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Biomedical subjects

R F Harrison

Publications and source records attributed to R F Harrison.

At least 19 recordsLinked to original sources
PubMed2006

Expression of receptor activator of nuclear factor kappabeta ligand (RANKL) and tumour necrosis factor related, apoptosis inducing ligand (TRAIL) in breast cancer, and their relations with osteoprotegerin, oestrogen receptor, and clinicopathological variables.

BACKGROUND: Receptor activator of nuclear factor kappabeta ligand (RANKL) has an important role in bone remodelling, and tumour necrosis factor related, apoptosis inducing ligand (TRAIL) can induce apoptosis in cancer cells. Their functions are linked by their interactions with osteoprotegerin (OPG). OBJECTIVE: To investigate the expression of RANKL and TRAIL in a large series of unselected breast cancers and to analyse the relations between these expressions and the expression of OPG, oestrogen receptor, and clinicopathological variables. METHODS: 395 breast cancers were sampled into tissue microarrays and immunohistochemistry undertaken for RANKL and TRAIL. RESULTS: There was strong expression of RANKL in 14% of the cancers and strong expression of TRAIL in 30%. Expression of RANKL had a negative association with expression of oestrogen receptor (p = 0.036). Expression of TRAIL had a negative association with the Nottingham Prognostic Index (p = 0.021). There was a significant negative relation between expression of RANKL and TRAIL (p<0.005). Unsupervised cluster analysis produced a dendrogram that showed a clear division into two groups, and the expression of oestrogen receptor was significantly higher in one of those groups (p = 0.012). CONCLUSIONS: There is apparent loss of expression of RANKL in 86% of breast cancers; those tumours that retain expression tend to be oestrogen receptor negative and of a high histological grade. There is strong expression of TRAIL in 30% of breast cancers and these tend to be of better prognostic type. These results may be important in the processes of metastasis to bone and the apoptotic cell death pathway in cancer.

Apoptosis Regulatory Proteins↗
PubMed2006

The hidden costs of IVF.

Whether the payment is personal or funded via a third party, IVF is expensive. Clinical and drug costs are known and if necessary can be budgeted for. But, indirect expenses involved in participation also need to be considered. In order to find out what these latter might be, women attending Human Assisted Reproduction Ireland at the Rotunda Hospital Dublin completed prospectively a detailed questionnaire on all likely areas of extra expense during a single IVF cycle from down-regulation to zygote transfer. Four groups participated, divided according to their distance from the clinic. Group A were within Dublin and Group B within a 50 mile radius. Group C were between a 50-130 mile radius and Group D a 130-200 mile radius. Mean levels of costs increased with distance:- Group A 104 euros. to Group D 703 euros. Food, meals and accommodation were the main contributors. Travel time and time-off work also increased with distance. These were respectively, Group A to Group D 15hrs to 139hrs: 35hrs to 75hrs. The study demonstrates that significant extra expense in time and money can be spent in an IVF cycle over and above medical and drug costs. This must be advised prior to commencement. All other issues being equal, geographical location should be part of the decision as to which clinic to attend.

Adult↗
PubMed2005

Identification of patients with evolving coronary syndromes by using statistical models with data from the time of presentation.

OBJECTIVE: To derive statistical models for the diagnosis of acute coronary syndromes by using clinical and ECG information at presentation and to assess performance, portability, and calibration of these models, as well as how they may be used with cardiac marker proteins. DESIGN AND METHODS: Data from 3462 patients in four UK teaching hospitals were used. Inputs for 8, 14, 25, and 43 factor logistic regression models were selected by using log10 likelihood ratios (log10 LRs). Performance was analysed by receiver operating characteristic curves. RESULTS: A 25 factor model derived from 1253 patients from one centre was selected for further study. On training data, 98.2% of ST elevation myocardial infarctions (STEMIs) and 96.2% of non-ST elevation myocardial infarctions (non-STEMIs) were correctly classified, whereas only 2.1% of non-cardiac cases were incorrectly classified. On data from three other centres, 97.3% of STEMIs and 91.9% of non-STEMIs were correctly classified. Differences in log10 LRs for individual inputs from different centres accounted for the decline in performance when models were applied to unseen data. Classification was improved when output was combined with either clinical opinion or marker proteins. CONCLUSIONS: Logistic regression models based on data available at presentation can classify patients with chest pain with a high degree of accuracy, particularly when combined with clinical opinion or marker proteins.

