Sperm Agglutination

Sperm agglutination due to antisperm antibodies (ASAB) has been recognized as an important factor to reduce sperm function. Several risk factors have been reported to be able to damage the blood–testis barrier inducing sperm autoimmune responses, such as genital tract obstruction, infection, varicocele, or testicular trauma. The WHO recommended direct and indirect methods to detect ASAB. The mixed antiglobulin test (MAR) allows direct detection of ASAB on the sperm surface, and the immunobead test (IB) can be used for both direct detection on the sperm and indirect detection in sperm-free fluids. The lack of a standardized method to detect ASAB and the inability to establish a cutoff value to distinguish fertile from infertile men decreased the researcher’s interest in this field in the last 2 decades. However, the issuances of the latest 6th edition of the WHO manual, and the COVID-19 pandemic have increased the attention to this item lately. However, to diagnose immune-mediated male infertility, additional examinations may be required such as testing for seminal leukocytes and/or semen culture in addition to ultrasonography to identify the underlying cause of ASAB formation. Different strategies have been followed to treat ASAB-mediated male infertility including the use of oral immunosuppressives, antibiotics, IUI, and ICSI. However, the use of corticosteroids as immunosuppressives have been declined due to their possible side effect, and employment of ATR is still debated. Finally, more research is required to establish a standardized method to detect ASAB and to build up a treatment strategy to improve pregnancy outcomes.