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Antisperm antibodies(29 Posts)
After 2yrs TTC and finally at door of IVF, just found out yesterday that DH has antisperm antibodies, making his sperm 'clump' together. This is a test not done as standard on the NHS until very last minute (i.e. in IVF process), so I am shattered that we wasted time chasing other things not knowing about this at all. We were also told it is extremely rare.
Does anyone have any experience of this, and know of any treatment - medical or alternative? I know IVF and/or IUI - maybe even ICSI - are probably on the cards, but looking to hear anything anyone can tell us about this condition, what you've learned and done to get through it.
yes that is the problem dh and I have (he has lowish numbers of sperm, poor morphology and 30% antibodies) - we were told:
1) Change supplements to Menevit (can only get from Australia/New Zealand online about £40ish for 3 months or find out their contents and buy lots of bottles in chemist to make up the same level. It has made a difference, 4 SA later we can see a rise in number of sperm, improved motility but same level of antibodies! Took 11months of nhs testing to find out the real problem.
2) We were told we need ICSI (but as you know, noone will treat us despite PCT funding for one cycle!) - so did the dr recommend anything for you? Are you nhs or private?
All the best - we go to see a dr (if can get through rest of hurdles tehy are putting up) in 3 weeks, so will let you know what they say. x
There are a variety of treatments available to help couples struggling with antisperm antibodies to conceive.
Sperms are complicated things and there is much about them that is not understood. Simple remedies will make no difference here so please do not waste your cash on vitamin supplements.
Treatments for semen antibodies include:-
Corticosteroids: Corticosteroids help to decrease the production of antisperm antibodies. Unfortunately, corticosteroids are associated with side effects, including hipbone damage.
Intrauterine Insemination(IUI): IUI can help couples to overcome antisperm antibodies as it allows sperm to bypass the cervical mucus. Fertility drugs can also be used.
In-Vitro Fertilization(IVF): IVF is the most successful treatment for couples with antisperm antibodies. This allows the sperm to be directly injected into the egg, without havng to travel throguh the uterus and fallopian tubes.
Hi - I was purely stating what the fertility clinic told us to do, so apologies for sharing out treatment protocol.
PS - more than 2years of serious ttc later I have failed to get pregnant (no miscarriages) and we are hoping one day we will get the IVF treatment we need.
Hi all(waves to keziah): Tony Weschler in TCOYF recommends 1000mg a day of a vitamin C pill containing calcium, magnesium, and manganese for sperm agglutination(or clumping of sperm). Her recommendations are based on a fertility study whereby 100% of the men taking the vitamin supplement got their partners pregnant, whereas not a single man in the control group did! I'd suggest discussing this potential remedy with your doctor. It's worth a try- surely?
Any of you guys tried it, hears of it, or considering it?
I'm really sorry to hear you've had this news.
As far as your treatment options go, IUI is only really any use if it is the female who has the antibodies. Steroid treatment is now not widely used as the dose needed is so high (to suppress the immune system) that the side effects become unacceptable. Sadly it is true that if the antibodies are severe enough to badly affect the number of free swimming sperm then ICSI is the recommended treatment. Conventional IVF may not work because the antibodies may be bound to the sperm head and interfere with sperm-egg binding.
I've worked in infertility for 18 years now and haven't heard of any supplements that help, sorry - but then I wouldn't! I only see the couples who need my scientific help so the ones who have done it by themselves I never hear about.
Good luck with whatever you decide.
Freelance, yes we were told ICSI was the only scientific treatment which is what we are aiming and hoping for. The supplement change was just recommended as a better one to take and we know it will not help us get pregnant.
ICSI it is then Choccie - well that is what the hospital told us as my dh has the antibody problem.
Thank you all for replying ...
The MARS results are as follows:
igA 40% binding, and igG 57%. The embryologist has said 50% of the sperm is in patches and clumps.
We've been told that on the basis of this sample we can try IVF. DH will be asked to give his sample into a culture, and they will look at it while I am on the table and decide then whether we need ICSI or not, and DH will consent for both of us.
I have so many questions though, and would really appreciate your thoughts:
1/ What do the different MARS results mean...?