Adolescent↗
PubMed2005

Preservation of fertility in women affected by cancer. An audit of the cryopreservation services provided for women at Human Assisted Reproduction Ireland.

There has been a remarkable improvement in survival rates for adult and childhood cancers, due to progress in cancer treatments. However multiagent chemotherapy and radiotherapy are associated with gonadal failure. Whereas sperm banking is commonly performed, female gametes are not so amenable to cryopreservation. Options available to women for fertility preservation include, embryo and oocyte cryopreservation. Our unit established an oocyte/embryo cryopreservation service for women affected by cancer in October 2003. Ninteen women have been referred and five (26%) women have had oocytes cryopreserved. The mean age of women in the group cryopreserved was 34 years (range 21-41). Their mean day 3 FSH was 6.2 IU (range 5.5-6.8). The mean dose of rFSH used was 1870 units (range 1500-2600). The mean number of oocytes cryopreserved was 8 (range 3-16). Preservation of fertility is of major concern to women affected by cancer. This service offers them hope for their future fertility.

Adult↗
PubMed2004

The metabolic marker tumour pyruvate kinase type M2 (tumour M2-PK) shows increased expression along the metaplasia-dysplasia-adenocarcinoma sequence in Barrett's oesophagus.

BACKGROUND: Proliferating and tumour cells express the glycolytic isoenzyme, pyruvate kinase type M2 (M2-PK). In tumours cells, M2-PK usually exists in dimeric form (tumour M2-PK), causing the accumulation of glycolytic phosphometabolites, which allows cells to invade areas with low oxygen and glucose concentrations. AIMS: To investigate the expression of tumour M2-PK during the metaplasia-dysplasia-adenocarcinoma sequence of Barrett's oesophagus, and to assess the prognostic usefulness of tumour M2-PK in oesophageal cancer. MATERIALS/METHODS: One hundred and ninety cases selected from the histopathology archives as follows: 17 reflux oesophagitis, 37 Barrett's oesophagus, 21 high grade dysplasia, 112 adenocarcinomas, and three control tumours. Sections were stained immunohistochemically with antibody to tumour M2-PK. RESULTS: Tumour M2-PK was expressed in all cases, and increased cytoplasmic expression was seen with progression along the metaplasia-dysplasia-adenocarcinoma sequence. All cases of adenocarcinoma showed 100% staining so that tumour M2-PK was not a useful prognostic marker. CONCLUSIONS: Tumour M2-PK is not a specific marker of Barrett's adenocarcinoma, but may be important as a marker of transformed and highly proliferating clones during progression along the metaplasia-dysplasia-adenocarcinoma sequence.

Adenocarcinoma↗
PubMed2003

The role of beta-catenin signaling in the malignant potential of cystitis glandularis.

PURPOSE: Chronic inflammation is a risk factor for malignant transformation in the bladder. The pro-inflammatory cytokine tumor necrosis factor-alpha (TNFalpha) is a mediator of such inflammation that induces nuclear localization of the adherens junction component beta-catenin. This mechanism has a key role in the initiation and progression of the premalignant lesion Barrett's metaplasia of the esophagus. Cystitis glandularis is a metaplastic lesion of the bladder urothelium occurring in the presence of chronic inflammation and in up to 13% of asymptomatic bladders. Two subtypes are described (typical and intestinal/colonic) with uncertain malignant potential. Etiologically and histologically cystitis glandularis mimics Barrett's metaplasia. We investigated the roles of beta-catenin and TNFalpha in cystitis glandularis. MATERIALS AND METHODS: Immunohistochemistry and immunofluorescence were used to demonstrate the expression and localization of E-cadherin, beta-catenin and TNFalpha in 9 sections of typical cystitis glandularis and 4 of intestinal/colonic cystitis glandularis. Appropriate controls were used for all experiments. RESULTS: Immunohistochemistry demonstrated normal membranous expression of E-cadherin and beta-catenin in all cystitis glandularis sections with increased TNFalpha expression. Immunofluorescence showed nuclear localization of beta-catenin in the intestinal/colonic subtype only, which was not observed in typical cystitis glandularis. CONCLUSIONS: The presence of nuclear beta-catenin suggests that intestinal/colonic cystitis glandularis shares the same signaling pathway with the premalignant lesion Barrett's metaplasia of the esophagus and the intestinal/colonic subtype of cystitis glandularis may have the potential to progress to malignancy. This finding has important implications for the management of this lesion.

Adenocarcinoma↗
PubMed2003

A survey of Irish consultants regarding awareness of sperm freezing and assisted reproduction.

