Testicular immune privilege maintained in incidental testicular microlithiasis: Evidence from 1755 infertile men

Testicular microlithiasis (TM) has been hypothesized to impair testicular immune privilege and promote antisperm antibodies (ASA). We retrospectively evaluated 1755 infertile men who underwent semen analysis and scrotal ultrasound (2001-2022). ASA were measured by direct IgG mixed antiglobulin reaction (MAR), with ≥ 50% binding deemed clinically relevant. TM was present in 167 men (9.5%). ASA positivity occurred in 1.2% of TM vs. 3.5% of non-TM men (p = 0.17). Semen parameters were comparable; prior orchiectomy was more frequent in TM. These findings-the largest cohort to date-indicate that TM does not compromise immune privilege and do not support routine ASA testing in incidental TM. (98 words).