Question:
Dear Dr. Ramirez,
My husband and I suffer from idiopathic infertility. My husband was diagnosed positive ASA with MAR direct (90% bounded spermatozoids) and indirect (80% bounded spermatozoids) method, all results are good. He went to urologist, and since he couldn't find cause for it he sent him to do ELISA test from serum which came up negative. For past two years he repeated these tests several times in different laboratories, every time with same results - MAR positive and ELISA negative. The urologist refused to give him any medical treatment since results are confusing.
How is this possible? Which of these tests is more reliable?
S. from Serbia
Answer:
Hello S. from Serbia,
I assume you have gone through an infertility evaluation as well, and that the results cleared you of any problems. Since your husband's sperm shows antisperm antibodies, you should just proceed from there. I think you have done enough repeat tests, and there is NO treatment that a Urologist can do to change that, unfortunately. With antisperm antibodies, your husband is forming antibodies that attach to the sperm and prevent them from being able to fertilize an egg. This leads to a functional defect.
The treatment of choice in this regard, and for this problem, is to undergo ICSI in conjunction with IVF so that the sperm can be washed and the antibodies removed. This can be done for IUI but does not work as well. Once the sperm are washed, they can then be injected into the eggs for fertilization to take effect.
I cannot explain or debate the effectiveness of these testing methods, as I am not a biochemist and not well versed on these testing methods.
Good luck and do not hesitate to continue trying by proceeding to assisted reproductive techniques,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California, U.S.A.
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