Chemotherapy and radiotherapy decrease male fertility. Pretreatment semen cryopreservation offers a chance for future fatherhood. However many eligible patients are not referred. One potential reason for the reduced uptake is lack of awareness by referring consultants. We sent a questionnaire to all 41 consultant oncologists, haematologists and urologists listed in the Irish Medical Directory. The questionnaire surveyed the current knowledge, opinions and clinical practices of this key group regarding semen cryopreservation for male cancer patients. 63% responded. 73% routinely discuss semen freezing with their male cancer patients (mostly testicular carcinomas and lymphomas). 100% believe semen cryopreservation helps the patient psychologically. 12% do not know where facilities exist. 92% will only refer men aged between 20 and 40 years. 92% are unaware that semen freezing does not delay cancer treatment. 54% have heard of intracytoplasmic sperm injection (ICSI) but 88% are unaware of its benefits for patients with low sperm counts. Consultants dealing with male cancer patients do not prioritise future fertility. Most of the consultants surveyed were unaware of the advances in reproductive technology and this may be contributing to underutilization of sperm cryopreservation by male cancer patients. Units offering this service need to increase awareness of its potential benefits.

Awareness↗
PubMed2002

Day 5 inhibin B levels in a treatment cycle are predictive of IVF outcome.

BACKGROUND: Day 5 serum inhibin B during IVF treatment has been investigated as a predictor of outcome. METHODS: A total of 54 women (< or = 39 years, normal menses and endocrine profiles) were treated with urinary gonadotrophins or recombinant FSH following pituitary down-regulation. Serum day 3 FSH in a preceding cycle was <8.5 IU/l. Plasma inhibin B, inhibin A and estradiol were determined after 4 days of gonadotrophin administration (day 5). RESULTS: Day 5 inhibin B was the most highly correlated with the number of mature follicles (>14 mm), oocytes retrieved and fertilized. Receiver operating characteristic analysis gave high accuracy for day 5 inhibin B in predicting ovarian response and indicated that a threshold of 400 pg/ml may be helpful in the decision as to whether to continue treatment. Women with <400 pg/ml (n = 16) had lower numbers of follicles, mature follicles, oocytes retrieved, fertilized and cleaved compared with those >400 pg/ml (n = 36) and this threshold gave a positive likelihood ratio of 30, 92.9% sensitivity, 95.0% specificity and 86.7% positive predictive value to detect poor ovarian response. Day 5 inhibin B was the best predictor of pregnancy (no live births and four cycles cancelled, low inhibin group; nine live births and no cancelled cycles, high inhibin group). CONCLUSIONS: Normogonadotrophic, normogonadal women with day 5 inhibin B <400 pg/ml in down-regulated cycles have a poor response to ovarian stimulation and are less likely to conceive compared with women with higher day 5 inhibin B.

Adult↗
PubMed2002

Advancing donor liver age and rapid fibrosis progression following transplantation for hepatitis C.

BACKGROUND AND AIM: Cirrhosis with liver failure due to hepatitis C virus (HCV) infection is the most common indication for liver transplantation (LT). Reinfection of the transplanted liver by HCV is inevitable, and aggressive hepatitis with accelerated progression to graft cirrhosis may be observed. Of concern, recent reports suggest that the outcome of LT for HCV may have deteriorated in recent years. Determinants of rate of progression to cirrhosis in the immunocompetent non-transplant patient are well defined, and the most powerful determinant is patient age at the time of infection. Following LT for HCV, recipient age does not affect outcome of HCV reinfection. However, the impact of donor age on graft fibrosis progression rate following LT has not been examined. METHODS: We have examined post-transplant biopsies to assess histological activity, including fibrosis stage (scored 0-6 units, 6 representing established cirrhosis), and to calculate fibrosis progression rates in 101 post-transplant specimens from 56 HCV infected LT patients. Univariate and multivariate analyses examined the impact of parameters including recipient and donor age and sex on fibrosis progression rate, and on predicted time to cirrhosis. RESULTS: For the cohort, median fibrosis progression rate was 0.78 units/year, and median interval from transplantation to development of cirrhosis was 7.7 years. In multivariate analysis, donor age (not recipient age) was a powerful determinant (p=0.02) of fibrosis progression rate. When the liver donor was younger than 40 years, median progression rate was 0.6 units/year and interval to cirrhosis was 10 years. When the donor was aged 50 years or more, median progression rate was 2.7 units/year and interval to cirrhosis only 2.2 years. During the observation period there has been a significant increase in donor age (p=0.01) but date of transplantation per se is not a determinant of progression rate when included in multivariate analyses. CONCLUSIONS: Donor age has a major influence on graft outcome following transplantation for HCV. The changing organ donor profile will affect the long term results of LT for HCV. These observations have important implications for donor liver allocation.

