Leukocytospermia is a condition which is characterized by abnormally high concentrations of white blood cells (leukocytes) in the semen, typically defined by the World Health Organization (WHO) as more than 1 million leukocytes per milliliter of ejaculate. It is also termed as pyospermia or leukospermia. This is important to consider as it affects the sperm quality and male fertility adversely. This is a condition where leukocytes in semen are associated with inflammation and infection of the male reproductive tract.
Causes of Leukocytospermia
Leukocytospermia can arise from a variety of causes, most commonly related to infections and inflammatory processes within the male genital tract:
- Genital Infections: This is the most common cause of bacterial infections that includes sexually transmitted infections (STIs) such as Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma, and Escherichia coli. Such infections lead to inflammation in the seminal vesicles, urethra, prostate, and epididymis.
- Systemic Infections and Autoimmune Disorders: These infections affect the entire body or autoimmune conditions where the immune system attacks the tissues of the body, and can cause leukocytospermia.
- Inflammation: Various non-infectious inflammation can occur in the male reproductive tract, mainly due to trauma or other irritants, which can increase leukocyte levels.
- Varicocele: Dilated veins in the scrotum (varicocele) can be associated with increased leukocytes due to impaired testicular function and inflammation.
- Urethral Strictures or Narrowing: local inflammation and leukocyte accumulation can occur due to obstruction in the urethra.
- Lifestyle Factors: Use of alcohol, tobacco, and marijuana has been linked to leukocytospermia. For example, cigarette smoking can activate leukocytes and increase reactive oxygen species (ROS), contributing to oxidative stress and sperm damage.
- Infrequent Ejaculation: Prolonged intervals between ejaculations can lead to the accumulation of leukocytes in semen.
- Idiopathic Cases: In many men with leukocytospermia, no clear infectious or inflammatory cause is identified, making the condition idiopathic in nature.
Pathophysiology and Impact on Fertility
Leukocytes in semen are part of the immune defense system, primarily involved in phagocytosis of abnormal sperm and pathogens. The predominant leukocyte types in semen are granulocytes (50–60%), macrophages (20–30%), and T-lymphocytes (2–5%).
However, excessive leukocytes produce high levels of reactive oxygen species (ROS), which can cause oxidative stress. This oxidative stress damages sperm membranes rich in polyunsaturated fatty acids, induces lipid peroxidation, mitochondrial dysfunction, and DNA fragmentation in sperm cells. These effects impair sperm motility, morphology, and fertilization capacity, leading to reduced male fertility and a negative impact on outcomes of assisted reproductive technologies such as in vitro fertilization (IVF).
Leukocytospermia is found in approximately 30% of infertile men, although in 80% of these cases, no microbial infection is detected, suggesting inflammation or other non-infectious causes.
Diagnosis of Leukocytospermia
The diagnosis of leukocytospermia involves:
- Semen Analysis: Routine examination of semen helps in detecting the elevated round cells, but distinguishing leukocytes from immature germ cells requires special tests.
- Peroxidase (Endtz) Test: The identification of peroxidase-positive leukocytes in semen is performed with this test, which helps in confirming leukocytospermia.
- Immunohistochemical Staining and Flow Cytometry: These advanced techniques can specifically quantify leukocyte subpopulations in semen.
- Microbiological Cultures: Bacterial infection that causes leukocytospermia are identified while performing semen and urine cultures.
- Additional Tests: Depending on clinical suspicion, further urological evaluation may be needed to detect varicocele, urethral strictures, or systemic illnesses.
Clinical Presentation
Leukocytospermia is often asymptomatic. When symptoms occur, they are usually related to the underlying infection or inflammation, such as pain, discomfort, or urinary symptoms. The presence of leukocytes in semen itself does not usually cause noticeable symptoms.
Treatment of Leukocytospermia
Treatment depends on the underlying cause and may include:
- Antibiotics: If a bacterial infection is confirmed or strongly suspected, broad-spectrum antibiotics are commonly prescribed. Moreover, antibiotic therapy is taken into consideration for eradicating infection, improving sperm quality, and reducing inflammation. As per the studies, antibiotic treatment has showcases some improvements in pregnancy rates and sperm parameters, though the results are variable and not universally conclusive.
- Anti-inflammatory Agents: Anti-inflammatory medications are recommended in cases where inflammation is present without any clear infection for reducing leukocyte activity and oxidative stress.
- Antioxidants: As we know, leukocytes produce ROS that damage sperm; antioxidants such as vitamin C, vitamin E, and coenzyme Q10 are often used together for neutralizing oxidative stress and improving sperm function.
- Lifestyle Modifications: It is highly recommended to make some changes in your lifestyle, such as avoiding smoking, alcohol, and marijuana to reduce leukocyte activation and oxidative stress.
- Treatment of Associated Conditions: Management of varicocele, urethral strictures, or systemic illnesses may be necessary to resolve leukocytospermia.
- Assisted Reproductive Technologies (ART): For men with persistent leukocytospermia and infertility, ART such as intrauterine insemination (IUI), IVF, or intracytoplasmic sperm injection (ICSI) may be effective options to achieve pregnancy.
Prognosis and Considerations
Leukocytospermia is a significant negative prognostic factor for male fertility due to its detrimental effects on sperm quality and function. It can interfere with sperm’s ability to fertilize the egg and reduce success rates in ART. However, with appropriate diagnosis and management, including treatment of infections and lifestyle changes, sperm parameters and fertility outcomes can improve.
Persistent leukocytospermia without identifiable infection may require ongoing monitoring and tailored therapy. Further research is needed to clarify the best treatment strategies and to understand the full clinical implications of leukocytospermia.
Ending note
In summary, leukocytospermia is a condition marked by elevated white blood cells in semen, primarily caused by infections, inflammation, or lifestyle factors. It negatively affects sperm quality through oxidative stress and DNA damage, contributing to male infertility. Diagnosis involves semen analysis and microbiological testing, while treatment includes antibiotics, antioxidants, anti-inflammatory drugs, lifestyle modification, and assisted reproduction techniques when necessary.
This comprehensive approach helps address the underlying causes and mitigate the impact of leukocytospermia on male reproductive health and fertility potential. If you or someone you know is struggling with leukocytospermia, we at Aveya IVF centre are here to help you in your journey.
