Does Young's syndrome exist?

BACKGROUND AND METHODS: Young's syndrome describes a combination of male infertility, azoospermia, bronchiectasis and sinusitis. Although Young's syndrome is a well accepted disorder within the realms of infertility medicine, it is also accepted as being a potential cause of sino-nasal disease which is rarely seen by otolaryngologists. However, the significance of the sinus component within this triad is not fully understood. To gain further insight into the relationship of sinusitis with Young's syndrome, we reviewed all of the currently available published literature. RESULTS: Within the reviewed literature, the diagnosis of sinusitis in Young's syndrome was crude and poorly defined; there was little emphasis on sinus disease in most publications. CONCLUSIONS: The prevalence of Young's syndrome is reported to be declining, and the level of evidence regarding sinus disease within this syndrome is limited to case series only. There is, in fact, little evidence to support Young's syndrome being a significant aetiological factor for sinus disease, nor indeed to support the existence of Young's syndrome as an entity in its own right. The only documented aetiological factor is mercury exposure in childhood, an event that is seldom currently encountered; this would support our theory of the extinction of the condition. As an incidental finding, we found that the term Young's syndrome refers to two different medical conditions.

Follicular fluid expression of alpha-defensins and their role in ovulation.

INTRODUCTION: Defensins are cytotoxic peptides and have a well-defined role in host defense. Human alpha defensins 1-3 (HNP1-3) are primarily produced by peripheral neutrophils and constitute about 50% of the azurphil granule protein. Studies have suggested that peripheral neutrophils and the resident neutrophils in the ovary enhance the release of IL-8 and TNF-alpha that play a role in ovulation and influence fertilisation rate and IVF outcome. The production of HNP1-3 by follicular fluid and its role in ovulation has never studied. The aim of this study was to demonstrate the presence of HNP1-3 in follicular fluid and to ascertain its correlation with fertilisation rate and IVF outcome. METHOD: Women attending the Reproductive Medicine Unit at Liverpool Women's Hospital UK, for IVF treatment were invited to participate in the study. Sixty-three patients were recruited for the study and underwent controlled ovarian stimulation and oocyte retrieval according to the unit's protocol. Fluid from the first follicle only was collected to minimise blood contamination of the sample and HNP1-3 was estimated using ELISA technique. RESULTS: HNP1-3 was detected in follicular fluid samples. The concentration did not correlate with the fertilisation rate (r=0.01). The concentrations were also not significantly different in the women who did or did not become pregnant following treatment. Subgroup analysis showed that women with endometriosis were not more likely to have higher levels of the HNP1-3 when compared with controls (male factor infertility group). CONCLUSION: This is the first study to show the expression of HNP1-3 in follicular fluid. HNP1-3 concentrations did not correlate with fertilisation rate or IVF outcome. It did not show an increased expression of HNP1-3 in fluid collected from women with endometriosis suggesting that inflammatory processes associated with endometriosis do not influence HNP1-3 concentration in the follicular fluid. Further studies to evaluate the correlation between HNP1-3 and IL-8 and TNF-alpha may clarify the role of defensins in ovulation.

The expression of human alpha and beta defensin in the endometrium and their effect on implantation.

BACKGROUND: Alpha and beta defensins have been isolated from various human tissues and form an important part of the innate immune system. Their role in implantation of the embryo has not yet been studied. This study was designed to detect both alpha and beta defensins in the mid luteal phase endometrium and investigate the correlation between the defensin expression and implantation of the embryo. METHOD AND RESULTS: An experimental study was designed to detect alpha defensin (HNP1-3) and beta defensin (HBD1) in midluteal phase endometrial samples obtained from women attending the IVF unit at the Liverpool Women's Hospital, UK. Samples were obtained at least two menstrual cycles before IVF treatment was commenced. Immunohistochemical staining was conducted to estimate defensin expression. Some endometrial stromal cells stained positive for HNP1-3 during the midluteal phase. HNP1-3 expression is significantly higher in cases presenting with female factor infertility as compared with purely male factor infertility. A significant increase was not observed in tubal factor or endometriosis when considered separately. Endometrial stromal neutrophils were shown to be the main source of endometrial HNP1-3. HBD1 was the only beta defensin detected by immunochemical staining in the midluteal phase endometrium. The intensity of staining was significantly different in the endometrial stroma, luminal and glandular epithelia. HBD1 expression is not significantly higher in female factor infertility. CONCLUSION: The study confirmed secretion of HNP1-3 by endometrial stromal neutrophils. Glandular epithelium is the main source of HBD1 expression in the human endometrium. HNP1-3 shows increased expression in female factor infertility. HBD1 expression is not higher in female factor infertility. These defensins do not appear to influence implantation.

Morphological and morphometric attributes of epididymal and testicular spermatozoa following surgical sperm retrieval for obstructive and nonobstructive azoospermia.