Adult↗
PubMed2002

Discriminant histological features in the diagnosis of chronic idiopathic inflammatory bowel disease: analysis of a large dataset by a novel data visualisation technique.

BACKGROUND/AIMS: The histopathological assessment of endoscopic colorectal biopsies is important in the distinction between normality and chronic idiopathic inflammatory bowel disease, and between ulcerative colitis and Crohn's disease, in subjects with symptoms of bowel dysfunction. This study aims to use carefully defined histopathological observations on a large study population to produce systems that improve classification into these diagnostic categories. METHODS: Eight hundred and nine endoscopic colorectal biopsies with verified outcomes (165 normal, 473 ulcerative colitis, 171 Crohn's disease) were examined by a single experienced histopathologist and 20 defined features were recorded for each case using a novel graphical interface with reference images of each feature. These features, together with age and sex, were used to produce and test statistical classifiers using logistic regression and a novel growing cell structure technique. RESULTS: The distinction between chronic idiopathic inflammatory bowel disease and normality was made with a good level of performance by both statistical classifiers (with areas under the receiver operating characteristic curves above 0.80). The growing cell structure system selected features as discriminant that agreed with the published literature. Logistic regression produced a more variable selection of discriminant features because of the high correlation between many features. The distinction between ulcerative colitis and Crohn's disease was performed less accurately, with areas under the receiver operating characteristic curves of about 0.70. Again the features selected as discriminant broadly agreed with those in the published literature. CONCLUSIONS: Histopathological examination of endoscopic colorectal biopsies is an effective method of distinguishing between subjects with chronic idiopathic inflammatory bowel disease and normality, but less good at distinguishing between ulcerative colitis and Crohn's disease. The features selected as discriminant in this large statistical analysis broadly agree with those published in the literature from more qualitative studies.

Adolescent↗
PubMed2001

A prospective randomized clinical trial of differing starter doses of recombinant follicle-stimulating hormone (follitropin-beta) for first time in vitro fertilization and intracytoplasmic sperm injection treatment cycles.

OBJECTIVE: Comparison of the efficacy of differing starter doses of recombinant follicle stimulating hormone (rFSH) for IVF and intracytoplasmic sperm injection cycles when the treatment is administered both subcutaneously and intramuscularly. DESIGN: Single center 1-year prospective randomized study. SETTING: Academic teaching hospital. PATIENT(S): 345 couples in first cycle. INTERVENTION(S): Treatment with subcutaneous or intramuscular rFSH, followed by E(2) and ultrasound follicle tracking, with later oocyte collection and zygote transfer. MAIN OUTCOME MEASURE(S): Ovarian response and other clinically dependent variables. RESULT(S): Group 1 patients, with day-3 FSH levels of less than 8.5 U/L, were randomized to begin treatment with rFSH at 150 IU (n = 146) or 200 IU (n = 151). The total dose of the drugs used was significantly lower in 150 IU group, as was the number of ICSI metaphase II oocytes. No other significant differences found. The dosage was increased in 9% on day 5. Group 2 patients, with day-3 FSH levels of greater than 8.5 U/L, were randomized to treatment with rFSH at 300 IU (n = 24) or 400 IU (n = 24). No significant outcome differences found between the two subgroups. Pregnancy rates for this group were half that of Group 1.Intramuscular administration was significantly more likely to result in a need for increased dosage than was subcutaneous administration. The level of E(2) at the time of hCG treatment was significantly lower in the intramuscular 150 IU group. CONCLUSION(S): In the main study total dosage used, the ICSI metaphase II oocyte numbers were significantly lower and there was a trend toward a need for a dosage increase on day 5 when 150 IU rFSH was the starter dosage, as compared to a starting dosage of 200 IU. Otherwise, there is little advantage to using the higher dosage.

Adult↗
PubMed2001

A randomized prospective assessor-blind evaluation of luteinizing hormone dosage and in vitro fertilization outcome.

