Autoimmunity to spermatozoa: effect on sperm penetration of cervical mucus as reflected by postcoital testing.

In couples with abnormal postcoital tests, where husbands exhibited autoimmunity to spermatozoa, the degree of impairment of sperm penetration into cervical mucus correlated with the proportion of sperm in ejaculates exhibiting surface-bound immunoglobulins. Residual sperm-directed antibodies detected within seminal fluid were not representative of the cell-bound immunoglobulins present on the sperm surfaces. When all sperm were antibody-bound, spermatozoa were rarely seen in cervical mucus. Conversely, the number of motile sperm seen at postcoital testing was normal, that is, no different from that of antibody-negative couples, when less than 50% of sperm were antibody-bound in the ejaculate. In this group, other causes of infertility should be explored. The extent of autoimmunity to spermatozoa as reflected in the proportion of sperm exhibiting immunobead binding, then, provides guidelines for treatment of these men.