Immune infertility

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Infertility is defined as the inability to conceive after one year of unprotected intercourse and is on the rise globally, with various causes in both male and female partners. Immune reactions to sperm can account for 2–30% of infertility cases. Sperm possesses autoantigenic and isoantigenic properties, leading to the production of antisperm antibodies (ASAs) and sperm-reactive T cells in both genders. Notably, over 75% of vasectomized men produce autoantibodies to sperm, complicating fertility restoration even after successful vasovasostomy. Early assessments of ASAs' role in human infertility were likely overstated due to unreliable methods and a lack of understanding of the immune response's complexity. This, coupled with insufficient well-designed studies and effective treatments, led to confusion about ASAs' significance in infertility. As a result, evaluating infertile couples for ASAs was not prioritized. However, advancements in accurate testing methods and the discovery of mucosal immunity, which can operate independently of systemic immunity, have prompted a reevaluation of sperm cells and genital tract secretions in the context of ASAs, highlighting their potential role in infertility.