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Treatment and Prognosis of Immunological Factors in Unexplained Male Infertility

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Unexplained Infertility

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Abstract

It is widely accepted that immunological infertility is one of the major causes of infertility in humans. On average, infertility occurs in one in every five couples of reproductive age and about 10–20 % of them is unexplained. A subset of infertile patients has been found to possess antisperm antibodies (ASA) in semen, blood, cervical mucus, or follicular fluid. ASA may affect sperm concentration and survival, limit sperm transport and motility and therefore the passage through the female reproductive tract specifically the cervix, inhibit sperm oocyte binding, prevent capacitation and acrosome reaction, affect embryo development and implantation, and has been proposed to lead to spontaneous miscarriage. Several strategies are used to counteract the deleterious effects of ASA-mediated infertility. The basic approaches for the treatment of men with ASA are as follows: minimizing exposure to sperm antigen like the use of condoms, decrease ASA production by immunosuppression with prednisone, removal of sperm bound ASA by a combination of laboratory techniques and sperm washing, and finally the most successful of all, the assisted reproductive technologies (ART).

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References

  1. Mathur S, Rosenlund C, Carlton M, et al. Studies on sperm survival and motility in the presence of cytotoxic sperm antibodies. Am J Reprod Immunol Microbiol. 1988;17:41–7.

    CAS  PubMed  Google Scholar 

  2. Check JH, Adelson HG, Bollendorf A. Effect of antisperm antibodies on computerized semen analysis. Arch Androl. 1991;27:61–3.

    Article  CAS  PubMed  Google Scholar 

  3. Upadhyaya M, Hibbard BM, Walker SM. Antisperm antibodies and male infertility. Br J Urol. 1984;56:531–6.

    Article  CAS  PubMed  Google Scholar 

  4. Practice Committee of American Society for Reproductive M. Diagnostic evaluation of the infertile male: a committee opinion. Fertil Steril. 2012;98:294–301.

    Article  Google Scholar 

  5. Jager S, Kremer J, van Slochteren-Draaisma T. A simple method of screening for antisperm antibodies in the human male. Detection of spermatozoal surface IgG with the direct mixed antiglobulin reaction carried out on untreated fresh human semen. Int J Fertil. 1978;23:12–21.

    CAS  PubMed  Google Scholar 

  6. Haas GG, Jr., Schreiber AD, Blasco L. The incidence of sperm-associated immunoglobulin and C3, the third component of complement, in infertile men. Fertil Steril. 1983;39:542–7.

    PubMed  Google Scholar 

  7. D’Cruz OJ, Haas GG, Jr., Wang BL, DeBault LE. Activation of human complement by IgG antisperm antibody and the demonstration of C3 and C5b-9-mediated immune injury to human sperm. J Immunol. 1991;146:611–20.

    PubMed  Google Scholar 

  8. Price RJ, Boettcher B. The presence of complement in human cervical mucus and its possible relevance to infertility in women with complement-dependent sperm-immobilizing antibodies. Fertil Steril. 1979;32:61–6.

    CAS  PubMed  Google Scholar 

  9. De Almeida M, Soumah A, Jouannet P. Incidence of sperm-associated immunoglobulins in infertile men with suspected autoimmunity to sperm. Int J Androl. 1986;9:321–30.

    Article  CAS  PubMed  Google Scholar 

  10. Busacca M, Fusi F, Brigante C, Doldi N, Smid M, Vigano P. Evaluation of antisperm antibodies in infertile couples with immunobead test: prevalence and prognostic value. Acta Eur Fertil. 1989;20:77–82.

    CAS  PubMed  Google Scholar 

  11. Menge AC, Beitner O. Interrelationships among semen characteristics, antisperm antibodies, and cervical mucus penetration assays in infertile human couples. Fertil Steril. 1989;51:486–92.

    CAS  PubMed  Google Scholar 

  12. Mortimer D, Pandya IJ, Sawers RS. Relationship between human sperm motility characteristics and sperm penetration into human cervical mucus in vitro. J Reprod Fertil. 1986;78:93–102.