Whilst the morphological (shape) and morphometric (sperm head size) attributes of ejaculated spermatozoa have been well studied, the morphological and morphometric qualities of testicular and epididymal spermatozoa retrieved from males with obstructive and nonobstructive azoospermia is much less documented. We wished to examine the effect of aetiology of azoospermia and site of retrieval on the attributes of retrieved spermatozoa. This was a prospective observational study of 30 consecutive successful sperm retrievals, six for nonobstructive azoospermia and 24 for obstructive, of which five were retrieved from the epididymis and the remainder from the testis. The proportion of morphologically normal testicular spermatozoa in patients with obstructive and nonobstructive azoospermia was not significantly different (7% versus 7.6%, P = 0.97). Testicular spermatozoa from males with obstructive azoospermia showed an increase in frequency of sperm with small heads [47/180 (26%) versus 97/909 (11%), P = 0.036] as well as small acrosome and increasing vacuole formation over nonobstructive spermatozoa. Similarly, there was a significant increase in tail deformities and decreases in tail lengths in sperm from males with nonobstructive azoospermia. Epididymal spermatozoa showed significantly greater proportion of morphologically normal spermatozoa than testicular (20% versus 13%, P = 0.001) as well as a significant increase in acrosome vacuoles. Furthermore, morphometrically epididymal spermatozoa displayed with smaller head length, width and area than testicular spermatozoa. Testicular spermatozoa from obstructive azoospermia displayed significantly less tail defects (35% versus 57%, P = 0.003) as well as significantly longer tail lengths (30.6 microm versus 10.7 microm). These morphological and morphometric differences between epididymal and testicular and obstructive and nonobstructive spermatozoa may represent part of the natural maturation process. There were no associations between any morphological or morphometric abnormality with any significant parameter in subsequent use in ICSI.

Concentration of interleukin-12 in the peritoneal fluid is not influenced by the presence of endometriosis, its stage or the phase of the menstrual cycle.

BACKGROUND: IL-12 is a key immunomodulatory cytokine. Its presence or concentration in peritoneal fluid is not related to the presence of endometriosis or the stage of the disease. A study was carried out to gain insight into the role of IL-12 in the development and maintenance of endometriosis in relation to menstrual cycle. METHODS: A prospective study recruiting 64 consecutive women undergoing laparoscopic surgery for benign gynecological indications. Peritoneal fluid was obtained during laparoscopy. Concentration of IL-12 was measured and correlated to the presence of endometriosis, its stage and the phase of the menstrual cycle. RESULT(S): Peritoneal fluid concentrations of IL-12 showed no correlation with the presence of endometriosis, the AFS stage of the disease or the phase of the menstrual cycle. CONCLUSION(S): IL-12 is a normal constituent of peritoneal fluid in around one third of the population tested and is not involved in the pathogenesis of endometriosis at any stage of the disease or the phase of the menstrual cycle.

Leukocytes in semen from men with spinal cord injuries.

OBJECTIVE: To assess the leukocyte populations in semen samples from men with spinal cord injuries (SCIs) and their relation to sperm motility. DESIGN: Cross-sectional study. SETTING: A joint spinal cord injury and fertility clinic at an academic tertiary referral center for fertility treatment and a university-based department of immunology. PATIENT(S): Nine men with chronic SCIs and seven healthy sperm donors as controls. INTERVENTION(S): Semen samples were obtained by electroejaculation from men with SCIs and by masturbation from donors. MAIN OUTCOME MEASURE(S): Leukocyte populations determined by immunohistochemical techniques, bacteriologic assessment of urine, and sperm density and motility. RESULT(S): The most cellular specimens were antegrade specimens obtained from men with SCIs and coexisting urinary tract infections. The highest proportion of leukocytes occurred in retrograde samples from men with SCIs and urinary tract infections. The most predominant leukocytes in all specimens were granulocytes. Infection increased the number of T cells and the degree of cell activation. There was no significant correlation between leukocyte populations and total motile sperm counts. CONCLUSION(S): Increased numbers of leukocytes in semen samples from men with SCIs are the result of urinary tract infections. The reduced sperm motility seen in men with SCIs does not correlate with the numbers of leukocytes; therefore, other factors also contribute to the semen abnormalities in these patients.

The sperm deformity index: a reliable predictor of the outcome of oocyte fertilization in vitro.

OBJECTIVE: To evaluate a novel expression of sperm morphological parameters, the sperm deformity index, as a predictor of fertilization in vitro. DESIGN: Prospective blind clinical trial. SETTING: Academic tertiary referral center. INTERVENTION(S): Detailed sperm morphological assessment applying strict morphological criteria and a multiple entry technique for an unselected male population undergoing IVF. The sperm deformity index, defined as the average number of deformities per sperm assessed, was calculated. PATIENT(S): One hundred fifty-eight patients undergoing IVF treatment. Females with conditions negatively influencing fertilization were excluded. MAIN OUTCOME MEASURE(S): Fertilization rates and pregnancy. RESULT(S): Seventy-three percent of patients achieved fertilization. Patients achieving fertilization had a significantly higher median proportion of normal forms and a significantly lower median sperm deformity index than the nonfertilizers. The receiver operator characteristic (ROC) curves identified cutoff points that maximized the sum of sensitivity and specificity at sperm deformity index 1.6 and normal forms 4%. The sperm deformity index had a greater sensitivity (96%), specificity (72%), positive predictive value (90%), and negative predictive value (86%) than the proportion of normal sperm morphology (87%, 69%, 89%, 66%, respectively) at the optimal cutoff points. The area under the ROC curve was greater for the sperm deformity index (0.875) than for the proportion of normal sperm morphology (0.622). Achieving pregnancy did not correlated with sperm morphology. CONCLUSION(S): The sperm deformity index is a more reliable predictor of the outcome of fertilization in vitro than the proportion of normal sperm morphology and can assist to identify patients who require techniques such as intracytoplasmic sperm injection.

Placental-type alkaline phosphatase in human seminal plasma from fertile and infertile men.

Solid-phase enzyme immunoassays, based on monoclonal antibodies reactive with different forms of human placental-type alkaline phosphatases, were applied to their detection in human seminal plasma from fertile and infertile men. The placental-like form of alkaline phosphatase (PLAP-like AP), known to occur in testicular tissue, was found in normal seminal plasma. The incidence of detection and levels of this isoenzyme correlated significantly with the designated fertility status of the donor. Seminal plasma (PLAP-like AP) may reflect germ cell function and/or access of testicular products to the ejaculate.