Does Leukocytospermia Considered as an Indicator of Infection

Abstract

Background: The acceptable count of Leukocytospermia in semen sample has been defined by the World Health Organization (WHO) as ≤1 × 106 WBC/ml. The presence of more than one million peroxidase positive white blood cells (WBC) per ml is considered abnormal and is labeled as “leukocytospermia” [1]. But, is there any deterioration in the semen parameters in cases where the number of leukocytes is higher than “normal”, or is it an indication for infection? Objective: To test the significance of the presence of leukocytes in the semen sample. Design: A retrospective randomised study. Materials and Methods: 6481 semen samples were divided into two groups according to the availability of the leukocytes. Group I includes samples with ≤1 × 106 leukocyte/ml (n = 3948) and group II includes samples with >1 × 106 leukocyte/ml (n = 2533). Semen samples were from partners of couples undergoing infertility evaluation. Specimens were collected by masturbation, and subjected to routine semen analysis including count, motility, sperm morphology (assessments were performed according to the Tygerberg strict criteria), number of leukocytes present (identification of Leukocytes was done using peroxidase staining) and Mixed Antiglobin Reaction (MAR) test was done for detection of sperm surface antibodies. All semen samples from group II were sent for culture. Results: A comparison in the mean ± standard deviation (mean ± SD) between the two groups showed statistical significant differences in the mean ± SD motility (55.9 ± 27.8 vs 53.4 ± 27.3, P < 0.001), mean ± SD progressive motility (19.5 ± 14.7 vs 18.3 ± 14.2, P < 0.001) and mean ± SD rapid sperm movement (35.6 ± 54.9 vs 31.4 ± 19.9, P < 0.001), which could be mediated by the induction of lipid peroxidation by the Radical Oxygen Species (ROS) where the effect could be directed to nuclear DNA of sperm. All samples sent for culture were microbiologically negative. Conclusion: From the results obtained, we support the studies showing that the presence of leukocytes may not be linked to infection. Future studies are needed to verify the effect of lipoperoxidation process as a result of leukocytes’ presence and to determine the cut off number of leukocytes in semen to be considered of importance since the semen parameters were affected significantly.