THE ZHAI CLINIC

TRADITIONAL CHINESE MEDICINEThe management of antisperm antibodies

By Dr Sheryl Homa PhD ARCS AIBMS

Dr xiao Ping Zhai MATCM

10 HARLEY STREET, LONDON, W1G 9PF TELEPHONE: 020 7467 8420WWW.ZHAICLINIC.COM E-MAIL: ZHAI@TENHARLEYSTREET.CO.UK

Case oneDR HOMA: This patient had a seminoma in 1993 and had his left testisremoved. As a consequence, his sperm count was reduced and he developedantisperm antibodies. He and his partner wanted to have a child, so they weretreated at a fertility clinic, undergoing one IVF treatment cycle and six ICSItreatment cycles between 1996 and 1999. Unfortunately, they did not achievea pregnancy. At that point, they decided to seek complementary treatment tosee if they could improve their chances of conceiving. In August 2000 just priorto TCM treatment, the patient’s sperm count was below normal limits at 8 mil-lion per ml. 38% of the sperm were moving, albeit erratically, and there was anexceptionally high proportion of abnormal looking sperm (97%). Antibody lev-els were high as shown by 80% sperm binding the MAR test. The patient wasprescribed a course of Chinese herbs for 42 days and his semen assessed again.This time the count had increased to 22 million per ml. and only 20% spermreacted the MAR test. The motility and proportion of abnormal sperm remainedunchanged. In October, the couple had another attempt at ICSI and a clinicalpregnancy has been confirmed.

DR ZHAI: This was a classic case of a degnerative condition. The patient’shealthy testis was injured due to a trauma of his left testis being removed. Theoperation disturbed the normal function of the reproductive system and normalblood flow to the testis was not properly restored. Although there were fewcomplaints from the patient himself, his facial colour was slightly dull with anormal tongue and coating. I found his pulses to be a slight thread and hesitant.The sperm sample appeared to have generally poor characteristics. The treat-ment for this patient aimed to slightly improve his reproductive organs as wellas restore the local blood supply. His improvement was straightforward andresults satisfactory.

Case twoDR HOMA: This patient developed antisperm antibodiesas a result of a hernia repair operation. His sperm count,motility, progression and abnormal forms were all wellwithin the normal range, except there was approxi-mately 50% sperm binding in the MAR test. Oneattempt at IVF in 1998 and another at ICSI in 1999resulted in one out of five eggs collected being fertilisedboth times, but no pregnancy. This couple turned toTCM in March and after taking the herbs for fivemonths, the MAR test showed a gradual decline to lessthan 25% sperm binding by August. In September,another ICSI cycle resulted in five out of six eggs beingfertilised – and a clinical pregnancy.

DR ZHAI: This case was very similar to the last one. Thetrauma from the hernia operation had disturbed the nor-mal function of the reproductive system. The blood flowaround the testis had been injured and did not restoreproperly. Apart from this obvious cause, the patient alsohad the classic symptoms of phlegm-dampness. He felttired and needed a lot of sleep. He had a normal tonguewith a white, greasy, thick coating and the pulses wereslippery. The treatment for this patient was to dispel thephlegm-dampness and energise the digestive system. Heresponded well and the result was satisfying. His partnerwas a classic endocrine dysfunctional obesity type withphlegm-dampness symptoms (perhaps their lifestyleswere quite similar). Her treatment was designed to dispelphlegm-dampness and warming the uterus, so energisingher digestive systems and increasing the blood flow with-in her body. This time her follicles had all grown to ahigher level of maturity which resulted in six out of eighteggs being collected and five being fertilised. This nodoubt contributed to her successful ICSI cycle.

Case threeDR HOMA: In this case, the patient had an epididymo-vasos-tomy eight years previously. Although the sperm count wasalways within normal limits, motility was exceptionally poor(<5%) and the MAR test showed almost all the sperm werecoated in antisperm antibodies. The couple had two ICSItreatments in 1998, neither of which resulted in a pregnan-cy. The patient embarked on TCM treatment, and after threemonths on herbs, the motility of the sperm had increased to45%, although they were hardly moving forward at all. Inthis case, the herbs had no effect on the presence of anti-sperm antibodies.

DR ZHAI: This patient’s blood flow around the testes wasunable to be restored after his operation. Although there wassome improvement in sperm count and motility, there wasno effect on antisperm antibodies. Perhaps the patient wouldhave responded better if he had carried on the treatment fora longer period. More studies will help get to the root ofcases like this.

CONCLUSION

Assisted reproduction techniques such as IUI, IVF or ICSI can be carriedout to encourage fertilisation when there are antisperm antibodies pre-sent, but these procedures are much more likely to succeed the lower thelevels of anitbody. The first two case studies reveal that TCM reduced theconcentrations to a level where the chances of success with assistedreproduction techniques were considerably enhanced. Whether TCM canhave a significant effect on lowering antisperm antibodies remains to beseen, as many more studies need to be carried out to confirm these obser-vations. Even if it has an impact only in selected cases, it is worth pursu-ing for those that may be helped, particularly as conventional treatment isalso only effective in some cases.

The next article in this series will examine the role of TCM in explaining the characteristics and functions oforgans, and case studies on the TCM-approach to the management of FSH.

ANTISPERM ANITBODIES

• ANTIBODIES are produced by specialisedwhite blood cells (lymphocytes) when theydo not recognise something in the body.Normally, there is a barrier between theblood stream and various organs in the body– including the testes – which prevents bloodcells from coming into contact with them. Ifthe blood-testes barrier is broken, blood cellsare suddenly exposed to sperm cells, whichthey do not recognise because they have notseen them before. This may trigger the bloodcells to start making antisperm antibodies. Abreakdown in the blood-testes barrier mayoccur as a result of testicular inflammation,injury, or surgery such as vasectomy, herniarepair or hydrocoele removal.

• ANTISPERM antibodes occur in approxi-mately eight per cent of infertile men.Whether or not the presence of antibodies tosperm is a cause of infertility has been the

subject of great debate over the years. It isnow clear that antibodies can only cuase aproblem if they are in the vicinity of thesperm, and only if they are present at rela-tively high levels. While antisperm antibod-ies do not appear to affect sperm production,sperm that have antibodies over most of theirsurface are unable to penetrate the cervicalmucus. Presence of antibodies on the tail mayaffect sperm movement and antibodies maycause the sperm to stick to one another(agglutination) leaving fewer free to pene-trate the egg.

• TESTS for antisperm antibodies on semenuse the Mixed Agglutination Reaction(MAR), or the immunobead test. If there areno antisperm antibodies, the test will showfreely moving sperm. If antibodies are pre-sent, the sperm will be bound or coated inparticles. The binding of more than 10 percent motile sperm to particles indicates thepresence of antisperm antibodies. It is onlywhen the MAR test shows about 50 per cent

binding or more that antisperm antibodies arelikely to have an effect on fertility. Indeed,there is a significant reduction in the fertilisa-tion rate during IVF when there are high lev-els of antisperm antibody and as a result,pregnancy rates are reduced.

• REDUCTION of antisperm antibodiesusing conventional treatment involves theuse of drugs such as steroids that suppressthe production of antibodies by the immunesystem. However, these have to be given inlarge doses and have unplesant side effects.Alternatively, TCM may be used to try toreduce antibody levels. Here I have present-ed three case studies of men who have anti-sperm antibodies, and who were prescribeda course of Chinese herbs after failing toconceive using conventional assisted con-ception alone. In two cases, the levels ofantibody were reduced after taking theherbs, whereas in another, there was noeffect on the level of antibody, althoughsperm motility was increased.