Re: Automated Smartphone-Based System for Measuring Sperm Viability, DNA Fragmentation, and Hyaluronic Binding Assay Score.

available at http://www.ncbi. nlm.nih. gov/pubmed/31029245 Editorial Comment: Exosomes are little balls of chemicals such as nucleic acids, proteins and lipids that are released from cells. The seminal plasma contains exosomes originating from the prostate, epididymis and other glands. As nature mostly does not operate arbitrarily, it is reasonable to ask what exosomes are doing there and whether that information can be used to improve male fertility. These investigators isolated seminal fluid exosomes, determined their content and interestingly demonstrated that exosomes from normozoospermic but not asthenozoospermic men improved sperm motility and the acrosome reaction. This work may offer new ways of assaying male reproductive health beyond the male gamete by looking into its surrounding milieu, and also novel treatments to stimulate sperm. Craig Niederberger, MD Re: Features of the Metabolic Syndrome in Late Adolescence are Associated with Impaired Testicular Function at 20 Years of Age R. J. Hart, D. A. Doherty, T. A. Mori, L. A. Adams, R. C. Huang, N. Minaee, D. J. Handelsman, R. McLachlan, R. J. Norman, J. E. Dickinson, J. K. Olynyk and L. J. Beilin Division of Obstetrics and Gynaecology, Medical School, Royal Perth Hospital and Telethon Kids Institute, University of Western Australia, and Women and Infants Research Foundation, Perth, Fertility Specialists of Western Australia, Claremont, Sir Charles Gairdner Hospital, Nedlands and Department of Gastroenterology, Fiona Stanley and Fremantle Hospital, and School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, ANZAC Research Institute, University of Sydney, Sydney, New South Wales, Hudson Institute, Monash University, Melbourne, Victoria and Robinson Institute, Research Institute, School of Medicine, University of Adelaide and Fertility SA, Adelaide, South Australia, Australia MALE INFERTILITY 1083 Copyright © 2019 American Urological Association Education and Research, Inc. Unauthorized reproduction of this article is prohibited. Hum Reprod 2019; 34: 389e402. doi: 10.1093/humrep/dey371 Abstract available at http://www.ncbi. nlm.nih. gov/pubmed/30576537available at http://www.ncbi. nlm.nih. gov/pubmed/30576537 Editorial Comment: Accumulating evidence points toward the role general health has in male fertility, including the metabolic syndrome and its ill effect on male reproduction. But how early in a man’s life does overall health affect his fertility down the road? These investigators analyzed a database containing health data of 1,454 boys since their birth in 1989 to 1991 and observed that males at age 17 years with increased cardiometabolic risk factors had lower testosterone and inhibin B than their peers. They also observed that males with evidence of nonalcoholic fatty liver disease had lower sperm counts, testosterone and inhibin B, and those with a high concentration of tumor necrosis factor receptor 1, a marker of the metabolic syndrome, had lower sperm counts and inhhibin B, and elevated luteinizing hormone and follicle-stimulating hormone. It is sobering to think that poor health in adolescence can play out in early adulthood as reduced fertility but these findings point to exactly that. Craig Niederberger, MD