Do Anti-Sperm Antibodies (ASA) Lower Vasectomy Reversal Success Rates? – 2023 Update
No, anti-sperm antibodies do NOT reduce vasectomy reversal success rates, male fertility or conception rates for most men!
This article, by globally recognized vas reversal expert, author and authority Sheldon Marks, MD, explains the facts and current thinking by top experts about anti-sperm antibodies (ASA) and vasectomy reversals as well as many of the common misconceptions about ASA that still persist.
Questions and concerns about anti-sperm antibodies are very common, even among urologists and doctors that specialize in in-vitro fertilization (IVF) and female fertility (Reproductive Endocrinologists). This often leads to confusion as many patients are told what we believe to be incorrect information about whether or not anti-sperm antibodies have any impact on natural conception after vasectomy reversal.
What are anti-sperm antibodies?
Here’s what we know about anti-sperm antibodies: anti-sperm antibodies are the body’s natural immune response to the exposure of sperm to the body and blood stream. Normally sperm are within a “closed “ system of the tubules within the testicles, where they then travel through the vas and then out the urethra. Technically then sperm are always “outside” the body.
With any testicular trauma or surgery, the body is then exposed to sperm which are perceived as an attacking “foreign protein” (such as a virus or bacteria) and so the body creates an immune response which includes anti-sperm antibodies. A vasectomy is a common cause of anti-sperm antibody formation in males, with no influence on any aspect of the man’s health.
Many doctors still incorrectly believe old data that anti-sperm antibodies impact on fertility and natural conception. We do know that sometimes they can cause the sperm to clump together and so reduce their motility and ability to swim up to fertilize the egg.
Rarely, the antibodies can cover the head of the sperm so that they can swim up to but cannot penetrate the egg. IVF doctors started looking at antibodies when they did the old-style IVF where they just mixed sperm and the egg to make the embryos. Then the technology advanced to now involve ICSI (Intra-Cytoplasmic Sperm Injection) where the sperm are injected directly into the egg, bypassing the need for the sperm to swim and so the issues of antibodies became irrelevant for IVF with ICSI. Even with this, many doctors still order antibody levels for reasons that can’t explain. It’s kind of a “we do it because we did it” logic. Just as confusing for couples, many times patients are told, even when they have great motility, that antibodies are a problem and so no matter what their sperm counts are they need to move directly to IVF.
The good news is that there are several very powerful research studies looking at thousands of vas reversal patients that convincingly show that anti-sperm antibodies do not reduce success rates nor impact fertility through natural conception after vasectomy reversal for most men (1,2).
Our andrologist looked at antibody levels and found that following a vasectomy reversal these antibody levels exhibit a widely unpredictable and inconsistent fluctuation of patterns that vary between individuals and test to test. Some men have stable anti-sperm antibody levels while others can have level that can have extreme fluctuations. The bottom line, whether the levels are high or low, anti-sperm antibodies did not impact on fertility(3). To make things even more confusing, experts agree that 40% or less binding of antibodies is considered normal, so it is not an all or nothing issue. So a man with 38% binding is normal but another with 42% is abnormal.
In fact, we know of one of our patients who had 100% antibodies and yet still fathered childrennaturally! So the presence of anti-sperm antibodies means almost nothing for most men. Old studies and incorrect assumptions over many years have lead many (including many doctors and even fertility experts) to falsely believe that these anti-sperm antibodies can harm fertility after a vas reversal. It is clear that anti-sperm antibodies are a meaningless finding for almost all men after vasectomy reversal (4).
If there are any questions, please contact our full time, reverse vas only “Center of Excellence” and when ready, set up no-cost office, phone, or virtual consultation by Zoom, Skype or Face Time with ICVR’s Dr. Marks or Dr. Burrows.
This page was reviewed, edited and updated June 13, 2023, by Sheldon H. F. Marks, MD.
References:
1.Carbone DJ Jr, Shah A, Thomas AJ Jr, Agarwal A. Partial obstruction, not antisperm antibodies, is what is the most common cause of low sperm counts, low motility and so reduced fertility after a vasovasostomy (VV). J Urol 1998;159(3):827-830.
2. Newton RA. IgG antisperm antibodies attached to sperm do not correlate with infertility following vasovasostomy. Microsurgery 1998;9(4):278-280.
3.Marks M, Perkins A, Russell H, Burrows P, Marks S. Antisperm antibodies: prevalence, patterns and impact on natural conception following vasectomy reversal. Fertil Steril 2013;100(3): S375.
4.Silber SJ, Grotjan HE. Microscopic vasectomy reversal 30 years later: a summary of 4010 cases by the same surgeon. J Androl 2004;25(6):845-859.
