Dr Eric Daiter has served Monmouth and Middlesex Counties of New Jersey as an infertility expert for the past 20 years. Dr. Daiter is happy to offer second opinions (at the office or over the telephone) or new patient appointments. It is easy, just call us at 908 226 0250 to set up an appointment (leave a message with your name and number if we are unable to get to the phone and someone will call you back).
Availability
"I always try to be available for my patients since I do understand the pain and frustration associated with fertility problems or endometriosis."
Cost
"I understand that the economy is very tough and insurance companies do not cover a lot of the services that might help you. I always try to minimize your out of pocket cost while encouraging the most successful and effective treatments available."
Anti-sperm Antibodies (detailed)
Anti sperm antibodies and the need for their assessment have been
a source of great controversy. Normally sperm develops within
the testes in the seminiferous tubules and are completely isolated
from the man's circulating blood (via a blood testes barrier).
This blood testes barrier is important since sperm (with their
unique surface antigens) elicit an immune response if detected
by the immune cells in the man's blood, and the antibodies that
are formed against sperm are designed to immobilize and destroy
them.
Anti sperm antibodies can theoretically cause infertility by interfering
with the sperm's ability to arrive at and to fertilize the egg.
In tests that have specifically correlated the location of anti
sperm antibodies on the sperm (head, midpiece, tail) and the demonstrated
defect in fertility have reported that head directed antibodies
affects binding of the sperm head to the egg while sperm tail
directed antibodies affects sperm motility.
A number of events can disrupt the blood testes barrier and allow
the immune system to become activated against the sperm. These
include trauma to the testes, torsion (twisting) of the testes,
a history of a vasectomy and reversal, any other surgery within
the scrotum, and infection within the testes.
The postcoital test is the most widely used test for antisperm
antibodies yet it is quite nonspecific. That is, abnormal postcoital
test results may be due to antisperm antibodies or a large variety
of other factors. It is widely accepted that a normal postcoital
test result if properly timed to allow for activation of the immune
system (here, the complement system) rules out significant motility
abnormalities due to antisperm antibodies. There remains the possibility
of head directed antibodies that may effect binding of the sperm
to the egg, but the incidence of these as a cause for infertility
is unestablished and generally considered low. Testing for these
antisperm antibodies may have greater benefit if In Vitro Fertilization
is performed.
The two recognized and widely accepted testes to specifically
assess for the presence of antisperm antibodies are
* the SpermMar test: this is called a "mixed agglutination
test" in which (a) antisera to a class of antibodies (IgG
antibodies) is incubated with the sample being tested along with
(b) known IgG type antibodies immobilized onto latex beads or
red blood cells. In the presence of IgG antibodies adherent to
the sample sperm (that is, antisperm antibodies), the anti-IgG
antibodies in the test solution (which binds to more than one
IgG antibody) binds the sperm to form a bridge to the immobilized
test IgG antibodies. This will form large clumps (agglutinations)
of sperm stuck to either latex particles or red blood cells, which
can easily be seen under the microscope. The benefit of this test
is that it is performed on unprepared (unwashed) semen so that
it can be an office screening test. Interpretation of test results
are not well established, with 10-39% of motile sperm attached
to latex being considered significant, greater than 40% bound
being considered highly significant, and less than 10% bound being
likely insignificant. The WHO uses 10% as the cutoff of normal.
* the Immunobead test: this is a sophisticated test
in which beads bound to antibodies specifically directed against
either IgG, IgM or IgA types of antibodies are incubated with
washed motile sperm. The test solution's beads will bind to any
sperm containing the specific antibodies detected by the beads.
This test will further allow detection of the site on the sperm
(head, tail, midpiece) containing the antibodies, resulting in
the detection of say "IgG antibodies against the head of
the sperm." The WHO considers greater than 20% of sperm bound
to immunobeads as abnormal. This test certainly provides a large
amount of information concerning the type and location of the
antisperm antibodies in the sperm sample tested. However, the
importance of this amount of information is controversial.
