Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-5cf477f64f-tgq86 Total loading time: 0 Render date: 2025-04-04T16:27:23.241Z Has data issue: false hasContentIssue false

Chapter 4 - Standard Semen Analysis: Leukocytospermia

Published online by Cambridge University Press:  05 April 2021

By
Renata Finelli  and
Ralf Henkel
Edited by
Ashok Agarwal ,
Ralf Henkel  and
Ahmad Majzoub
Ashok Agarwal
Affiliation:
The Cleveland Clinic Foundation, Cleveland, OH
Ralf Henkel
Affiliation:
University of the Western Cape, South Africa
Ahmad Majzoub
Affiliation:
Hamad Medical Corporation, Doha
Get access

Summary

The investigation of the male fertility potential starts with the analysis of seminal fluid. The seminal fluid or ejaculate is composed of a heterogeneous water-based solution (seminal plasma) deriving from secretions of prostate, testes, seminal vesicles and bulbourethral glands, and cellular components that include mature spermatozoa and epithelial cells derived from the genitourinary tract as well as the generically defined “round cells” (i.e. leukocytes, Sertoli cells and germ cells) [1]. Hence, the standard semen analysis provides insight into the testicular production of spermatozoa as well as the functionality and secretory activity of the associated sex glands [2]. Moreover, it permits the identification of genetic conditions associated with male infertility, such as azoospermia or globozoospermia, and orientates the choice of treatments or the necessity for further tests and investigations. Currently, semen analysis is performed according to the most recent WHO guidelines [2], which provide instructions for the evaluation of macroscopic (liquefaction, viscosity, appearance, volume, pH) and microscopic (sperm concentration, motility, morphology, vitality, presence of round cells and agglutination zones) seminal characteristics. The lower reference value for each parameter is represented by the fifth percentile, calculated based on a selected population of 1953 recent fathers [2]. However, it should be noted that men having seminal parameters below the reference values provided can still be fertile. On the other hand, men showing seminal parameters above the lower reference values are not necessarily fertile as about 15 percent of the men are reported to be infertile despite having normal semen parameters according to World Health Organization (WHO) criteria [3].

Type
Chapter
Information
Manual of Sperm Function Testing in Human Assisted Reproduction , pp. 31 - 38
Publisher: Cambridge University Press
Print publication year: 2021

