Original Article Varicocele and Antisperm Antibody: Fact or Fiction? Hooman Djaladat, MD, Abdolrasol Mehrsai, MD, Modjtaba Rezazade, PHD, Yasaman Djaladat, MD, and Gholamreza Pourmand, MD Objective: To study the level of antisperm antibodies (ASAB) in the serum and semen of infertile men with varicocele before and 6 months after varicocelectomy. Materials and Methods: We performed a prospective study of 81 infertile men undergoing microsurgical inguinal varicocelectomy. Female factor was excluded. Semen analysis and seminal and serum ASAB (direct and indirect IgG and IgA), as measured by SpermMar test, were performed before and after surgery at 6 months. A control group consisting of idiopathic infertile patients was evaluated for ASAB. Results: Eighty-one patients with a mean age of 28.7 years (23 to 42) completed our study. Mean sperm count, motility, and abnormal forms were improved after surgery and were statistically significant for sperm density and morphology (P  0.05). Before surgery, 21 patients (26%) had a low positivity for ASAB (10 to 40%). Six months after surgery, the ASAB titer was reduced in 15 (A group), increased in 3 (B group), and reduced in another 3 (C group). The C group also had an increase in other titers. In the A group sperm count, motility and normal forms improved after surgery (P  0.05). In the B group, motility was reduced after surgery. In the C group, motility and normal forms were reduced after surgery. Sixty patients were negative for ASAB before surgery. Of these, 48 showed an increase in at least one of the ASAB types to some degree that had no significant effect on semen parameters. In the control group, two patients (7%) were weakly positive for ASAB. Conclusions: Varicocelectomy may reduce the ASAB level, and this reduction has a good effect on semen parameter quality. Also, it may raise the ASAB level in some patients. This positive conversion has no adverse effect on semen parameters. Key Words: varicocele, infertility, antibody V aricocele is a common cause of infertility. Semen pa- rameter aberrations, including oligospermia, impaired motility, and increased abnormal forms of sperm have been described by MacLeod. 1 Other detrimental effects of varico- celes are testicular growth failure, Leydig cell dysfunction, and histologic changes. 2 Despite data obtained from animal models as well as human studies, the pathophysiology remains unclear. 3 Higher intrascrotal temperature, 4 reflux of renal and adrenal metabolites from the renal vein, 5 decreased blood flow 6 and hypoxia, local hormonal imbalance, and intratesticular hyperperfusion injury 2 have all been proposed as the mech- anisms by which varicoceles affect testicular function. Varicocelectomy improves seminal parameters in ap- proximately 70% of patients, most commonly in sperm mo- tility, but also in regard to density and morphology. 7 Fertility may also be impaired as the result of the presence of anti- sperm antibodies (ASAB). Varicocele-related infertility with ASAB formation has been described in literature. 8,9 Knudson et al 10 demonstrated an increased incidence of sperm-bound antibodies in infertile varicocele patients and their adverse effect on motile sperm count compared with infertile patients without varicocele. However, the debate regarding the rela- tionship of infertility, varicocele, and ASAB is ongoing. A prospective investigation was done to assess the inci- dence of pre- and postoperative ASAB in varicocele-associ- ated infertile patients. From the Department of Urology, Mohammadi Hospital, Hormozgan Uni- versity of Medical Sciences; the Department of Urology, Urology and Transplant Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran; and the Department of Embryology, Rooyan Research Institute. Reprint requests to Dr. Hooman Djaladat, Urology and Transplant Research Center, Sina Hospital, Department of Urology, Tehran University of Medical Sciences, Tehran, Iran. E-mail: hoomanj@yahoo.com Accepted July 29, 2005. Copyright © 2006 by The Southern Medical Association 0038-4348/0-2000/9900-0044 Key Points • Varicocelectomy may reduce antisperm antibody level. • Varicocelectomy may induce antibody formation in those with preoperative negative antibody level. • Reduction of antisperm antibodies after varicocelec- tomy is associated with improving count, motility, and normal forms of sperm. 44 © 2006 Southern Medical Association