[Epidemiology and causes of autoimmune male infertility]

To study epidemiology and etiopathogenesis of male autoimmune infertility, we examined ejaculate samples from 3660 males of reproductive age, clinico-laboratory data on 560 males from infertile couples with antispermal antibodies (ASAB), 647 males without ASAB and 40 fertile males. Ejaculate was tested according to WHO recommendations, ASAB were identified by mixed agglutination reaction (MAR) and flow cytofluorometry (FCFM), infections of the reproductive tract (IRT)--by polymerase chain reaction (PCR). Experiments were made on 136 white non-inbred mature male rats and 40 mature female rats: 1/3 of the only testis was removed in male rats, then morphology of the operated on testis was studied as well as real fertility. ASAB were detected in 18% males of reproductive age. Factors of risk of antispermal immunity are the following: IRT (52%), varicocele (35%), blunt scrotal injuries without orchitis (21%) and previous epididymoorchitis (6%), obstruction (3%), cryptorchism and anejaculation (1%). Absolute risk of immune infertility makes up 67% after orchitis and epididymoorchitis, 66% after blunt scrotal injuries without clinical orchitis, 39-43% in clinical and previously operated varicocele, 32% after IRT. Combination of the risk factors raises immune infertility probability 1.2-4.1 fold. The efficacy of antibiotic therapy for bacterial IRT in ASAB is described. It is shown than it is possible to preserve spermatogenesis after testicular trauma by stimulation of its regeneration. Immunological mechanisms of male autoimmune infertility are analysed. Thus, main causes of male autoimmune infertility are mechanical, infectious or other affection of the testis leading to impairment of hematotesticular barrier, varicocele increases the risk of autoimmune reactions and orchitis after traumas; cross-over interaction between antigenic determinants of sperm and IRT; obstruction of the ejaculatory tract; specific features of antiinfectious immunity.