2/ How did DH and I manage to have two BFPs in 2009 (both ended in MCs)?
3/ Did the antibodies have anything to do with the MCs?
4/ Can the fact that he has antibodies on his sperm make my CM develop antibodies as well ... could this explain no luck with TTC now?
5/ Is this a progressive condition ... is it going to get worse as he gets older?
6/ Is every sample going to be about the same, or might we get to IVF day and find his sample much much worse?
7/DH wants to know if only one testicle at a time could be affected (meaning he might have one OK testicle and one not OK)....?
8/ Will using pre-seed during SWI improve odds for the non clumping ones?
What upsets me, is at the start of this year I went to see a private consultant and we specifically said that at our age (I am nearly 40) we didn't want any last minute nasty shocks because we had to plan fast. And we asked what tests we could have --- which we were prepared to pay for. The guy looked at us and said to my DH "It's not you who has the problem, it's her - her age....". I'd love to slap him - here I am, even older, and struggling to find a way forward, no thanks to him.
On vitamins.... I think they do seem to help:
DH has had 3 SA. His first two SAs had similar results, and then he went on a regime of vitamins recommended by a nutritionist, and I also added pycnogenol (which she said would do him no harm). (Keziah, I can only get these online). There has been a significant improvement, so stick with your regime - it won't do him any harm:
Change between June and November:
Overall motile: was 44% - now 79%
Progressive motility: was 39% - now 71%
Concentration: was 121 - now 110 (but the volume sample was also lower so we not sure if that affected)
Total motile: was 202, and now 304
Morphology: was 8 - now 14
I'm going to dig out my TCOYF book to read through again as well...
I can answer a few of your Qs:
It is possible to concieve with ASAbs, it is more difficult, and it depends on the level and where on the sperm they are bound (head binding is the worst). It will not have caused the miscarriages - they interfere with sperm reaching egg and binding, nothing else.
The antibodies have formed because at some time in the past your DH has had an injury or swelling to his testes that have allowed his immune system to 'see' his sperm and it then mounts an immune reaction to them. The antibodies are in the seminal plasma (the liquid bit of the semen) so not from one testicle or the other.
The levels can vary. We used to have a cut off of 80%, then dropped it to 50% as we had some poor results with IVF. IgA and IgG are just different types of Ab. The main factor is the clumping really - this is significantly reducing the number of free sperm that are able to escape from the semen and reach the egg. Abs also act as little 'balls and chains' and weigh the sperm down.
I don't know of any evidence that ASAbs in the male cause a reaction in the female.
And as for whether it will get worse or not, I actually don't know. It is normal for counts and motility to vary and reduce as men age.
And no advice about the pre-seed either, sorry.
The embryologist will get DH to produce into medium as this can 'mop up' some of the antibodies and hopefully reduce the clumping. It then depends how many free-swimming sperm can be isolated.
That sounds really useful information. Interesting we were told ICSI only and nothing about producing into a culture, which does sound very sensible. We were not given a breakdown of antibodies... how interesting different dr's and hospitals vary so much.
Choccie have you asked the hospital about miscarriage factors, as it may be a separate problem or linked to Ab's?
freelance that's really helpful, thank you. Can you help us understand if there is a correlation between our June and November test results and the findings now.
In first two tests (April and then June), DH's results said his 'Consistency' was Normal, both times, and now in November it is 'Abnormal' - thick. Agglutination in first two tests was '0', and in November was 50%.
Does this suggest something that has happened in the last six months, or does consistency and agglutination have nothing to do with the 'clumping'?
DH had pain in one of his testicles in May this year and went to see his GP, but GP said nothing was wrong and gave him no antibiotics or anything. We are now wondering if this has effectivly led to where we are now.
Both times we got our BFP in 2009, it was absurdly quick - on the second attempt of TTC each time - which seems really odd if this problem makes things more difficult.
freelance can you also explain more on why IUI is not an option if the male has the ASabs...? I've read that his sperm would be 'washed' and 'spun', separating the free sperm from the non-clumping ones which would then be put into me. DH has been Googling and is keen for us to try squeeze in an IUI before IVF next year if possible, but are we just throwing our money down the drain?