    Article  CAS  PubMed  Google Scholar 

  13. Kremer J, Jager S. Characteristics of anti-spermatozoal antibodies responsible for the shaking phenomenon with special regard to immunoglobulin class and antigen-reactive sites. Int J Androl. 1980;3:143–52.

    Article  CAS  PubMed  Google Scholar 

  14. Witkin SS, Viti D, David SS, Stangel J, Rosenwaks Z. Relation between antisperm antibodies and the rate of fertilization of human oocytes in vitro. J Assist Reprod Genet. 1992;9:9–13.

    Article  CAS  PubMed  Google Scholar 

  15. Wang C, Baker HW, Jennings MG, Burger HG, Lutjen P. Interaction between human cervical mucus and sperm surface antibodies. Fertil Steril. 1985;44:484–8.

    CAS  PubMed  Google Scholar 

  16. Hall JL, Engel D, Naz RK. Significance of antibodies against human sperm FA-1 antigen in immunoinfertility. Arch Androl. 1994;32:25–30.

    Article  CAS  PubMed  Google Scholar 

  17. Bronson RA, Cooper GW, Rosenfeld DL. Sperm-specific isoantibodies and autoantibodies inhibit the binding of human sperm to the human zona pellucida. Fertil Steril. 1982;38:724–9.

    CAS  PubMed  Google Scholar 

  18. Mahony MC, Blackmore PF, Bronson RA, Alexander NJ. Inhibition of human sperm-zona pellucida tight binding in the presence of antisperm antibody positive polyclonal patient sera. J Reprod Immunol. 1991;19:287–301.

    Article  CAS  PubMed  Google Scholar 

  19. Naz RK, Brazil C, Overstreet JW. Effects of antibodies to sperm surface fertilization antigen-1 on human sperm-zona pellucida interaction. Fertil Steril. 1992;57:1304–10.

    CAS  PubMed  Google Scholar 

  20. Abdel-Latif A, Mathur S, Rust PF, Fredericks CM, Abdel-Aal H, Williamson HO. Cytotoxic sperm antibodies inhibit sperm penetration of zona-free hamster eggs. Fertil Steril. 1986;45:542–9.

    CAS  PubMed  Google Scholar 

  21. Shibahara H, Shigeta M, Inoue M, et al. Diversity of the blocking effects of antisperm antibodies on fertilization in human and mouse. Hum Reprod. 1996;11:2595–9.

    Article  CAS  PubMed  Google Scholar 

  22. Francavilla F, Romano R, Santucci R, Marrone V, Properzi G, Ruvolo G. Occurrence of the interference of sperm-associated antibodies on sperm fertilizing ability as evaluated by the sperm-zona pellucida binding test and by the TEST-yolk buffer enhanced sperm penetration assay. Am J Reprod Immunol. 1997;37:267–74.

    Article  CAS  PubMed  Google Scholar 

  23. Tian X, Zhang L, Wu Y, Yang C, Liu P. Relationship between serum antisperm antibodies and anticardiolipin antibodies and clinical pregnancy outcome in an in vitro fertilization and embryo transfer program. Chin Med J (Engl). 1999;112:34–6.

    CAS  Google Scholar 

  24. Lahteenmaki A, Reima I, Hovatta O. Treatment of severe male immunological infertility by intracytoplasmic sperm injection. Hum Reprod. 1995;10:2824–8.

    Article  CAS  PubMed  Google Scholar 

  25. Wolff H, Schill WB. Antisperm antibodies in infertile and homosexual men: relationship to serologic and clinical findings. Fertil Steril. 1985;44:673–7.

    CAS  PubMed  Google Scholar 

  26. Greskovich F, Mathur S, Nyberg LM, Jr., Collins BS. Effect of early antibiotic treatment on the formation of sperm antibodies in experimentally induced epididymitis. Arch Androl. 1993;30:183–91.