OBJECTIVE: To determine the effect of exogenous LH dosage on IVF outcome. DESIGN: Single-blinded (assessor-blinded) study with random assignment of treatment groups. SETTING: Human Assisted Reproduction Unit, Rotunda Hospital, Dublin, Ireland. PATIENT(S): Infertile normogonadotropic women undergoing their first cycle of IVF were studied. INTERVENTION(S): Patients were randomized to gonadotropin drugs with varying doses of LH per ampule: recombinant FSH containing no LH (group 0, n = 39), urinary FSH containing <1 IU of LH per ampule (group 1, n = 30), hMG containing 25 IU of LH per ampule (group 25, n = 30), and hMG containing 75 IU of LH per ampule (group 75, n = 29). The FSH dose was kept constant at 75 IU per ampule. A long-protocol GnRH-analog regimen was used. MAIN OUTCOME MEASURE(S): Dose and duration of gonadotropin stimulation, follicle and oocyte numbers, implantation rate, and pregnancy rate. RESULT(S): The median duration of ovarian stimulation; median number of gonadotropin ampules used; serum E2 levels; and numbers of follicles, oocytes, and embryos were similar among the four groups. Median LH levels on the day of hCG administration, however, differed significantly. Live birth rates per cycle differed markedly, but statistical significance was not achieved (23%, 7%, 20%, and 31% for groups 0, 1, 25, and 75, respectively). A significant trend in implantation rates was noted with increasing LH dosage of the urinary preparations (19%, 10%, 18%, and 28% for groups 0, 1, 25, and 75, respectively). CONCLUSION(S): In the present study, although the residual endogenous LH after down-regulation was adequate for ovarian response and E2 synthesis, the addition of exogenous LH improved implantation. An FSH/LH ratio of 75/75 IU per ampule appeared to be the optimum dose.

Adult↗
PubMed2001

The effect of gonadotrophins with differing LH/FSH ratios on the secretion of the various species of inhibin in women receiving IVF.

We have measured secretory patterns of inhibin A, B, total alpha inhibin, pro-alphaC inhibin and oestradiol in women following pituitary suppression who were randomised into two groups to receive either urinary gonadotrophin (25:75 IU/ampoule of luteinizing hormone (LH) and follicle stimulating hormone (FSH; Normegon; n = 11) or recombinant (r)FSH (75 IU/ampoule of FSH alone, n = 16). The women were of similar age (approximately 33 years) and length of infertility (approximately 4 years) and had a normal endocrine evaluation. Plasma FSH, LH, oestradiol, inhibin A, B, pro-alphaC and total alpha inhibin were measured by immunoassay prior to and following gonadotrophin stimulation. Immunoactive FSH, LH and oestradiol blood concentrations following pituitary down regulation were similar in the two groups being <2.0, <3.6 IU/l and <82 pmol/l respectively. The units of FSH given (2230 versus 2764 IU; Normegon versus rFSH), duration of treatment (9.1 versus 9.4 days) and number of follicles of > or =14mm on the day of human chorionic gonadotrophin (HCG) administration (17 versus 14) were also similar. Inhibin A or B concentrations rose similarly during Normegon or rFSH administration, peaking at days 9-11. Total alpha and pro-alphaC inhibin concentrations were lower (P < 0.05) in the rFSH group during days 10 and 11 of treatment being 18.9 +/- 15.9 ng/ml (Normegon) and 4.6 +/- 2.8 ng/ml (rFSH) for total alpha inhibin and 8.5 +/- 6.8 ng/ml (Normegon) and 2.8 +/- 1.6 ng/ml (rFSH) for pro-alphaC inhibin on day 10. Overall, higher total alpha inhibin concentrations were associated with more mature follicles and oocytes, greater fertilization rates and better quality embryos. We conclude that inhibin A and B secretion was similar in both groups and is primarily controlled by FSH, whereas total alpha inhibin and pro-alphaC increased preferentially in the Normegon group over the rFSH group, indicating that they are, in part, stimulated by LH.

Adult↗
PubMed2000

Barrett's metaplasia.

The rate of oesophageal adenocarcinoma is increasing in the western world and has a poor prognosis mainly because individuals present at a late stage. Attempts to intervene at an early stage of tumour progression have not proven cost effective, although lesions identified during surveillance programmes have a better prognosis. As a consequence, there has been renewed interest in strategies that might prevent the precursor lesion Barrett's oesophagus. Furthermore, there is an improved understanding of genetic and environmental interactions necessary for the clonal expansion and propagation of metaplastic premalignant lesions. Clearly, three mechanisms promote cancer progression--inheritance of germ-line mutations or polymorphisms, sporadic mutagenesis, and local epigenetic alterations. Locally produced cytokines and bile acids in the refluxate create a microenvironment that sets the scene for metaplastic transformation of the oesophageal epithelium, mainly by directly affecting metaplastic stem cells.