Thank for your input - I really appreciate it. We're spinning here. Total shock.
keziah One of the things I am finding it hardest to adjust to right now is how little support we've had in this process. I've spent most of my life fighting for others' rights, and I feel now there is NO ONE fighting for mine in my time of need. Everything we've achieved has been through DH and I pushing and pushing. If we had assumed the NHS would take care of us, we'd still be being told that because I got PG twice, there was nothing wrong, and we needed to just keep trying before even having basic tests. We'd also still be being told that all of our problems were down to my age. We only got basic tests because we got a letter from a private consultant sent to our GP; and we got the referral to the FC because DH and I ganged up on our GP together and I started crying ... the GP told us he'd write but said he thought they'd refuse to see us ... well they didn't, and here we are.
So I guess what I am saying is that I think hell would probably freeze over before we got people to test us for our MCs. I have asked and asked about this, but because of my age, they are assuming it's just poor egg quality. I've been told I have to have THREE MCs before I get tests (not great if the BFP are self-funded IVF). I have my doubts about the MCs being 'normal' because I get these extreme physical symptoms whenever I am PG, and I think something wrong is happening in my body ... but as you know from other threads, the NHS consensus is that's all in my head.
DH and I are so worn out. It has been two years of struggle after struggle after struggle. He just said to me in the car that he'll never trust doctors again ever. We were told by the IVF people that I needed to try and relax around IVF time ... if only I had the guts to tell them that most of my source of stress was NHS related .........
... sorry, I'm ranting ... but I know your story and know you'll understand my depair and pain over the problem AND the way it is not dealt with.
Mmm, does sound like the problem started in May, doesn't it? Does this fit with your timeline in terms of difficulty conceiving?
Consistency (or viscosity)is, as far as I know, not related to antibodies. The clumping/agglutination very definitely is. If there was none before, DH had an episode of testicular pain, then there is evidence of Abs, it does sound like this was what caused the abs to form. If it helps, by the time he reported pain the damage may have been done. Any swelling in that region can cause a break in what is called the 'blood-testis barrier' which then exposes the sperm and sperm-making cells to the immune system.
Has he been examined at all? Men need to check for lumps and bumps just as much as women and he maybe needs to be looked at as much for reassurance.
As far as I know (and I'm a lab rat, not a doctor) IUI is really only recommended by NICE where there is no known male factor. I'd be concerned that even with the sperm washing the Abs can't be washed off, and you may just be wasting time and money. Certainly at my clinic we wouldn't recommend IUI and we'd be strongly steering you towards ICSI. But all clinics have different criteria and not having seen your DHs sperm down the microscope it may be that they are confident there is no head binding and good numbers are not agglutinated.
I can only sympathise with the miscarriage investigations. I've had 4 miscarriages in total myself (2 before DS then 2 before DD) and had to battle to see a consultant for any help at all (and I work with 4 gynaecologists). I can see why one is not investigated, but surely 2 on the run needs looking at.
Pants, isn't it?
Choccie - I do hear you. I know how much we have had to push for testing also, and how now we cannot get treatment currently. And we told them my husband was diagnosed and operated on for an undescended testicle right at the beginning of this treatment and no one raised any concerns!! (Operation around puberty as not picked up before!)
I struggled with our nhs hospital as despite antibody problem and 11 months of testing we were told to keep trying for another 6months - when we know of one couple with no identified problem who are being treated there!! And they did not have to wait 3months between testing.... it is so hard.
Agree with freelance that getting your dh properly tested might be good - am I right in thinking anyone can go to a GUM clinic (male or female) for testing - and no waiting?
Yes, know here it is 3 miscarriages before they investigate, didn't know if it was the same elsewhere.
keziah It is so so hard. We're both struggling.
freelance My DH went to the GP as soon as he experienced pain especially because we were TTC. He did everything right. He was examined, but the GP said nothing was wrong and sent him away without any treatment or other investigations. In fact, the GP suggested it was probably just a groin strain.
