From the Guidelines
If sperm agglutination is noted during microscopy, the comment in a semen analysis report should state: "Sperm agglutination present," followed by a description of the degree (mild, moderate, or severe) and pattern of agglutination (head-to-head, tail-to-tail, or mixed). Agglutination should be differentiated from non-specific clumping, as true agglutination suggests the presence of antisperm antibodies. The report should recommend immunological testing if agglutination is significant, particularly if associated with other abnormal parameters or in cases of unexplained infertility. Sperm agglutination occurs when antibodies cause sperm to stick together, potentially impairing sperm motility and function. This finding may indicate an autoimmune response against sperm antigens, which can occur following testicular trauma, infection, or surgery that disrupts the blood-testis barrier. While mild agglutination may not significantly impact fertility, moderate to severe agglutination warrants further investigation as it may contribute to difficulties achieving pregnancy, as suggested by recent guidelines 1.
Some key points to consider when evaluating sperm agglutination include:
- Differentiating between true agglutination and non-specific clumping
- Describing the degree and pattern of agglutination
- Recommending immunological testing if agglutination is significant
- Considering the potential impact on fertility, particularly in cases of moderate to severe agglutination
- Recognizing the potential causes of sperm agglutination, including autoimmune responses and disruption of the blood-testis barrier, as discussed in the context of male infertility diagnosis and treatment 1.
In clinical practice, it is essential to prioritize the evaluation and management of sperm agglutination, given its potential impact on fertility outcomes, and to consider the latest guidelines and evidence-based recommendations when interpreting semen analysis results and developing treatment plans.
From the Research
Sperm Agglutination in Semen Analysis
If sperm agglutination is noted in microscopy during a semen analysis, the following points should be considered when writing a comment in the report:
- Sperm agglutination is a relatively common finding in men presenting to a reproductive clinic, with a prevalence of 12.1% as reported in a study 2.
- The presence of agglutination may be associated with various factors, including antisperm antibodies (ASAs), genital tract infection, and ascorbic acid deficiency 2.
- However, studies have shown that the presence of ASAs is not always associated with chronic inflammation and infection of the seminal tract 3.
- Sperm agglutination can also be caused by other factors, such as the adherence of Escherichia coli to sperm, which is a mannose-mediated phenomenon 4.
- The observation of sperm agglutination may suggest the presence of ASAs, but it is not conclusive for the diagnosis of immunological infertility 5.
- When commenting on sperm agglutination in a semen analysis report, it is essential to consider the potential underlying causes and the clinical significance of this finding, as discussed in various studies 2, 6, 5.
Potential Causes of Sperm Agglutination
Some potential causes of sperm agglutination include:
- Antisperm antibodies (ASAs) 2, 6, 5
- Genital tract infection 2, 3
- Ascorbic acid deficiency 2
- Adherence of Escherichia coli to sperm 4
- Scrotal surgery or trauma, which may increase the risk of agglutination and variability 2
Clinical Significance of Sperm Agglutination
The clinical significance of sperm agglutination is still being researched, but it is known to be a potential cause of immunoinfertility 5.
- The presence of ASAs can affect human fertility, but normally, they may be controlled by anti-idiotypic antibodies and immunosuppressor factors in semen 6.
- The balance between detrimental and "beneficial" immune response to sperm may be shifted toward an antisperm antibody response by stimulatory factors such as infection 6.