Parenting: Preconception

What if you were allergic to your husband's sperm? This might seem like a cruel joke from nature, but it does happen, and women aren't the only ones who can be affected – a man can be allergic to his own sperm. "Antisperm antibodies" is the correct term for this misunderstood condition.

Some women fear they may have this condition due to painful intercourse or burning and itching after intimacy. In truth, symptoms like burning, itching or inflammation signal other medical problems such as a genital tract infection.

"The condition known as 'sperm allergy' is not really an allergy; it does not make you sneeze," says Dr. Steven Witkin, Ph.D., a professor in the department of obstetrics and gynecology at Weill Medical College of Cornell University. "The immune system of some men and women see sperm as a foreign invader, like a germ, and their bodies make antibodies to attack the sperm." Antisperm antibodies may cause infertility by preventing the sperm from reaching and fertilizing the egg.

Indeed, infertility in one or both partners is the only symptom of antisperm antibodies. Infertility is generally diagnosed after a couple has tried to conceive for more than one year.

"I was terrified when I first heard the words 'sperm allergy,'" says Pregnancy Today diary writer Tammy Cole. "I very clearly remember looking at the slide under the microscope with the doctor and seeing tons of sperm – but nothing moving. I knew that could not be good news."

"Antisperm antibodies may be a complicating factor in as much as 5 to 10 percent of infertility cases," says Dr. Witkin. He adds that almost all men who have undergone a vasectomy (surgical operation that causes sterility) produce antisperm antibodies after the procedure. If he undergoes a vasectomy reversal, the antisperm antibodies will interfere with conception.

So what causes the immune system to make antisperm antibodies? A genital tract infection, a congenital abnormality in the male genital tract, a vasectomy (as mentioned above) or a varicocoele (a varicose vein in the testicles) can cause these antibodies to develop. Wives of men with abnormal sperm are also at increased risk for developing antisperm antibodies.

Testing 1, 2, 3
When a couple experiences unexplained infertility, their doctor may recommend testing for antisperm antibodies. For males, a semen analysis can detect motionless or clumped sperm and identify the need for additional testing. Females undergo a post-coital test, in which a fluid sample is obtained from the cervix six to 12 hours after intercourse. The sample is then analyzed for the presence of shaking sperm. "In some cases, however, these tests may be normal, and antisperm antibodies may still be present," says Dr. Witkin.

A definitive diagnosis is reached after a couple undergoes a sperm antibody test. Dr. Witkin recommends the immunobead binding test (IBT) or the Mixed Agglutination Reaction (MAR) test. The IBT assesses the presence of antisperm antibodies in semen, cervical mucous or the blood of either person. The MAR is performed on a semen sample. "There are other tests available but they are non-specific and inaccurate," he says. "In my office we perform the immunobead binding test."

"[My husband and I] were both saddened that we could not get pregnant without any medical intervention, but at the same time, happy that we were getting answers to why conceiving was taking so long," says Cole. Delete: "I was so sad [after the diagnosis]," says Cole. Change to: "Before knowing too much about what [the diagnosis] meant, I immediately thought I could not have children," says Cole. "I was scared and frightened as well as determined to find out all the information I could. The doctor assured me there were ways around this 'allergy.'"

Oh, Baby
The presence of these antibodies doesn't mean a couple can't have a baby. There are several treatments available for men and women with antisperm antibodies.

"I was so sad [after the diagnosis]," says Cole. "Before knowing too much about what that meant, I immediately thought I could not have children. I was scared and frightened as well as determined to find out all the information I could. The doctor assured me their were ways around this 'allergy.'"

Many men and women with this condition jumpstart their fertility with steroid treatment. This can temporarily lower antibody levels and increase the odds of conception. Another option is intrauterine insemination (IUI) combined with an agent to induce ovulation. In this procedure, specially-prepared sperm are inserted into the uterus around the time of ovulation. IUI is less complex and cheaper than the third option for treating the antibodies – in-vitro fertilization (IVF).

Statistics from the Centers for Disease Control and Prevention revealed that almost 28,500 Assisted Reproductive Technology babies were delivered in the U.S. in 1998, yet this method of conception is expensive and not covered by many insurance companies.

"Other treatments [for antisperm antibodies] like prolonged antibiotic therapy, use of a condom for a period of time or washing the sperm are totally ineffective," says Dr. Witkin. A couple's doctor can present and discuss the viable treatment options in more detail. Some of the procedures are costly, so couples should check with their insurance company for coverage information.

There are rare cases of women who have a true allergy to seminal fluid, the non-sperm component of the ejaculate. These women may go into shock after sexual intercourse, and the condition can be life-threatening. When avoiding conception, these couples use condoms. Artificial insemination, where seminal fluid is separated from sperm, is recommended if the couple wishes to conceive.

For couples with antisperm antibodies, successful conception can take place. After three IUIs, Cole conceived. Later, she and her husband learned that three was their lucky number. Now the proud mother of triplets, Cole says, "It is amazing to be remembering those feelings I had then. Especially now that I have three newborns here with me."