    Article  CAS  PubMed  Google Scholar 

  27. Greentree LB. Antisperm antibodies in infertility: the role of condom therapy. Fertil Steril. 1982;37:451–2.

    CAS  PubMed  Google Scholar 

  28. Kremer J, Jager S, Kuiken J. Treatment of infertility caused by antisperm antibodies. Int J Fertil. 1978;23:270–6.

    CAS  PubMed  Google Scholar 

  29. Rosse WF. Quantitative immunology of immune hemolytic anemia: II. The relationship of cell-bound antibody to hemolysis and the effect of treatment. J Clin Invest. 1971;50:734–43.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  30. Turek PJ, Lipshultz LI. Immunologic infertility. Urol Clin North Am. 1994;21:447–68.

    CAS  PubMed  Google Scholar 

  31. Hendry WF, Treehuba K, Hughes L, Stedronska J, Parslow JM, Wass JA, Besser GM. Cyclic prednisolone therapy for male infertility associated with autoantibodies to spermatozoa. Fertil Steril. 1986;45(2):249–54.

    Google Scholar 

  32. Haas GG, Jr., Manganiello P. A double-blind, placebo-controlled study of the use of methylprednisolone in infertile men with sperm-associated immunoglobulins. Fertil Steril. 1987;47:295–301.

    PubMed  Google Scholar 

  33. De Almeida M, Feneux D, Rigaud C, Jouannet P. Steroid therapy for male infertility associated with antisperm antibodies: results of a small randomized clinical trial. Int J Androl. 1985;8:111–7.

    Article  CAS  PubMed  Google Scholar 

  34. Hendry WF, Hughes L, Scammell G, Pryor JP, Hargreave TB. Comparison of prednisolone and placebo in subfertile men with antibodies to spermatozoa. Lancet. 1990;335:85–8.

    Article  CAS  PubMed  Google Scholar 

  35. Sharma KK, Barratt CL, Pearson MJ, Cooke ID. Oral steroid therapy for subfertile males with antisperm antibodies in the semen: prediction of the responders. Hum Reprod. 1995;10:103–9.

    Article  CAS  PubMed  Google Scholar 

  36. Hoes JN, Jacobs JW, Verstappen SM, Bijlsma JW, Van der Heijden GJ. Adverse events of low- to medium-dose oral glucocorticoids in inflammatory diseases: a meta-analysis. Ann Rheum Dis. 2009;68:1833–8.

    Article  CAS  PubMed  Google Scholar 

  37. Sakamoto Y, Matsumoto T, Kumazawa J. Cell-mediated autoimmune response to testis induced by bilateral testicular injury can be suppressed by cyclosporin A. J Urol. 1998;159:1735–40.

    Article  CAS  PubMed  Google Scholar 

  38. Bouloux PM, Wass JA, Parslow JM, Hendry WF, Besser GM. Effect of cyclosporin A in male autoimmune infertility. Fertil Steril. 1986;46:81–5.

    CAS  PubMed  Google Scholar 

  39. Halim A, Antoniou D, Leedham PW, Blandy JP, Tresidder GC. Investigation and treatment of the infertile male. Proc R Soc Med. 1973;66:373–8.

    CAS  PubMed Central  PubMed  Google Scholar 

  40. Bronson R. Immunity in sperm and in vitro fertilization. J In Vitro Fert Embryo Transf. 1987;4:195–7.

    Article  CAS  PubMed  Google Scholar 

  41. Elder KT, Wick KL, Edwards RG. Seminal plasma anti-sperm antibodies and IVF: the effect of semen sample collection into 50 % serum. Hum Reprod. 1990;5:179–84.

    CAS  PubMed  Google Scholar 

  42. Lenzi A, Gandini L, Claroni F, Lombardo F, Morrone S, Dondero F. Immunological usefulness of semen manipulation for artificial insemination homologous (AIH) in subjects with antisperm antibodies bound to sperm surface. Andrologia. 1988;20:314–21.

    Article  CAS  PubMed  Google Scholar 

  43. Windt ML, Menkveld R, Kruger TF, van der Merwe JP, Lombard CJ. Effect of rapid dilution of semen on sperm-bound autoantibodies. Arch Androl. 1989;22:227–31.

    Article  CAS  PubMed  Google Scholar 

  44. Naz RK, Bhargava KK. Antibodies to sperm surface fertilization antigen (FA-1): their specificities and site of interaction with sperm in male genital tract. Mol Reprod Dev 1990;26:175–83.

