Autoimmune
orchitis is a relevant cause of decreased fecundity in males, and it is defined as a direct aggression to the testis with the concomitant presence of anti-sperm
antibodies (ASA). The presence of these specific
antibodies has been observed in approximately 5-12% of infertile male partners. Primary autoimmune
orchitis is defined by isolated
infertility with ASA but without evidence of a systemic disease. Secondary causes of
orchitis and/or testicular
vasculitis are uniformly associated with
autoimmune diseases, mainly in primary
vasculitis such as
polyarteritis nodosa, Behçet's disease, and Henoch-Schönlein
purpura. The overall frequencies of acute
orchitis and ASA in
rheumatic diseases are 2-31% and 0-50%, respectively. The pathogenesis of primary/secondary autoimmune
orchitis is not completely understood but probably involves the access of immune cells to the testicular microenvironment due to
inflammation,
infection or
trauma, leading to apoptosis of spermatocytes and spermatids.
Glucocorticoids and immunosuppressive drugs are indicated in autoimmune
orchitis-associated active systemic
autoimmune diseases. However, there are no standardized treatment options, and the real significance of ASA in infertile men is still controversial. Assisted reproductive technologies such as intrauterine insemination, in vitro fertilization, and intracytoplasmic sperm injection (ICSI) are therapeutic options for
male infertility associated with these
autoantibodies. ICSI is considered to be the best choice for patients with severe sperm autoimmunity, particularly in males with low semen counts or motility.