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The MAR Test: What is it?

Another very interesting investigation that is very often carried out within the framework of a semen analysis is the MAR – test (MIXED AGGLUTINATION REACTION). This method makes it possible to determine the percent of sperm cells that are covered with antisperm antibodies. Why does an organism suddenly start producing antibodies against its own cells? The thing is that a sperm cell contains a half-set of chromosomes: 46X or 46Y. Whereas men have a 46XY karyotype. I.e. a man’s sperm cell is a genetically foreign agent for his organism. There is no conflict between these two parties because of the blood-testis barrier that prevents blood cells from entering the testicular tissue and thus does not let an autoimmune process start. This barrier may be damaged after some types of surgical interventions (herniotomy, varicocelectomy), after sexually transmitted infections, traumas and, unfortunately, without any apparent reasons. We all know that routine semen analysis assesses sperm cell count per millilitre, the speed of sperm cells and their structural correctness. If semen analysis is performed without the MAR-test, one can mistake all these millions of sperm cells for combat-ready fighters capable of fertilizing everything on their way. What does the method consist in then? The test system includes a suspension of latex beads coated with human IgG and monospecific antiserum directed against the Fc fragment of this immunoglobulin. A drop of sperm is placed on the object glass. The first step consists in mixing sperm with the latex bead suspension, the second – in mixing it with the antiserum. Thereafter, we use a microscope to see what happened. If Abs are already on the heads of sperm cells, such a sperm cell adheres to a bead coated with IgG forming the so-called Ab-Ab interaction. The only thing left is to calculate the percent of sperm cells with Abs. If the result of the MAR – test is 3-5%, it means that almost the entire army of sperm cells is battle-ready. If the result is 50%, we may remove half of the spermatozoa from the list of potential FATHERS. And if the result comes close to 100%, we might want to start considering in vitro fertilization. Although the data of evidence-based medicine are controversial and no study has found a clear correlation between positive MAR-test results and prognosis for pregnancy occurrence in IVF programmes, embryologists observe a lower percent of oocytefertilization. The “hat” of antisperm antibodies on a sperm cell head is thought to hinder sperm cell penetration into an oocyte. An egg cell is coated with a thick shiny membrane, hence the acrosome of a sperm cell must be devoid of antibodies for the sperm cell to be able to break through it.  Which is why when the results of the MAR-test are positive, embryologists always perform ICSI to avoid the possibility of oocyte fertilization failure. 

Sometimes it is suggested that male (or even female) patients should undergo antisperm antibody blood test (ASAB blood test). This investigation does not in any way correlate with the presence of Abs on a sperm cell head; and the severity of the disease cannot be predicted based on Ab titers. 

Back in the day, there were many questions as to the positive MAR-test treatment options. Considering that this is an autoimmune condition, it was suggested that men should take glucocorticoids. It produced no positive effect whatsoever but instead caused a bunch of complications. Hence studies as regards the treatment of antisperm antibodies with glucocorticoids stopped everywhere in the world after 1995. Unfortunately, in our country there are still some poor patients undergoing treatment with these drugs. The last thing they think about is reproduction. In a way, it is also A SOLUTION TO THE PROBLEM :)

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