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Johanisson, E, Campana, A, Luthi, R, De Agostini A. Evaluation of “round cells” in semen analysis: a comparative study. Hum Reprod Update 2000; 6: 404–12.CrossRefGoogle ScholarPubMed
World Health Organization. (2010) WHO Laboratory Manual for the Examination and Processing of Human Semen, 5th ed. Geneva: The WHO Press.Google Scholar
Hamada, A, Esteves, SC, Nizza, M, Agarwal, A. Unexplained male infertility: diagnosis and management. Int Braz J Urol 2012; 38: 576–94.Google Scholar
Endtz, AW. A rapid staining method for differentiating granulocytes from “germinal cells” in Papanicolaou stained semen. Acta Cytol 1974; 18: 2–7.Google Scholar
Rowe, PJ, Comhaire, FH, Hargreave, TB, Mahmoud, AMA, World Health Organization. (2000) WHO Manual for the Standardized Investigation, Diagnosis and Management of the Infertile Male. Cambridge: Cambridge University Press.Google Scholar
Pfeifer, S, Butts, S, Dumesic, D et al. Diagnostic evaluation of the infertile male: a committee opinion. Fertil Steril 2015; 103: e18–25.Google Scholar
Rossi, AG, Aitken, RJ. Interactions between leukocytes and the male reproductive system: the unanswered questions. Adv Exp Med Biol 1997; 424: 245–52.CrossRefGoogle ScholarPubMed
D’Cruz, OJ, Wang, B-L, Haas, GG. Phagocytosis of immunoglobulin G and C3-bound human sperm by human polymorphonuclear leukocytes is not associated with the release of oxidative radicals. Biol Reprod 1992; 46: 721–32.Google Scholar
Aitken, RJ, Baker, MA. Oxidative stress, spermatozoa and leukocytic infiltration: relationships forged by the opposing forces of microbial invasion and the search for perfection. J Reprod Immunol 2013; 100: 11–19.CrossRefGoogle ScholarPubMed
Piasecka, M, Fraczek, M, Gaczarzewicz, D et al. Novel morphological findings of human sperm removal by leukocytes in in vivo and in vitro conditions: preliminary study. Am J Reprod Immunol 2014; 72: 348–58.CrossRefGoogle ScholarPubMed
Comhaire, FH, Mahmoud, AMA, Depuydt, CE, Zalata, AA, Christophe, AB. Mechanisms and effects of male genital tract infection on sperm quality and fertilizing potential: the andrologist’s viewpoint. Hum Reprod Update 1999; 5: 393–8.Google Scholar
Sandoval, JS, Raburn, D, Muasher, S. Leukocytospermia: overview of diagnosis, implications, and management of a controversial finding. Middle East Fertil Soc J 2013; 18: 129–34.Google Scholar
Holdsworth, SR, Can, PY. Cytokines: names and numbers you should care about. Clin J Am Soc Nephrol 2015; 10: 2243–54.Google Scholar
Martínez-Prado, E, Camejo Bermúdez, MI. Expression of IL-6, IL-8, TNF-α, IL-10, HSP-60, anti-HSP-60 antibodies, and anti-sperm antibodies, in semen of men with leukocytes and/or bacteria. Am J Reprod Immunol 2010; 63: 233–43.CrossRefGoogle ScholarPubMed
Eggert-Kruse, W, Boit, R, Rohr, G, Aufenanger, J, Hund, M, Strowitzki, T. Relationship of seminal plasma interleukin (IL) -8 and IL-6 with semen quality. Hum Reprod 2001; 16: 517–28.CrossRefGoogle ScholarPubMed
Martínez, P, Proverbio, F, Camejo, MI. Sperm lipid peroxidation and pro-inflammatory cytokines. Asian J Androl 2007; 9: 102–7.Google ScholarPubMed
Mohanty, G, Swain, N, Goswami, C, Kar, S, Samanta, L. Histone retention, protein carbonylation, and lipid peroxidation in spermatozoa: possible role in recurrent pregnancy loss. Syst Biol Reprod Med 2016; 62: 201–12.Google Scholar
Suleiman, SA, Elamin Ali, M, Zaki, ZMS, El-Malik, EMA, Nasr, MA. Lipid peroxidation and human sperm motility: protective role of vitamin E. J Androl 1996; 17: 530–7.Google Scholar
Saleh, RA, Agarwal, A, Sharma, RK, Nelson, DR, Thomas, AJ. Effect of cigarette smoking on levels of seminal oxidative stress in infertile men: a prospective study. Fertil Steril 2002; 78: 491–9.CrossRefGoogle ScholarPubMed
Close, CE, Roberts, PL, Berger, RE. Cigarettes, alcohol and marijuana are related to pyospermia in infertile men. J Urol 1990; 144: 900–3.Google Scholar
Agarwal, A, Rana, M, Qiu, E, AlBunni, H, Bui, A, Henkel, R. Role of oxidative stress, infection and inflammation in male infertility. Andrologia 2018; 50: e13126.Google Scholar