    Article  CAS  PubMed  Google Scholar 

  45. Gould JE, Brazil CK, Overstreet JW. Sperm-immunobead binding decreases with in vitro incubation. Fertil Steril. 1994;62:167–71.

    CAS  PubMed  Google Scholar 

  46. Grundy CE, Robinson J, Guthrie KA, Gordon AG, Hay DM. Establishment of pregnancy after removal of sperm antibodies in vitro. BMJ. 1992;304:292–3.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  47. Verheyen G, Tournaye H, Laurier K, Devroey P, Van Steirteghem A. Auto-controlled study on in-vitro fertilization performance with ‘antibody-free’ spermatozoa selected by immunobead adsorption from semen of patients with anti-sperm antibodies. Hum Reprod. 1994;9:1119–26.

    CAS  PubMed  Google Scholar 

  48. Junk SM, Matson PL, O'Halloran F, Yovich JL. Use of immunobeads to detect human antispermatozoal antibodies. Clin Reprod Fertil. 1986;4:199–206.

    CAS  PubMed  Google Scholar 

  49. Hanson FM, Rock J. Artificial insemination with husband’s sperm. Fertil Steril. 1951;2:162–74.

    CAS  PubMed  Google Scholar 

  50. Shulman S, Harlin B, Davis P, Reyniak JV. Immune infertility and new approaches to treatment. Fertil Steril. 1978;29:309–13.

    CAS  PubMed  Google Scholar 

  51. Adeghe AJ. Effect of washing on sperm surface autoantibodies. Br J Urol. 1987;60:360–3.

    Article  CAS  PubMed  Google Scholar 

  52. Shekarriz M, DeWire DM, Thomas AJ, Jr., Agarwal A. A method of human semen centrifugation to minimize the iatrogenic sperm injuries caused by reactive oxygen species. Eur Urol. 1995;28:31–5.

    CAS  PubMed  Google Scholar 

  53. Bollendorf A, Check JH, Katsoff D, Fedele A. The use of chymotrypsin/galactose to treat spermatozoa bound with anti-sperm antibodies prior to intra-uterine insemination. Hum Reprod. 1994;9:484–8.

    CAS  PubMed  Google Scholar 

  54. Bronson RA, Cooper GW, Rosenfeld DL, Gilbert JV, Plaut AG. The effect of an IgA1 protease on immunoglobulins bound to the sperm surface and sperm cervical mucus penetrating ability. Fertil Steril. 1987;47:985–91.

    CAS  PubMed  Google Scholar 

  55. Kutteh WH, Kilian M, Ermel LD, Byrd EW, Mestecky J. Antisperm antibodies (ASAs) in infertile males: subclass distribution of IgA antibodies and the effect of an IgA1 protease on sperm-bound antibodies. Am J Reprod Immunol. 1994;31:77–83.

    Article  CAS  PubMed  Google Scholar 

  56. Pattinson HA, Mortimer D, Curtis EF, Leader A, Taylor PJ. Treatment of spermagglutination with proteolytic enzymes. I. Sperm motility, vitality, longevity and successful disagglutination. Hum Reprod. 1990;5:167–73.

    CAS  PubMed  Google Scholar 

  57. Pattinson HA, Mortimer D, Taylor PJ. Treatment of spermagglutination with proteolytic enzymes. II. Sperm function after enzymatic disagglutination. Hum Reprod. 1990;5:174–8.

    CAS  PubMed  Google Scholar 

  58. Kiser GC, Alexander NJ, Fuchs EF, Fulgham DL. In vitro immune absorption of antisperm antibodies with immunobead-rise, immunomagnetic, and immunocolumn separation techniques. Fertil Steril. 1987;47:466–74.

    CAS  PubMed  Google Scholar 

  59. Clarke GN, Hsieh C, Koh SH, Cauchi MN. Sperm antibodies, immunoglobulins, and complement in human follicular fluid. Am J Reprod Immunol. 1984;5:179–81.

