohamed A. Amer; Hassan Mamdouh; Ahmed F. El-Sherbiny; Hany Aboelwafa; Omar A. Omar; Mohammed Abdelshakour; Mohammad Elesawy; Mohamed Sonbol; Ahmed N. Maawad; Elsayed M. Zayed; Mostafa T. Eldestawy

doi:10.4081/aiua.2024.12335

Authors

Tamer A. Abouelgreed
dr_tamer_ali@yahoo.com
Gulf medical university, Ajman, United Arab Emirates; Department of Urology, Al-Azhar University, Cairo, Egypt. https://orcid.org/0000-0003-2640-3425
Mohamed A. Amer Department of Dermatology & Andrology, Al-Azhar University, Cairo, Egypt.
Hassan Mamdouh Department of Dermatology & Andrology, Al-Azhar University, Cairo, Egypt.
Ahmed F. El-Sherbiny Department of Andrology, International Islamic Center for Population Studies and Research, Al-Azhar University, Cairo, Egypt.
Hany Aboelwafa Department of Dermatology & Andrology, Al-Azhar University, Cairo, Egypt.
Omar A. Omar Department of Dermatology & Andrology, Al-Azhar University, Cairo, Egypt. https://orcid.org/0009-0008-5983-8189
Mohammed Abdelshakour Department of Dermatology & Andrology, Al-Azhar University, Cairo, Egypt.
Mohammad Elesawy Department of Dermatology & Andrology, Al-Azhar University, Cairo, Egypt.
Mohamed Sonbol Department of Dermatology & Andrology, Al-Azhar University, Cairo, Egypt.
Ahmed N. Maawad Department of Dermatology & Andrology, Al-Azhar University, Cairo, Egypt. https://orcid.org/0009-0003-6044-8640
Elsayed M. Zayed Department of Dermatology & Andrology, Al-Azhar University, Cairo, Egypt.
Mostafa T. Eldestawy Department of Dermatology & Andrology, Al-Azhar University, Cairo, Egypt.

Objective: To investigate the correlation between antisperm antibodies (ASAs), pregnancy rates, and the method of conception following vasectomy reversal. This is particularly relevant as patients undergoing vasectomy reversal often express concerns about the potential inhibitory effects of ASAs on achieving pregnancy. Additionally, the American Urological Association guidelines for vasectomy emphasize the need for further research to address this question.

Patient and Methods: We conducted a retrospective analysis involving chart reviews and phone interviews with individuals who underwent vasectomy reversal at our institution between May 2015 and April 2023. Patients who underwent vasectomy reversal for reasons other than fertility, as well as those lacking postoperative semen analysis with ASA data, were excluded. We classified patients based on low (below 50%) or high (50% or above) ASA levels determined by their initial postoperative semen analysis. The primary outcome measured was the pregnancy rate, including details on the method of conception.

Results: A total of 145 patients were subjected to chart review. The median age at the time of surgery was 43 years, with a median obstruction interval of 7.7 years. The median age of their partners was 29 years. The majority (80%) of patients underwent bilateral vasovasostomy. Among them, 60 patients (41.4%) exhibited low (< 50%) ASA levels, while 85 (58.6%) had high (≥ 50%) ASA levels. Follow-up phone interviews were completed by 48 patients. Among them, the 19 men with low ASA levels, 13 (68.4%) achieved pregnancy, with 6 (31.6%) experiencing spontaneous conception. For the 29 men with high ASA levels, 21 (72.4%) achieved pregnancy, including 11 (38%) through spontaneous conception. The p-value from Fisher’s exact test was 0.2.

Conclusions: Our findings suggest that ASA levels do not show a significant association with either the pregnancy rate or the method of conception following vasectomy reversal.

Ostrowski KA, Holt SK, Haynes B, et al. Evaluation of Vasectomy Trends in the United States. Urology. 2018; 118:76-79. DOI: https://doi.org/10.1016/j.urology.2018.03.016

Sandlow JI, Nagler HM. Preface. Urol Clin North Am. 2009;36:xiii-xiv. DOI: https://doi.org/10.1016/j.ucl.2009.06.001

Dubin JM, White J, Ory J, et al. Vasectomy reversal vs. sperm retrieval with in vitro fertilization: a contemporary, comparative analysis. Fertil Steril. 2021; 115:1377-1383. DOI: https://doi.org/10.1016/j.fertnstert.2021.03.050

Silva AF, Ramalho-Santos J, Amaral S. The impact of antisperm antibodies on human male reproductive function: an update. Reproduction. 2021; 162:R55-R71. DOI: https://doi.org/10.1530/REP-21-0123

