Anti-sperm antibodies post vasectomy

[Eve__0]

  My husband has finally agreed to have his 16-month-old vasectomy reversed.  Our doctor is very optimistic about our chances for a successful reversal.  I have been corresponding via e-mail with some other people who have undergone vasectomy reversal and very few of them seem to be getting pregnant, despite adequate sperm counts.  Two of them recently had positive antibody tests which apparently means it will be difficult or impossible for them to conceive.  Questions are as follows:  Our doctor has not suggested having this test before the reversal.  Should we suggest it?  What percentage of men have these antibodies and why do they develop?  Are they more likely in men who have had their vasectomy for a long time?  Also, one woman told me their doctor told her they should still be able to conceive because her husband's antibodies were confined to the TAILS of his sperm . . . . can you explain this or did she misunderstand what she was told?  I guess any information you could offer regarding anti-sperm antibodies is what I am asking for.  We would like to be optimistic about the success of the reversal, but I don't want to be falsely optimistic.  Thank you for your time.
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Dear Eve,
As you are probably aware, the success of a vasectomy reversal is indirectly proportional to the time duration since vasectomy is performed.  However, there are other factors that come into play that may prevent successful pregnancy after a vasectomy reversal such as anti-sperm antibodies as you correctly mentioned.
Normally, the sperm are not directly exposed to one’s immune system through what’s called the “Blood-Testes barrier”.  Therefore, throughout formation and maturation of sperm, the immature sperm cells receive nutrients from the blood, but are not directly exposed to the immune cells in the blood which are responsible for forming antibodies against foreign antigens (or things that the body does not recognize belonging to the individual).  Since the sperm go through development and maturation under protection from the blood-testes barrier, there is a possibility that under various conditions antibodies may be formed to different components of the sperm cell if sperm  become exposed to the immune system. This is possible during a vasectomy (despite precautionary measures).  Antisperm antibodies have been identified in approximately  60% of men following vasectomy.  These antibodies circulate in the blood stream and can cross the blood-testes barrier (since antibodies are very small protein molecules) and may prevent the sperm from being able to fertilize an egg depending on what component of the sperm is covered by the antibody.  Therefore, as you correctly mentioned, there is still a possibility of fertility if the antibodies are formed against the tail alone, but chances of fertility are less compared to individuals without antisperm antibodies.
In general, testing for antisperm antibodies is not routine prior to vasectomy reversal because it usually does not normally affect the decision making process.  I wish you the best.
This information is provided for general medical information purposes only. Please consult  your physician for diagnostic and treatment options pertaining to your specific medical condition. Dr. Caleb Fleming
at our institution has experience/ interest/ in infertility and vasectomy reversals and I would highly recommend that you see him for your problem. If you would like to make an appointment please call us at  (1-800-653-6568). We can also arrange local accommodations through this [number if this is  your need. Please bring any x-rays [and pathology slides] (not just the reports) as well as any physicians’ notes and lab test results that you may be able to obtain. These will help us greatly.

Sincerely,
HFHS M.D.-JJ
*Keyword: Vasectomy reversal, Antisperm antibodies