From the Guidelines
If sperm agglutination is observed during microscopy, the semen analysis report should include a comment stating the presence, degree, and pattern of agglutination, and recommend further immunological testing, such as an antisperm antibody test, to determine if the agglutination is immune-mediated. When noting sperm agglutination in a semen analysis report, it is crucial to distinguish it from sperm aggregation, which is a non-specific clumping of spermatozoa. Sperm agglutination, on the other hand, refers to the specific adherence of spermatozoa to each other, often in a head-to-head, tail-to-tail, or mixed pattern, which can be indicative of an immunological issue, such as the presence of antisperm antibodies 1. The presence of antisperm antibodies can significantly impair fertility by reducing sperm motility and preventing normal sperm-egg interaction. Therefore, identifying and addressing the underlying cause of sperm agglutination is essential for the management of male infertility. Key points to consider when commenting on sperm agglutination in a semen analysis report include:
- Specifying the degree of agglutination (mild, moderate, or severe) to understand its potential impact on fertility
- Describing the pattern of agglutination (head-to-head, tail-to-tail, or mixed) to help in identifying the possible cause
- Recommending further testing, such as an antisperm antibody test, to confirm an immune-mediated cause
- Noting any potential associations with previous genital tract infections, trauma, or surgery, which could be relevant for the patient's history and treatment plan
- Suggesting referral to a reproductive specialist if significant agglutination is present, as treatment options such as corticosteroids, sperm washing, or assisted reproductive techniques may be necessary depending on the severity and impact on fertility, as per the latest guidelines and recommendations 1.
From the Research
Sperm Agglutination in Semen Analysis
If sperm agglutination is observed during microscopy in a semen analysis, the following comments could be included in the report:
- The presence of agglutinated spermatozoa may be suggestive of an immunological cause of infertility, such as the existence of antisperm antibodies (ASAs) 2
- Sperm agglutination can be caused by various factors, including ASAs, genital tract infection, and ascorbic acid deficiency 3
- The degree of sperm agglutination may be correlated with the presence of ASAs in seminal plasma, which can be a predictive indicator of immunological infertility 2
- Patients with a history of scrotal trauma or surgery may be at higher risk of sperm agglutination and variability in their semen analysis results 3
- The presence of sperm agglutination does not necessarily imply infertility, as some men with high sperm agglutination titers may still be fertile 4
Possible Causes of Sperm Agglutination
Some possible causes of sperm agglutination that could be mentioned in the report include: