Table 3. Studies reporting the reproductive outcomes after ART in ASA-positive patients.
| Intervention | Reference | Observation | ||
|---|---|---|---|---|
| IUI | Barbonetti et al, 2020 [63] |
Population | Group 1: 44 men with 100% ASA positive | |
| Group 2: 40 men with 50%–99% ASA positive | ||||
| ASA testing | IgG-MAR test on semen | |||
| Main outcome | Lower natural LBR in group 1 (p<0.0001) | |||
| Comparable LBR after IUI | ||||
| Study limitations | Retrospective analysis | |||
| Relatively small sample size | ||||
| Ombelet et al, 1997 [58] |
Population | Group I: n=14 couples treated with ovarian stimulation/ IUI, followed by IVF if no pregnancy occurred after three IUI cycles. | ||
| Group II: n=15 patients treated with IVF as a first-choice procedure | ||||
| ASA testing | IgG and IgA MAR test in serum and semen (positivity: >50%) | |||
| Main outcome | Take home baby rate of 64.3% (n=9) with 3 IUI cycles | |||
| Recommend superovulation with IUI as first line of management for immunological infertility | ||||
| Study limitations | Small sample size, no randomization protocol | |||
| IVF | Lu et al, 2019 [29] |
Population | Infertile couples (n=399 cycles): | |
| - 39 ASA positive | ||||
| - 360 ASA negative | ||||
| ASA testing | ELISA test kit for serum ASA (positivity: ASA >75 IU) | |||
| Main outcome | Lower rates of FR, good embryos, PR, and LBR in ASA positive than ASA negative men (p<0.05) | |||
| Study limitations | Small sample size of ASA positive, selection bias, serum ASA tested | |||
| Clarke, 2006 [59] |
Population | Group 1: 51 ASA negative (control) | ||
| Group 2: 13 ASA positive <80% | ||||
| Group 3: 25 ASA positive ≥80% | ||||
| ASA testing | Direct IBT for IgA (positivity: ≥20%) | |||
| Main outcome | Lower FR in ASA positive groups than ASA negative (p<0.05) | |||
| Study limitations | Small sample size | |||
| Vujisić et al, 2005 [60] |
Population | Group 1: 38 ASA positive IgG <20% | ||
| Group 2: 14 ASA positive IgG >20% | ||||
| ASA testing | MAR test for IgG, IgA, and IgM on semen | |||
| Main outcome | Comparable FR (73.2% vs. 71.5%) and PR (28.9% vs. 28.57%) | |||
| Study limitations | Small sample size, lack of control group | |||
| ICSI | Lu et al, 2019 [29] |
Population | Infertile couples (n=155 cycles): | |
| - 19 ASA positive | ||||
| - 136 ASA negative | ||||
| ASA testing | ELISA test kit for serum ASA (positivity: ASA >75 IU) | |||
| Main outcome | Comparable PR and LBR between ASA positive and ASA negative | |||
| Study limitations | Small sample size of ASA positive, selection bias | |||
| Esteves et al, 2007 [61] |
Population | Group 1: 0%–10% ASA (n=194) | ||
| Group 2: 11%–20% ASA (n=107) | ||||
| Group 3: 21%–50% ASA (n=33) | ||||
| Group 4: 51%–100% ASA (n=17) | ||||
| ASA testing | Direct IBT for IgA, IgG, and IgM | |||
| Main outcome | Comparable results for FR, abnormal FR, cleavage rate and velocity, percentage of good quality embryos, clinical PR, and miscarriage rate | |||
| Study limitations | Retrospective cohort | |||
| Mercan et al, 1998 [62] |
Population | 207 couples (279 cycles) | ||
| ASA testing | IgG and IgA MAR and IBT in semen (positivity: >30%) | |||
| Main outcome | Comparable clinical PR and delivery rate in ASA positive and ASA negative men | |||
| Study limitations | Number of ASA positive and negative patients not clearly stated, retrospective cohort | |||
ART: assisted reproductive technology, ASA: antisperm antibodies, IUI: intrauterine insemination, IVF: in vitro fertilization, ICSI: intracytoplasmic sperm injection, IgG: immunoglobulin G, MAR: mixed antiglobulin reaction, LBR: live birth rate, IgA: immunoglobulin A, ELISA: enzyme linked immunosorbent assay, FR: fertilization rate, PR: pregnancy rate, IBT: immunobead test, IgM: immunoglobulin M.