The only thing DH can think that might have caused the pain was sitting for a long time on a hard chair through an intensive work period of days at a time..... This is the ONLY thing he can associate with the pain at the time. I find this difficult to believe could be the main factor with the abs: surely it would be a lot more common if that could bring it on....? It's not what I would have thought was major trauma.
As far as timing and our problems, we had our second MC in Dec last year, and haven't managed to get a BFP this year at all despite extremely well-timed planned SWI. We didn't know if this was because there was an issue - we actually thought it was probably more down to it just sometimes taking a long time.
We got the shock of our lives when we heard about the abs, and even now, it hasn't fully sunk in for us how much of a problem this is going to be.
Is it even worth us TTC naturally anymore...? And really, what are the odds of us conceiving with ICSI at my age (I'll be 40 when we go through the procedure). I'm so low about this, I don't even know what to think.
freelance, do your clinic advise against tranferring two embryos because of twin risks....? We got given a big lecture about that, but right now I'm wondering if we need to try and make the most of the few eggs I might have left (if any)! I don;t think I have many chances left at my age.
freelance sorry, one more question. Do you know of cases of abs where there is an improvement shown in subsequent SA...?
Or is it more common for this to stay stable at 50%?
Or are we looking at things probably worsening...?
DH is wondering if too much sex could make the abs 'flare up' etc .....
Choccie - my dh and I are low too, had a break of 2 months of ttc and now feel more happy trying naturally again ... it takes a while to process. Are you on a list for FT? Have you had an AMH test (I haven't) to see what your ovarian reserve is to help you decide treatment options?
We know my dh had an undescended testicle, not treated for 12yrs, hence we can see a reason - but sitting on a hard chair sounds strange (didn't most teens do that all day at school etc?) It might help you both to have another SA - my dh had 4 (3 on nhs, one private) which has helped us, as some numbers have changed (volume etc!)
Sending you empathetic hugs xx
hi again keziah.
We are on schedule (so far) for IVF in February. Not NHS funded, although done through an NHS hospital. I'm too old for funded cycles. I had an AMH test privately a little while ago, and I've been told that my egg reserve and DH's sample make us candidates for IVF. What we will only know on the day my eggs are removed, is whether my egg QUALITY is good enough for IVF, and we may still have to go ICSI if it isn't.
My DH phoned the consultant embryologist again today (more than 20yrs experience) with even more questions. I want to share this with you because we've been told this is quite a rare problem (although, from what I've read, common if you have a vasectomy reversal).
He asked about pre-seed, and whether it would help or hinder. She looked it up online and said she thought it was fine to use it, but couldn't say whether it would improve things. She didn't think it would do any harm.
We asked how often we had to SWI. I'd read that if men with antibodies ejaculate more frequently, that the antibodies have less time to cling on to the sperm, so we were thinking maybe SWI twice on peak days... The embryologist just said regularly through the month - wasn't too sure on this one. But I have read that long periods of abstinence allow the antibodies to build up, so my DH is on instruction from me to 'sort himself out' if we're too tired to DTD.
She also told DH that antibodies could be worse in his next test, or even could be better. She said she'd seen cases where they seemed to be one-off 'episodes' as well, and the antibodies disappeared to never come back again! I read online last night of two cases in the fertilityfriends forum where exactly that happened: two couples were told they had antibodies and were devastated, only to find in subsequent tests that they'd gone away.
She thinks IUI is an option for us. Under normal circumstances, she said they would tell people there wasn't a huge difference in success rates between IUI and doing nothing for couples who have 'unexplained infertility' (there was a huge study on this - I thnk I've told you about before). But in our case, because the sperm is 'washed', she thought it was an argument for trying IUI. That, plus the fact that my DH has 50% without the antibodies, and a reasonably good count, made her think it was worth a shot. We will have to do this privately, and it'll cost us about £450. DH really wants to give it a go, so we're seriously looking into it. To him, it makes sense.
She told my DH that his antibodies were mostly on the tail, which was 'good news' because antibodies on the head can prevent the sperm penetrating the egg.
She thinks with DH's count - even with 50% antibodies - that it is still worth us trying naturally, and she thinks it could happen. But we're going IVF anyway because of our age, but will try naturally or IUI in the meanwhile.
