Association of anti-sperm antibodies with chronic prostatitis: A systematic review and meta-analysis
Introduction
Prostatitis is the most common urological disease in men under the age of 50 years, with prevalence ranging from 2.2% to 9.7% worldwide, with an overall rate of 8.2% (Krieger et al., 2008). It is defined as a heterogeneous mixture of syndromes, with broad diagnostic criteria but its etiology and pathophysiology are somewhat vague (Sharp et al., 2010, Pontari and Ruggieri, 2008). The prostate is a male accessory sex organ that provides secretions vital for normal fertility. It secretes several major components of seminal plasma that nourish and protect spermatozoa following ejaculation. The current study considered the prostate to be an immunocompetent and not an immunoprivileged site as previously thought (Whitmore and Gittes, 1977, Kramer et al., 2007). Given the intimate association of the prostate with male reproductive function, prostatitis has long been suspected of playing a role in male subfertility. But strong evidence for a direct impact of prostatitis on male fertility is lacking.
Research on anti-sperm antibodies (ASAs) began in 1899, when it was initially reported that sperm could be antigenic if injected into a foreign species (Landsteiner, 1899). The presence of ASAs in infertile men was first reported by Rumke (1954) and Wilson (1954). Since then, ASAs have been considered by several authors as a possible causative factor in infertility, with significant levels being detected in the semen of 5–15% (Adeghe, 1993) of infertile men but in only 1–2% (Ayvaliotis et al., 1985, Bates, 1997) of fertile men. It is assumed that the development of ASAs is mainly a consequence of trauma to the blood–testis barrier, epididymis, or vas deferens (Gubin et al., 1998). ASAs is also associated with inflammation, and their appearance is often thought to be of idiopathic origin (Lenzi et al., 1997).
Current studies have investigated the correlation between the presence of ASAs and chronic prostatitis, but have shown contradictory results. Some studies have shown a significant ASA-positive relationship in patients with chronic prostatitis compared with healthy individuals (Hoover and Naz, 2012, Marconi et al., 2009, Mie, 2009), but not other studies (Deng et al., 1992, Qin et al., 2005, Zhang et al., 2004). Therefore, we systematically reviewed the available literature and performed a meta-analysis to evaluate the correlation of ASAs and chronic prostatitis, which might shed valuable insights into the relationship between chronic prostatitis and male infertility.
Section snippets
Literature search
This meta-analysis was restricted to published studies that investigated the ASA-positive relationship between chronic prostatitis versus normal controls. Two independent reviewers (Jiang YM and Cui D) searched PubMed, EMBASE, Science Direct/Elsevier, Medline, CNKI, and the Cochrane Library from inception to December 2014. The language or study type was not restricted. The search terms combined text words and MeSH terms. For example, the search terms for ASAs were: ‘antisperm antibodies’,
Characteristics of the included studies
Fig. 1 shows the detailed review process. A total of 1173 unduplicated studies were identified. Six studies were ultimately selected according to the eligibility criteria; three studies investigated a relationship between the ASAs and NIH II, and three investigated a relationship between the ASAs and NIH III. After group discussion, all reviewers were in agreement to include all six papers.
Table 1 summarizes the data from the six studies. All retrieved studies involved 721 cases and 160
Discussion
Six studies investigated the ASA-positive relationship between chronic prostatitis patients versus normal controls. Only three studies (Deng et al., 1992, Qin et al., 2005, Zhang et al., 2004) reported a significant correlation. In our meta-analysis, there was a significant correlation of the ASA-positive relationship between chronic prostatitis versus normal controls (Fig. 2). To understand better the correlation of the ASA-positive relationship between chronic prostatitis versus healthy male,
Acknowledgement
The present study was supported by the National Science Foundation of China (grant No. 81072107 and 81372736).
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These authors contributed equally to this work.