Testicular Immune Privilege and the Impact of Autoimmunity and Inflammation in Male Infertility: A Narrative Review

Male infertility represents a multifaceted clinical condition due to a combination of several features, including inflammatory and autoimmune factors. Although immune mechanisms are known to play a critical role in reproductive function, their precise contributions remain to be clarified. This review paper aims to expand the complex relationship between infections, inflammation, autoimmunity, and male infertility, with particular emphasis on testicular and epididymal biology. It explores the immunological characteristics and functions of these reproductive organs, their vulnerability to immune-mediated injury, and the mechanisms through which inflammation and autoimmunity may impair male reproductive function. Such pathological processes can negatively affect sperm quality through increased oxidative stress driven by reactive oxygen species (ROS) and the development of antisperm antibodies, ultimately reducing male reproductive potential. Accordingly, a literature search was conducted using the PubMed database to identify relevant publications available up to May 2026. The search included terms related to male infertility, immune system dysfunction, inflammatory disease, oxidative stress and antisperm antibodies. Studies addressing the immunological and inflammatory aspects of male reproductive health were selected for inclusion in this narrative review. Particular attention was given to the role of ROS and oxidative stress in sperm quality and testicular dysfunction. Overall, this narrative review highlights the contribution of infectious, inflammatory, and autoimmune mechanisms to the pathophysiology of male infertility. This review also addresses the urgent need for improved diagnostic tools and deeper insight into immune-mediated pathophysiology, with greater attention paid to those features that might impair male fertility. Advancing understanding in these areas may facilitate the development of novel therapeutic approaches, improve reproductive outcomes, and reduce the broader social and legal consequences of infertility.