She then told my DH that we were 'young', to which he immediately said we were not!! But she said in her mind we were, because we were educated and therefore probably taking care of ourselves, didn't have a history of heavy drinking, smoking, drugs etc - all of which makes a difference. So that was nice to hear even if I still think I am old.
I also contacted a nutritionist again today with the news ... lots of info from her too and a cocktail of stuff for DH, but I'll share that in another message if you're keen to know more about this. My thinking here is to boost his count as much as possible, and , as I seid in a previous post, we've seen seen a significant positive imporvement in his results since he started the vits in last five months.
AND, we're waiting for a call-back from a TCM guy that DH knows very well. He's superqualified and decades experience - we're going to explore TCM with him for DH if possible, and will let you know what he says. I've read that 'tai-boi' has been shown to help antisperm antibodies ... I don't know yet, need to see what our friend says before doing anything like that just yet.
One thing though - I was told by the FC to stay away from TCM during IVF because they didn't know how these interacted with the drugs... so I am!
...whew... long post.... but I am on a marathon of trying to do things to help us get through this. Will share info all the way if you're interested.
Empathetic hug back to you. x
Sounds like you had a good chat with the consultant embryologist there! Glad DH's Abs are tail only - this makes a lot of difference and makes IUI or IVF a more feasible option.
I don't have any more to add really except to say good luck to you both - and any lurkers who haven't posted...
Wow thanks for all that information. How amazing you know where all the antibody problems are etc - we didn't get anything other than a percentage.
Any extra info on nutrition etc would be great - as you seem to have tapped into some experienced professionals there - feel free to pm if you don't want to post here. We too are not getting any younger.
Is it the private fertility clinic that gave you all this information about antibodies and the fact ey were mainly on the tail? Wondering how we could get more information etc. Apart from lowish numbers myself on day 21 test (21-24) they have not picked up any issues for me, so I am concerned that we haven't got pregnant at all, if there was some chance of it working normally - as dh's AB number was 37%, although motility etc much lower than your dh's numbers.
Ooh - I am not that old either, based on what you were told (well educated etc...)
Yes, would really like to do everything we can to improve chances naturally (as not yet got their approval for fertility treatment due to having been on ADS in the past, well you know the story!) as well as if we get passed for IVF!!
Anything you can share to help us with this "rare problem!" would be great - and no dh not had a vasectomy, but an undescended testicls - and we read now that is the probable problem (feel like throttling his parents for not noticing, or the dr when he was born!!)
freelance You've been utterly amazing. Thanks so much for the support. I appreciate it so much.
keziah It was actually the NHS hospital where we'll be having the IVF (but paying). We didn't get anything except the percentages either, initially, which is why I felt so unsettled and just not quite KNOWING. Without the detail it just felt like devastating news. But DH and I spent the weekend googling and we wrote down a bunch of questions, some of freelances answers got us reading in directions too. So we basically got answers to very specific questions.
That's the trick, isn't it, KNOWING what to ask at the time. So hard.
My DH just picks up the phone and phones now to get answers. After his second SA in June he was annoyed that the GP wouldn't tell him what the figures meant, so he asked for a copy of the test results, which came with a telephone number of the lab on it, and he phoned the lab direct . DH got a lab person to explain everything to him because the GP wouldn't. Incredible really, that you have tests and the GP refuses to tell you if they are good or bad!
DH's attitude is 'why the hell not give it a try'. The embryologist was on the phone to DH for ages today, and he said she looked stuff up on her computer to check things he was asking etc. Told him she wished there were long-term studies into men with antibody problems ... she said there hadn't been many studies like that done ... so DH said, "Well, I ticked the research box on my consent form..." She was very pleased about that.
So, here's an idea: why not get your DH to call and offer to take part in studies because this is rare ... but he should ask if he can make a telephone appointment to talk about the antibodies and get a full understanding, or even go in and see the embryologist. If this is fairly unusual, then maybe they'd be keen to meet with him (assuming he can cope with all that ), and who knows, maybe it'll help with getting you both personally known to the people at the hospital as well....? (Not that I am sneaky or anything..)