    Article  CAS  PubMed  Google Scholar 

  60. Bronson RA. Antisperm antibodies: a critical evaluation and clinical guidelines. J Reprod Immunol. 1999;45:159–83.

    Article  CAS  PubMed  Google Scholar 

  61. Check JH, Bollendorf A, Katsoff D, Kozak J. The frequency of antisperm antibodies in the cervical mucus of women with poor postcoital tests and their effect on pregnancy rates. Am J Reprod Immunol. 1994;32:38–42.

    Article  CAS  PubMed  Google Scholar 

  62. Gregoriou O, Vitoratos N, Papadias C, Konidaris S, Maragudakis A, Zourlas PA. Intrauterine insemination as a treatment of infertility in women with antisperm antibodies. Int J Gynaecol Obstet. 1991;35:151–6.

    Article  CAS  PubMed  Google Scholar 

  63. Margalloth EJ, Sauter E, Bronson RA, Rosenfeld DL, Scholl GM, Cooper GW. Intrauterine insemination as treatment for antisperm antibodies in the female. Fertil Steril. 1988;50:441–6.

    CAS  PubMed  Google Scholar 

  64. Ulstein M. Fertility of husbands at homologous insemination. Acta Obstet Gynecol Scand. 1973;52:5–8.

    Article  CAS  PubMed  Google Scholar 

  65. Galle PC, McRae MA, Colliver JA, Alexander JS. Sperm washing and intrauterine insemination for cervical factor, oligospermia, immunologic infertility and unexplained infertility. J Reprod Med. 1990;35:116–22.

    CAS  PubMed  Google Scholar 

  66. Francavilla F, Romano R, Santucci R, Marrone V, Corrao G. Failure of intrauterine insemination in male immunological infertility in cases in which all spermatozoa are antibody-coated. Fertil Steril. 1992;58:587–92.

    CAS  PubMed  Google Scholar 

  67. Check JH, Bollendorf A. Effect of antisperm antibodies on postcoital results and effect of intrauterine insemination on pregnancy outcome. Arch Androl. 1992;28:25–31.

    Article  CAS  PubMed  Google Scholar 

  68. Agarwal A. Treatment of immunological infertility by sperm washing and intrauterine insemination. Arch Androl. 1992;29:207–13.

    Article  CAS  PubMed  Google Scholar 

  69. Junk SM, Matson PL, Yovich JM, Bootsma B, Yovich JL. The fertilization of human oocytes by spermatozoa from men with antispermatozoal antibodies in semen. J In Vitro Fert Embryo Transf. 1986;3:350–2.

    Article  CAS  PubMed  Google Scholar 

  70. Ford WC, Williams KM, McLaughlin EA, Harrison S, Ray B, Hull MG. The indirect immunobead test for seminal antisperm antibodies and fertilization rates at in-vitro fertilization. Hum Reprod. 1996;11:1418–22.

    Article  CAS  PubMed  Google Scholar 

  71. Acosta AA, Van Der Merwe JP, Doncel G, Kruger TF, Sayilgan A, Franken DR, Kolm P. Fertilization efficiency of morphologically abnormal spermatozoa in assisted reproduction is further impaired by antisperm antibodies on the male partner’s sperm. Fertil Steril. 1994;62:826–833.

    Google Scholar 

  72. Vujisic S, Lepej SZ, Jerkovic L, Emedi I, Sokolic B. Antisperm antibodies in semen, sera and follicular fluids of infertile patients: relation to reproductive outcome after in vitro fertilization. Am J Reprod Immunol. 2005;54:13–20.

    Google Scholar 

  73. Clarke GN. Association between sperm autoantibodies and enhanced embryo implantation rates during in vitro fertilization. Fertil Steril. 2006;86:753–4.

    Google Scholar 

  74. Clarke GN, Lopata A, McBain JC, Baker HW, Johnston WI. Effect of sperm antibodies in males on human in vitro fertilization (IVF). Am J Reprod Immunol Microbiol. 1985;8:62–6.

    CAS  PubMed  Google Scholar 

  75. Lahteenmaki A. In-vitro fertilization in the presence of antisperm antibodies detected by the mixed antiglobulin reaction (MAR) and the tray agglutination test (TAT). Hum Reprod. 1993;8:84–8.

