Prefertile vas lesion as a cause of sperm antibody formation: an experimental and clinical study

It is well known that vasectomy in adult men can induce formation of sperm antibody (SPA) and that the presence of such antibodies can be correlated to decreased fertility. Operations close to the vas, e.g. herniorrhaphy, are common in childhood, implying a potential risk of a vas lesion. However, very little is known about the consequences of a vas lesion at prefertile age with respect to SPA formation in adulthood. The aim of this study was to determine whether a vas lesion at prefertile age can induce SPA formation after puberty; if so, is it possible to prevent the occurrence of such antibodies by microsurgical reconstruction of the vas lumen before puberty? Prefertile rats (aged 3-6 weeks) were subjected to uni- and bilateral vasectomy, uni- and bilateral crush injury to the vas and bilateral injury to the ductal artery. SPA could be demonstrated in all groups of animals at the age of 18-20 weeks by means of indirect immunofluorescence technique. Prefertile uni- and bilateral vasectomy caused SPA formation to the same extent as did adult bilateral vasectomy (90% of the animals SPA-positive), whereas the prefertile vas appeared more sensitive to crush injury than the adult vas (70% and 11% SPA-positive, respectively). In rats subjected to vasectomy at the age of 3-4 weeks, it was possible to prevent SPA formation in adulthood by vas reconstruction before puberty. It was further shown that the vas repair did not have to be performed immediately after injury but could be delayed several weeks postvasectomy provided it was still performed before puberty. By using a tissue glueing agent (fibrin glue) it was found possible to improve the anastomosis healing in vasovasostomies. This was probably due to the fact that the fibrin glue minimises sperm leakage at the site of anastomosis in animals with an ongoing sperm flow through the vas at the time of vasovasostomy procedure. With this vasovasostomy technique, it was also possible to delay the vas reconstruction after prefertile vasectomy until puberty, still preventing the formation of SPA. The clinical implications of these experimental findings were underlined by the findings in a review of 31 postpubertal boys (mean age 17 years) operated upon for inguinal hernia in childhood. In this group, there was 100% accordance between the occurrence of SPA in the blood and vas obstruction. The findings in this clinical study further indicated that there may be a significant risk of acquiring an accidental, unknown vas lesion during herniorrhaphy in childhood.(ABSTRACT TRUNCATED AT 400 WORDS)