Abstract
This chapter reviews current knowledge on clinical male infertility, with emphasis on autoimmune orchitis and its pathogenetic mechanism. Male infertility associated with immunologic mechanisms may result from the presence of sperm antibodies or autoimmune disease of the testis and its excurrent ducts. In the first case, antibodies, once generated, may result in infertility by a variety of mechanisms, mainly disturbances in sperm transport or disruptions in gamete interaction. In the second case, immunopathologic damage of the testis occurs through T-cell-mediated mechanisms triggered by antigens or pathogens that disrupt testicular immunoprivilege. Male infertility may result from the binding of antisperm antibodies (ASAs) to ejaculated sperm. Importantly, data from in vitro fertilization programs indicate that a reduced fertilization rate is associated with IgA and IgG antibody binding to the head region of sperm. Moreover, the recent finding of a single gene (AIRE) defect causing a systemic human autoimmune polyglandular syndrome provides an exciting tool for exploring molecular therapy for these autoimmune diseases.
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