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Cutting-edge issues in autoimmune orchitis.

Clovis A Silva1, Marcello Cocuzza, Eduardo F Borba

  • 1Pediatric Rheumatology Unit, Department of Pediatric, University of São Paulo, SP, Brazil. clovis.silva@icr.usp.br

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Autoimmune orchitis, characterized by anti-sperm antibodies (ASA), affects male fertility. Intracytoplasmic sperm injection (ICSI) offers a viable treatment for related infertility.

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Area of Science:

  • Reproductive Immunology
  • Urology
  • Andrology

Background:

  • Autoimmune orchitis causes male infertility, defined by testicular damage and anti-sperm antibodies (ASA).
  • ASA are found in 5-12% of infertile men; primary autoimmune orchitis presents with isolated infertility, while secondary forms link to systemic autoimmune diseases.
  • Conditions like polyarteritis nodosa, Behçet's disease, and Henoch-Schönlein purpura are associated with secondary orchitis and testicular vasculitis.

Purpose of the Study:

  • To review the definition, pathogenesis, and treatment of autoimmune orchitis.
  • To discuss the role of anti-sperm antibodies (ASA) in male infertility.
  • To evaluate assisted reproductive technologies for managing infertility due to autoimmune orchitis.

Main Methods:

  • Literature review of autoimmune orchitis, anti-sperm antibodies, and male infertility.
  • Analysis of the pathogenesis involving immune cell infiltration and germ cell apoptosis.
  • Evaluation of current and emerging therapeutic strategies, including immunosuppression and assisted reproduction.

Main Results:

  • Autoimmune orchitis pathogenesis is linked to immune cell access to the testes, causing germ cell apoptosis.
  • Treatment for associated systemic diseases involves glucocorticoids and immunosuppressants, but standardized options for orchitis are lacking.
  • Assisted reproductive technologies (ART), particularly intracytoplasmic sperm injection (ICSI), are effective for infertility with severe sperm autoimmunity.

Conclusions:

  • Autoimmune orchitis is a significant factor in male infertility, with ASA playing a key role.
  • The exact significance of ASA in infertile men remains debated, and treatment protocols are not standardized.
  • ICSI represents the most effective ART option for severe cases of male infertility linked to sperm autoimmunity.