Role of Local Immune Reaction in Primary Obstructive Male Infertility

Objective: To find evidence of local immune reaction (cellular and, if possible, humoral) in patients of primary obstructive infertility and to extrapolate its role in the persistence of infertility even after a patent vasoepididymostomy. This was a prospective study in a tertiary hospital setting comparing epididymal histology and epididymal fluid antisperm antibody in men with primary obstructive infertility with those in men with proven fertility. Material and Methods: Twenty men with primary obstructive infertility in the study group and five men with proven fertility as controls were included in the study. While performing vasoepididymostomy on such patients, testicular and epididymal tissues were taken, and epididymal fluid was aspirated for estimation of antisperm antibodies. Testicular and epididymal histologies were studied under light microscopy for evidence of cellular immune response to obstruction. Antisperm antibodies in epididymal fluid were assayed by ELISA. Result(s): The cellular immune response as assessed by the presence of interstitial inflammatory cells and macrophages in epididymal histology was found in 12/20 patients. Testicular biopsies in all patients were normal. Humoral immune response as assessed by significant titres of antisperm antibodies in epididymal fluid was found in 14/20 patients. Evidence of local immune response (cellular or humoral or both) was found in 17/20 patients. Conclusion(s): Men with primary obstructive infertility develop local immune reaction in their epididymis secondary to obstruction. This factor may be responsible for the persistence of infertility even after a patent vasoepididymostomy