I will write another post tomorrow about the vit regime we're on. I'll post it here, just in case anyone else ever has this issue and needs support too. Speak tomorrow. x.
I'd encourage anyone in a similar position or with other questions to ask to speak to an embryologist at the clinic. We may not always be available at the drop of a hat but we can certainly call you or catch you at a time while you are waiting for a scan/blood test. Doctors know 'their' bit but we are the experts on the lab side of things. We all have to do very specific training and keep up to date with the latest research. We can help you to interpret things you find on the internet as well - many sites are not UK sites so the advice is not always appropriate (or possible in the UK!!). AND we love talking to patients - that is why we do this job and not locked away in another lab looking at slides all day.
That's really good to know freelance. Yesterday I was totally aimless, walking around in shock, losing my train of thought, confused. Stunned I suppose. When DH phoned me to tell me about his conversation with the embryologist I suddenly felt grounded again - still in shock - but as if I had some sense of control back. The other thing that I think made a difference for me, was apparently the embryologist empathised with DH about our MCs, and agreed the non-testing until 3 MCs wasn't cool. But she then went on to say how deeply everyone at the clinic felt for couples like us, and she was there to help and would do all she could. The acknowledgement of flaws in the NHS system (instead of impassive expert faces as if all things NHS are great and reasonable), plus the human kindness nearly undid me. But made a big difference.
So keziah DO call your clinic for more specific answers to your questions. I suggest though that you write them all down so you don't forget anything.
Keziah, as promised, the vit/diet regime we're on is as follows:
Fertility Plus for Men, 3 capsules daily (Natural Health Practice brand)
1000mg Vit C a day (because I read that some research had been done on Vit C and antibodies)
Fish oil capsules (Lamberts brand)
Biocare Nutriguard Plus (apparently a good antioxidant)
Seagreens food capsules - 4 capsules a day
Mum-2-be (Higher Nature brand, not the ones you can get in Boots), 3 capsules daily
Fish oils, 3 capsules daily
Evening primrose oil, 1000mg only in first half of my cycle
A very very weak tincture of agnes cactus, once a day only in second half of cycle
Biocare Mineral complex (because my mineral levels were very low)
Vit E oil once a day
Seagreens - 6 capsules a day
I also take Vit D in the winter months because I suffer from S.A.D.
The seagreens are for detoxing and we only need to do this for two months. We had a test that found very small levels of mercury in our systems (we assume from eating tuna) and the seagreens are supposed to help us shift this before Feb.
All of this can be bought here, but I'd recommend you go see a fertility nutritionist to get a 'programme' specific to you and your needs.
DH's multi-vit is supposed to be one that has higher numbers of the things sperm specifically need, so if you can compare what it contains with the one you get from Aus, maybe you can buy locally instead.
We also have smoothies every morning, to which I add brazil nuts and seeds, LOTS of different fruit, bio yoghurt, and a handful of oats. We've been doing this for a while. But I by coincidence read something on the 'net this weekend recommending smoothies for men who have antibodies - I assume maybe because of fruit antioxidants?
And we've been told to try aim for SEVEN fruit and veg a day (the smoothies go a long way to hitting that target!), and to try include a dark leafy green veg as one of the veg everyday.
Needless to say, we are not boozing ... but nor do we deny ourselves the odd glass of wine here and there. (Maybe a couple of glasses a month).
We've swapped to organic milk, and if its a veg that can't be thoroughly washed, we buy organic for that ... but I am sceptical about the assumptions organic is hugely better than other so I don't stress too much if I just get 'Tesco own brand' fruit for my smoothies.
None of this is cheap when all totled up, but DH's non-moving sperm in June was 56%, and in Nov this scarey number had dropped to 21%. His total progressive sperm in June was 39%, and in Nov it went up to 79%. We can only assume that the improvement is down to the vits and lifestyle and diet changes. So we're sticking with it religiously.
Wow, great info - will print it out and talk with dh as he is happy to do things to help, and I agree it may be expensive but it is healthy and cheaper than IVF!!
will post properly when absorbed all of that. Many thanks xx
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