Abstract
BackgroundLeukocytes contribute directly and indirectly to reactive oxygen species (ROS) production. Although leukocytospermia is defined as the presence of ≥1 × 106 white blood cells/mL (WBC/mL) in a semen sample, the presence of less than 1×106 WBC/mL (low-level leukocytospermia) can still produce a detectable amount of ROS, impairing sperm function and lowering the chances of pregnancy. Our objective was to assess the effect of low-level leukocytospermia on semen quality, ROS levels, and DNA damage in infertile men.MethodsSemen samples were examined from 472 patients and divided into 3 groups: no seminal leukocytes; group 2, men with low-level leukoctyospermia (0.1-1.0 × 106 WBC/mL); and group 3, frank leukocytospermia, (>1.0 × 106. WBC/mL). Semen analysis, leukoctyospermia, reactive oxygen species and DNA fragmentation was tested.ResultsConventional semen parameters between the 3 groups were similar. Group 2 patients had significantly higher levels of ROS and sperm DNA fragmentation (1839.65 ± 2173.57RLU/s; DNA damage: 26.47 ± 19.64%) compared with group 1 (ROS: 1101.09 ± 5557.54 RLU/s; DNA damage: 19.89 ± 17.31%) (ROS: p = 0.002; DNA damage: p = 0.047). There was no significant difference in ROS levels between groups 2 and 3.ConclusionsPatients presenting with low-level leukocytospermia have seminal oxidative stress. Although these patients are not categorized as leukocytospermic by current World Health Organization (WHO) guidelines, these men may benefit by treatment with antibiotics, testing for bacterial cultures, or antioxidant supplements to reduce ROS-induced sperm DNA fragmentation and improve their chances of fertility. The WHO guidelines for leukocytospermia may need to be revised accordingly.
Highlights
Leukocytes contribute directly and indirectly to reactive oxygen species (ROS) production
There were no significant differences between the three groups in terms of baseline clinical characteristics (Table 1) and conventional semen parameters (Table 2)
ROS levels Compared to 63.2% of patients with ROS levels above our reference value (>93 RLU/s/106 sperm), the incidence increased to 81.6% in group 2 (P < 0.016) and 92.3% in group 3 (P < 0.011) and it was comparable between group 2 and
Summary
Leukocytes contribute directly and indirectly to reactive oxygen species (ROS) production. Our objective was to assess the effect of low-level leukocytospermia on semen quality, ROS levels, and DNA damage in infertile men. In the absence of infection, it Leukocytes (polymorphonuclear neutrophils and macrophages) have important implications in male fertility in that they produce reactive oxygen species (ROS). ROS play a physiologic role [7], but at higher levels, they cause oxidative stress, which overwhelms the physiological mechanisms of sperm and causes damage. This damage has been established to occur via lipid peroxidation of the plasma membrane [8]. Oxidative stress can decrease success rates of assisted reproduction procedures such as in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) [12,13]
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