313
poisoning by inorganic mercury, including depression, irritability, failure of memory and concentration, and hand tremor, are found also in victims of methyl mercury poisoning. Methyl mercury is fat-soluble and has a particular affinity for brain tissue.
JOAN D. CROSS IAN M. DALE Department of Clinical Physics and Bio-Engineering LORETTA GOOLVARD West of Scotland Health Boards, Glasgow G4 9LF J. M. A. LENIHAN Department of Forensic Medicine, University of Glasgow
HAMILTON SMITH
SPERM-ANTIBODY TESTING IN INFERTILITY
SiR,—The article on hostility testing by Morgan et al. is interesting since the test provides a useful screen for immunological causes of infertility. Indeed we agree with Stone and Shulmanthat sperm-antibody tests should be included more frequently in the panel of diagnostic tests on an infertile couple. In our laboratory, when testing for sperm isoantibodies in infertile women, we usually use semen from normal donors as antigen, as do most laboratories. However, when we test with sperm from the partner and from
donors,
we
sometimes get
discordant results. RESULTS
and donors’ sperm, while in fifteen cases (50%) the tests were negative with both. In ten cases (33%)-and this is the most important result-the patient’s samples agglutinated her partner’s spermatozoa but not the pool of donors’ spermatozoa. In only one case (but with very low titre) did we observe positivity in the serum exclusively with donor sperm. In all thirty cases the pattern was the same,with the gel agglutination and capillary methods. The high number of positive cases is surprising. However, an isoimmune antisperm reaction was suspected, in theory at least, in these patients-indeed this was why we selected them in the way we did. The percent positivity in the search for antispermatozoa isoantibodies of the sperm-agglutinating type in unselected infertile women in our records is 10.5%. Furthermore if the tests had been performed with donor spermatozoa only, the percent positivity in our selected group would have been 17%. Use of spermatoza from the partner revealed positivity that would otherwise have been undected. The titres are given in the table. These data, if confirmed, emphasise the importance of doing spermagglutinin tests in infertile women (seminal and immunological patterns permitting) not only with sperm from donors but also with sperm from the partner if false negativity is to be avoided. We would offer two hypotheses to explain this discordance. First, besides common species-specific antigens, on sperm membrane individual antigens could be expressed; a particular immunisation mechanism and/or immune response could induce synthesis of antibodies against the latter antigens. Secondly, the surface sperm antigens present in all the members of the same species could be present with a variable quantitative degree in the individuals ; the immune response in the female would then be directed against the prevailing surface antigens on the spermatozoa of the partner. F. DONDERO Medical Pathology II, and Obstetrics and Gynæcology I and II,
M. CERASARO M. NICOTRA I. M. COGHI
University of Rome, Rome, Italy
H-Y ANTIGEN IN A MALE WITH A
45, X KARYOTYPE
SIR,-It is of great interest that H-Y antigen is detectable in XX males and XX true hermaphrodites, both of whom have testicular tissue but lack a recognisable Y chromosome.These observations suggest that testis-determining genes and the H-Y
To explore this discordance we tested the blood serum and cervical mucus of thirty infertile women with, as antigen, sperm from the partner and a donor pool. Patients were selected on the following criteria: (1) they had had so-called idiopathic infertility for at least 2 years; the husband had normal semen and no antisperm autoantibody (agglutinating, immobilising, cytotoxic) in blood serum or seminal plasma; and (2) consistently poor postcoital test, repeated at least three times. Donors also had normal semen and were negative in antisperm autoantibody tests. Furthermore, to avoid false positivity or negativity, all samples were tested with normal control serum and serum previously demonstrated to be positive. The gelatin agglutination method and capillary method 3 were used, with the precautions emphasised by Shulman. In four cases (13%) tests were positive with both partner’s
1. Morgan, H., Stedronska, J., Hendry, 2. 3.
W.
F., Chamberlain, G. V. P.,
Dewhurst, C. J. Lancet, 1977, i, 1228. Stone, M. L., Shulman, S. ibid. 1977, ii, 663. Shulman, S. Reproduction and Antibody Response. C.R.C. Press, 1975.
Cytotoxicity
of anti-mouse-H-Y antiserum after
absorption
8- - -8, unabsorbed; --8 absorbed with female XX cells; 0- - -0 absorbed with male XO cells; 0———0 absorbed with male XY cells. Points
are
s.n.±109%.
means
of 3 double-blind assays
by
two
observers.
poisoning by inorganic mercury, including depression, irritability, failure of memory and concentration, and hand tremor, are found also in victims of methyl mercury poisoning. Methyl mercury is fat-soluble and has a particular affinity for brain tissue.