El-Sherbiny AF, Ali TA, Hassan EA, et al. The prognostic value of seminal anti-sperm antibodies screening in men prepared for ICSI: a call to change the current antibody-directed viewpoint of sperm autoimmunity testing. Ther Adv Urol. 2021; 13:1756287220981488. DOI: https://doi.org/10.1177/1756287220981488

Royle MG, Parslow JM, Kingscott MM, et al. Reversal of vasectomy: the effects of sperm antibodies on subsequent fertility. Br J Urol. 1981; 53:654-9. DOI: https://doi.org/10.1111/j.1464-410X.1981.tb03284.x

Herrel LA, Goodman M, Goldstein M, et al. Outcomes of Microsurgical Vasovasostomy for Vasectomy Reversal: A Metaanalysis and Systematic Review. Urology. 2015; 85:819-825. DOI: https://doi.org/10.1016/j.urology.2014.12.023

Hellema HW, Samuel T, Rumke P. Sperm autoantibodies as a consequence of vasectomy. II. Long-term follow-up studies. Clin Exp Immunol. 1979; 38:31-36.

Tung KS. Human sperm antigens and antisperm antibodies I. Studies on vasectomy patients. Clin Exp Immunol. 1975; 20:93-104.

Parslow JM, Royle MG, Kingscott MM, et al. The effects of sperm antibodies on fertility after vasectomy reversal. Am J Reprod Immunol (1980). 1983; 3:28-31. DOI: https://doi.org/10.1111/j.1600-0897.1983.tb00208.x

Silber SJ, Grotjan HE. Microscopic vasectomy reversal 30 years later: A summary of 4010 cases by the same surgeon. J Androl. 2004;25:845-859. DOI: https://doi.org/10.1002/j.1939-4640.2004.tb03150.x

Cooper TG, Aitken J, Auger J, et al. WHO_ASA. World Health Organization. Published online 2010.

Thomas AJ Jr, Pontes JE, Rose NR, et al. Microsurgical vasovasostomy: immunologic consequences and subsequent fertility. Fertil Steril. 1981; 35:447-50. DOI: https://doi.org/10.1016/S0015-0282(16)45442-7

Nam CS, Tooke BP, Strasser O, et al. Antisperm Antibody Levels After Vasectomy Reversal Are Not Associated With Pregnancy Rates or Method of Conception. Urology. 2024 Feb 27: S0090-4295(24)00124-9.

Barbonetti A, Castellini C, D’Andrea S, et al. Prevalence of antisperm antibodies and relationship of degree of sperm auto-immunization to semen parameters and post-coital test outcome: a retrospective analysis of over 10 000 men. Human Reproduction. 2019;34:834-841. DOI: https://doi.org/10.1093/humrep/dez030

Tomlinson M, Lewis S, Morroll D. Sperm quality and its relationship to natural and assisted conception: British Fertility Society Guidelines for practice. Hum Fertil. 2013; 16:175-193. DOI: https://doi.org/10.3109/14647273.2013.807522

Verón GL, Molina RI, Tissera AD, et al. Incidence of Sperm Surface Autoantibodies and Relationship with Routine Semen Parameters and Sperm Kinematics. Am J Reprod Immunol. 2016;76:59-69. DOI: https://doi.org/10.1111/aji.12519

Cui D, Han G, Shang Y, et al. Antisperm antibodies in infertile men and their effect on semen parameters: A systematic review and meta-analysis. Clin Chim Acta. 2015; 444:29-36. DOI: https://doi.org/10.1016/j.cca.2015.01.033

Majzoub A, Tadros NN, Polackwich AS, et al. Vasectomy reversal semen analysis: new reference ranges predict pregnancy. Fertil Steril. 2017; 107:911-915. DOI: https://doi.org/10.1016/j.fertnstert.2017.01.018

Bjorndahl L, Apolikhin O, Baldi E, et al. WHO Laboratory Manual for the Examination and Processing of Human Semen Sixth Edition.

Abouelgreed, T. A., Amer, M. A., Mamdouh, H., El-Sherbiny, A. F., Aboelwafa, H., Omar, O. A., Abdelshakour, M., Elesawy, M., Sonbol, M., Maawad, A. N., Zayed, E. M., & Eldestawy, M. T. (2024). Effects of antisperm antibodies post vasectomy reversal on pregnancy rates. Archivio Italiano Di Urologia E Andrologia. https://doi.org/10.4081/aiua.2024.12335