Kahn, BE, Brannigan, RE. Obesity and male infertility. Curr Opin Urol 2017; 27: 441–5.CrossRefGoogle ScholarPubMed
Leisegang, K, Bouic, PJD, Henkel, R. Metabolic syndrome is associated with increased seminal inflammatory cytokines and reproductive dysfunction in a case-controlled male cohort. Am J Reprod Immunol 2016; 76: 155–63.Google Scholar
Wright, C, Milne, S, Leeson, H. Sperm DNA damage caused by oxidative stress: modifiable clinical, lifestyle and nutritional factors in male infertility. Reprod Biomed Online 2014; 28: 684–703.Google Scholar
Aitken, R. Reactive oxygen species as mediators of sperm capacitation and pathological damage. Mol Reprod Dev 2017; 84: 1039–52.Google Scholar
Tvrdá, E, Massanyi, P, Lukáč, N. Physiological and pathological roles of free radicals in male reproduction. In Meccariello, R, Chianese, R, eds. (2017) Spermatozoa - Facts and Perspectives. London: IntechOpen.Google Scholar
Plante, M, De Lamirande, E, Gagnon, C. Reactive oxygen species released by activated neutrophils, but not by deficient spermatozoa, are sufficient to affect normal sperm motility. Fertil Steril 1994; 62: 387–93.Google Scholar
Nahoum, CRD, Cardozo, D. Staining for volumetric count of leukocytes in semen and prostrate-vesicular fluid. Fertil Steril 1980; 34: 68–9.Google Scholar
Wolff, H, Anderson, DJ. Male genital tract inflammation associated with increased numbers of potential human immunodeficiency virus host cells in semen. Andrologia 1988; 20: 404–10.Google Scholar
Villegas, J, Schulz, M, Vallejos, V, Henkel, R, Miska, W, Sánchez, LR. Indirect immunofluorescence using monoclonal antibodies for the detection of leukocytospermia: comparison with peroxidase staining. Andrologia 2002; 34: 69–73.CrossRefGoogle ScholarPubMed
Bachir, BG, Jarvi, K. Infectious, inflammatory, and immunologic conditions resulting in male infertility. Urol Clin North Am 2014; 41: 67–81.Google Scholar
Domes, T, Lo, KC, Grober, ED, Mullen, JBM, Mazzulli, T, Jarvi, K. The incidence and effect of bacteriospermia and elevated seminal leukocytes on semen parameters. Fertil Steril 2012; 97: 1050–5.Google Scholar
Homa, ST, Vassiliou, AM, Stone, J et al. A comparison between two assays for measuring seminal oxidative stress and their relationship with sperm DNA fragmentation and semen parameters. Genes 2019; 10: 236.Google Scholar
Jarow, J, Sigman, M, Kolettis, PN et al. (2010) The Optimal Evaluation of the Infertile Male: AUA Best Practice Statement. American Urological Association Education and Research, Inc., pp. 1–38.Google Scholar
Curtis Nickel, J. Prostatitis. Can J Urol 2011; 5: 306–15.Google Scholar
Jungwirth, A, Giwercman, A, Tournaye, H et al. European Association of Urology guidelines on male infertility: the 2012 update. Eur Urol 2012; 62: 324–32.CrossRefGoogle Scholar
Henkel, R, Kierspel, E, Stalf, T et al. Effect of reactive oxygen species produced by spermatozoa and leukocytes on sperm functions in non-leukocytospermic patients. Fertil Steril 2005; 83: 635–42.CrossRefGoogle ScholarPubMed
Sharma, RK, Pasqualotto, FF, Nelson, DR, Thomas, AJ, Agarwal, A. Relationship between seminal white blood cell counts and oxidative stress in men treated at an infertility clinic. J Androl 2001; 22: 575–83.Google Scholar
Menkveld, R, Kruger, TF. Sperm morphology and male urogenital infections. Andrologia 1998; 30: 49–53.CrossRefGoogle ScholarPubMed
Punab, M, Lõivukene, K, Kermes, K, Mändar, R. The limit of leucocytospermia from the microbiological viewpoint. Andrologia 2003; 35: 271–8.Google Scholar
Lackner, J, Schatzl, G, Horvath, S, Kratzik, C, Marberger, M. Value of counting white blood cells (WBC) in semen samples to predict the presence of bacteria. Eur Urol 2006; 49: 148–53.Google Scholar
Thomas, J, Fishel, S, Hall, J, Green, S, Newton, T, Thornton, S. Increased polymorphonuclear granulocytes in seminal plasma in relation to sperm morphology. Hum Reprod 1997; 12: 2418–21.Google Scholar
Hamada, A, Agarwal, A, Sharma, R, French, DB, Ragheb, A, Sabanegh, ES. Empirical treatment of low-level leukocytospermia with doxycycline in male infertility patients. Urology 2011; 78: 1320–5.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×