Adenocarcinoma↗
PubMed2000

Barrett's mucosa: remodelling by the microenvironment.

Barrett's metaplasia and the associated adenocarcinoma are composed not only of epithelial cells, but also of inflammatory cells and endothelial cells in the lamina propria and around the tumour, respectively. The early incidence of vascular invasion and metastasis is a feature of Barrett's adenocarcinomas. A paper in this issue of The Journal of Pathology shows that vascular endothelial growth factor (VEGF) is expressed in both metaplastic cells and endothelial cells of pre-neoplastic Barrett's epithelium early in the development of neoplasia. It is becoming clearer that the harmful insults of acid and bile reflux alter not only the epithelium, but also the lamina propria. Cytokines such as tumour necrosis factor alpha (TNFalpha) or transforming growth factor (TGFalpha) are implicated in the formation of early Barrett's adenocarcinomas. From current knowledge it is possible to hypothesize that metaplastic cells, perhaps as a consequence of either TNFalpha or TGFalpha stimulation, secrete VEGF. VEGF can promote adjacent endothelial cell growth through phosphorylation of beta-catenin and vascular endothelial cadherin (VE-cadherin) in endothelial cells. In this de novo microenvironment, angiogenesis is therefore accelerated, enhancing the chance of microvascular invasion.

Barrett Esophagus↗
PubMed2000

Efficacy of medroxyprogesterone treatment in infertile women with endometriosis: a prospective, randomized, placebo-controlled study.

OBJECTIVE: To determine the efficacy of medroxyprogesterone acetate (MPA), 50 mg/d for 3 months, in treating endometriosis, with a follow-up of 6 months. DESIGN: Prospective, randomized, double-blind, placebo-controlled trial. SETTING: Academic infertility unit in a teaching hospital. PATIENT(S): One hundred infertile women found to have endometriosis at laparoscopy, with 50 recruited to each treatment arm. INTERVENTION(S): Laparoscopy within 3 months of finishing therapy. MAIN OUTCOME MEASURE(S): Initial and second-look laparoscopy for revised American Fertility Society stages and scores, pregnancies achieved, effects on well-being via symptomatic improvement, and side effects. RESULT(S): Whether initially high or low, both MPA and placebo therapy achieved similar statistically significant reductions in stages and scores at second-look laparoscopy. MPA was rated more effective in improving overall well-being. Side effects were minimal in both groups (10% MPA; 2% placebo). Six pregnancies occurred without other endometriosis therapy being instituted in the placebo group (3 during therapy), and one with MPA (0 during therapy). CONCLUSION(S): Both MPA and placebo appear equally and significantly effective in treating endometriosis over a 3-month period, as judged by comparative laparoscopy. Therefore, not only must the use of MPA at 50 mg/d over 3 months be questioned, but the performance of placebo also suggests the need to review whether therapy should be instituted at all as well as the present concept that endometriosis is frequently a spontaneously progressive phenomenon.

Adult↗
PubMed2000

Are seminal fluid microorganisms of significance or merely contaminants?

OBJECTIVE: To determine the contribution of urethral and skin flora to seminal fluid cultures and the relation between bacteriospermia and seminal leukocytes. DESIGN: Prospective study. SETTING: IVF-ET unit at a university teaching hospital. PATIENT(S): Sixty men starting an IVF-ET program. INTERVENTION(S): Culture of sequential first-catch urine, midstream urine, and semen samples with evaluation of seminal leukocytes. MAIN OUTCOME MEASURE(S): A comparison of microbes from first-catch urine, midstream urine, and semen samples and the correlations of seminal microbes, elevated leukocyte concentrations, and pregnancy. RESULT(S): Microorganisms were detected in 37% of first-catch urine samples, 27% of midstream urine samples, and 51% of semen samples. Most microorganisms were gram-positive microbes and were common to both urine and semen samples. Mean and median leukocyte concentrations were 0.98 x 10(6)/mL and 0.10 x 10(6)/mL, respectively. There was no correlation between seminal microbes and raised leukocytes or between leukocytospermia and/or bacteriospermia and pregnancy. CONCLUSION(S): Microorganisms are commonly found in insignificant quantities in the semen of asymptomatic men. The frequent isolation of gram-positive microbes common to both urine and semen and the absence of a correlation with raised leukocyte concentrations suggest that bacteriospermia most commonly represents contamination.

Embryo Transfer↗