JOAN D. CROSS IAN M. DALE Department of Clinical Physics and Bio-Engineering LORETTA GOOLVARD West of Scotland Health Boards, Glasgow G4 9LF J. M. A. LENIHAN Department of Forensic Medicine, University of Glasgow
HAMILTON SMITH
SPERM-ANTIBODY TESTING IN INFERTILITY
SiR,—The article on hostility testing by Morgan et al. is interesting since the test provides a useful screen for immunological causes of infertility. Indeed we agree with Stone and Shulmanthat sperm-antibody tests should be included more frequently in the panel of diagnostic tests on an infertile couple. In our laboratory, when testing for sperm isoantibodies in infertile women, we usually use semen from normal donors as antigen, as do most laboratories. However, when we test with sperm from the partner and from
donors,
we
sometimes get
discordant results. RESULTS
and donors’ sperm, while in fifteen cases (50%) the tests were negative with both. In ten cases (33%)-and this is the most important result-the patient’s samples agglutinated her partner’s spermatozoa but not the pool of donors’ spermatozoa. In only one case (but with very low titre) did we observe positivity in the serum exclusively with donor sperm. In all thirty cases the pattern was the same,with the gel agglutination and capillary methods. The high number of positive cases is surprising. However, an isoimmune antisperm reaction was suspected, in theory at least, in these patients-indeed this was why we selected them in the way we did. The percent positivity in the search for antispermatozoa isoantibodies of the sperm-agglutinating type in unselected infertile women in our records is 10.5%. Furthermore if the tests had been performed with donor spermatozoa only, the percent positivity in our selected group would have been 17%. Use of spermatoza from the partner revealed positivity that would otherwise have been undected. The titres are given in the table. These data, if confirmed, emphasise the importance of doing spermagglutinin tests in infertile women (seminal and immunological patterns permitting) not only with sperm from donors but also with sperm from the partner if false negativity is to be avoided. We would offer two hypotheses to explain this discordance. First, besides common species-specific antigens, on sperm membrane individual antigens could be expressed; a particular immunisation mechanism and/or immune response could induce synthesis of antibodies against the latter antigens. Secondly, the surface sperm antigens present in all the members of the same species could be present with a variable quantitative degree in the individuals ; the immune response in the female would then be directed against the prevailing surface antigens on the spermatozoa of the partner. F. DONDERO Medical Pathology II, and Obstetrics and Gynæcology I and II,
M. CERASARO M. NICOTRA I. M. COGHI
University of Rome, Rome, Italy
H-Y ANTIGEN IN A MALE WITH A
45, X KARYOTYPE
SIR,-It is of great interest that H-Y antigen is detectable in XX males and XX true hermaphrodites, both of whom have testicular tissue but lack a recognisable Y chromosome.These observations suggest that testis-determining genes and the H-Y
To explore this discordance we tested the blood serum and cervical mucus of thirty infertile women with, as antigen, sperm from the partner and a donor pool. Patients were selected on the following criteria: (1) they had had so-called idiopathic infertility for at least 2 years; the husband had normal semen and no antisperm autoantibody (agglutinating, immobilising, cytotoxic) in blood serum or seminal plasma; and (2) consistently poor postcoital test, repeated at least three times. Donors also had normal semen and were negative in antisperm autoantibody tests. Furthermore, to avoid false positivity or negativity, all samples were tested with normal control serum and serum previously demonstrated to be positive. The gelatin agglutination method and capillary method 3 were used, with the precautions emphasised by Shulman. In four cases (13%) tests were positive with both partner’s
1. Morgan, H., Stedronska, J., Hendry, 2. 3.
W.
F., Chamberlain, G. V. P.,
Dewhurst, C. J. Lancet, 1977, i, 1228. Stone, M. L., Shulman, S. ibid. 1977, ii, 663. Shulman, S. Reproduction and Antibody Response. C.R.C. Press, 1975.
Cytotoxicity
of anti-mouse-H-Y antiserum after
absorption
8- - -8, unabsorbed; --8 absorbed with female XX cells; 0- - -0 absorbed with male XO cells; 0———0 absorbed with male XY cells. Points
are
s.n.±109%.
means
of 3 double-blind assays
by
two
observers.