    CAS  PubMed  Google Scholar 

  76. De Almeida M, Herry M, Testart J, Belaisch-Allart J, Frydman R, Jouannet P. In-vitro fertilization results from 13 women with anti-sperm antibodies. Hum Reprod. 1987;2:599–602.

    CAS  PubMed  Google Scholar 

  77. Zini A, Lefebvre J, Kornitzer G, et al. Anti-sperm antibody levels are not related to fertilization or pregnancy rates after IVF or IVF/ICSI. J Reprod Immunol. 2011;88:80–4.

    Article  CAS  PubMed  Google Scholar 

  78. Yeh WR, Acosta AA, Seltman HJ, Doncel G. Impact of immunoglobulin isotype and sperm surface location of antisperm antibodies on fertilization in vitro in the human. Fertil Steril. 1995;63:1287–92.

    CAS  PubMed  Google Scholar 

  79. Mardesic T, Ulcova-Gallova Z, Huttelova R, et al. The influence of different types of antibodies on in vitro fertilization results. Am J Reprod Immunol. 2000;43:1–5.

    Article  CAS  PubMed  Google Scholar 

  80. Clarke GN, Bourne H, Baker HW. Intracytoplasmic sperm injection for treating infertility associated with sperm autoimmunity. Fertil Steril. 1997;68:112–7

    Google Scholar 

  81. Check ML, Check JH, Katsoff D, Summers-Chase D. ICSI as an effective therapy for male factor with antisperm antibodies. Arch Androl. 2000;45:125–30.

    Google Scholar 

  82. Esteves SC, Schneider DT, Verza S Jr. Influence of antisperm antibodies in the semen on intracytoplasmic sperm injection outcome. Int Braz J Urol. 2007;33:795–802.

    Google Scholar 

  83. Nagy ZP, Verheyen G, Liu J, et al. Results of 55 intracytoplasmic sperm injection cycles in the treatment of male-immunological infertility. Hum Reprod. 1995;10:1775–80.

    CAS  PubMed  Google Scholar 

  84. Ahmad K, Naz RK. Effects of human antisperm antibodies on development of preimplantation embryos. Arch Androl. 1992;29:9–20.

    Article  CAS  PubMed  Google Scholar 

  85. Naz RK. Involvement of fertilization antigen (FA-1) in involuntary immunoinfertility in humans. J Clin Invest. 1987;80:1375–83.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  86. Menge AC, Christman GM, Ohl DA, Naz RK. Fertilization antigen-1 removes antisperm autoantibodies from spermatozoa of infertile men and results in increased rates of acrosome reaction. Fertil Steril. 1999;71:256–60.

    Article  CAS  PubMed  Google Scholar 

  87. Steures P, van der Steeg JW, Mol BW, et al. Prediction of an ongoing pregnancy after intrauterine insemination. Fertil Steril. 2004;82:45–51.

    Article  PubMed  Google Scholar 

  88. van Weert JM, Repping S, van der Steeg JW, Steures P, van der Veen F, Mol BW. IUI in male subfertility: are we able to select the proper patients? Reprod Biomed Online 2005;11:624–31.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, 525 East 68th Street Starr Pavilion, 9th floor, Room 900, 10065, NY, USA

    Darius Paduch MD, PhD & Ali A. Dabaja

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  1. Darius Paduch MD, PhD
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  2. Ali A. Dabaja
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Correspondence to Darius Paduch MD, PhD .

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Editors and Affiliations

  1. Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York, USA

    Glenn L. Schattman

  2. Andrology and Human Reproduction Clinic Referral Center for Male Reproduction, ANDROFERT, Campinas, São Paulo, Brazil

    Sandro C. Esteves

  3. Andrology Center & Center for Reproductive Medicine, Lerner College of Medicine Case Western Reserve University, Cleveland, Ohio, USA

    Ashok Agarwal

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Paduch, D., Dabaja, A. (2015). Treatment and Prognosis of Immunological Factors in Unexplained Male Infertility. In: Schattman, G., Esteves, S., Agarwal, A. (eds) Unexplained Infertility. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2140-9_23

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