Relevance of Leukocytospermia and Semen Culture and Its True Place in Diagnosing and Treating Male Infertility

Rakesh Sharma; Sajal Gupta; Ashok Agarwal; Ralf Henkel; Renata Finelli; Neel Parekh; Ramadan Saleh; Mohamed Arafa; Edmund Ko; Armand Zini; Nicholas Tadros; Rupin Shah; Rafael F Ambar; Haitham Elbardisi; Pallav Sengupta; Marlon Martinez; Florence Boitrelle; Mara Simopoulou; Paraskevi Vogiatzi; Jaime Gosalvez; Parviz Kavoussi; Hussein Kandil; Ayad Palani; Marcelo Rodriguez Peña; Osvaldo Rajmil; Gian Maria Busetto; Christina Anagnostopoulou; Sava Micic; Marco G Alves; Lucia Rocco; Taymour Mostafa; Juan G Alvarez; Sunil Jindal; Hassan N Sallam; Israel Maldonado Rosas; Sheena E M Lewis; Sami AlSaid; Mesut Altan; Hyun Jun Park; Jonathan Ramsay; Sijo Parekattil; Marjan Sabbaghian; Kelton Tremellen; Kareim Khalafalla; Damayanthi Durairajanayagam; Giovanni M Colpi

doi:10.5534/wjmh.210063

Relevance of Leukocytospermia and Semen Culture and Its True Place in Diagnosing and Treating Male Infertility

World J Mens Health. 2022 Apr;40(2):191-207. doi: 10.5534/wjmh.210063. Epub 2021 Jun 9.

Authors

Rakesh Sharma¹, Sajal Gupta¹, Ashok Agarwal², Ralf Henkel^{1

3

4}, Renata Finelli¹, Neel Parekh⁵, Ramadan Saleh⁶, Mohamed Arafa^{1

7

8}, Edmund Ko⁹, Armand Zini¹⁰, Nicholas Tadros¹¹, Rupin Shah¹², Rafael F Ambar¹³, Haitham Elbardisi^{7

8}, Pallav Sengupta¹⁴, Marlon Martinez¹⁵, Florence Boitrelle^{16

17}, Mara Simopoulou¹⁸, Paraskevi Vogiatzi¹⁹, Jaime Gosalvez²⁰, Parviz Kavoussi²¹, Hussein Kandil²², Ayad Palani²³, Marcelo Rodriguez Peña²⁴, Osvaldo Rajmil²⁵, Gian Maria Busetto²⁶, Christina Anagnostopoulou²⁷, Sava Micic²⁸, Marco G Alves²⁹, Lucia Rocco³⁰, Taymour Mostafa³¹, Juan G Alvarez^{32

33}, Sunil Jindal³⁴, Hassan N Sallam³⁵, Israel Maldonado Rosas³⁶, Sheena E M Lewis³⁷, Sami AlSaid⁷, Mesut Altan³⁸, Hyun Jun Park^{39

40}, Jonathan Ramsay⁴¹, Sijo Parekattil⁴², Marjan Sabbaghian⁴³, Kelton Tremellen⁴⁴, Kareim Khalafalla⁷, Damayanthi Durairajanayagam⁴⁵, Giovanni M Colpi⁴⁶

Affiliations

¹ American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.
² American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA. [email protected].
³ Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
⁴ Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa.
⁵ Department of Urology, Cleveland Clinic, Cleveland, OH, USA.
⁶ Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt.
⁷ Department of Urology, Hamad Medical Corporation, Doha, Qatar.
⁸ Department of Urology, Weill Cornell Medical-Qatar, Doha, Qatar.
⁹ Department of Urology, Loma Linda University Health, Loma Linda, CA, USA.
¹⁰ Department of Surgery, McGill University, Montreal, Canada.
¹¹ Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA.
¹² Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India.
¹³ Department of Urology, Centro Universitario em Saude do ABC/Andrology Group at Ideia Fertil Institute of Human Reproduction, Santo André, Brazil.
¹⁴ Department of Physiology, Faculty of Medicine, Bioscience and Nursing, MAHSA University, Jenjarom, Selangor, Malaysia.
¹⁵ Section of Urology, University of Santo Tomas Hospital, Manila, Philippines.
¹⁶ Reproductive Biology, Fertility Preservation, Andrology, CECOS, Poissy Hospital, Poissy, France.
¹⁷ Paris Saclay University, UVSQ, INRAE, BREED, Jouy-en-Josas, France.
¹⁸ Department of Physiology, School of Medicine, National & Kapodistrian University of Athens, Maroussi, Athens, Greece.
¹⁹ Andromed Health & Reproduction, Fertility Diagnostics Laboratory, Maroussi, Greece.
²⁰ Departamento de Biología, Universidad Autónoma de Madrid, Madrid, Spain.
²¹ Austin Fertility and Reproductive Medicine/Westlake IVF, Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
²² Fakih IVF Fertility Center, Abu Dhabi, UAE.
²³ Department of Biochemistry, College of Medicine, University of Garmian, Kalar, Iraq.
²⁴ Departamento Docencia e Investigación, Hospital Militar Campo de Mayo, Universidad Barcelo, Buenos Aires, Argentina.
²⁵ Clinical and training Centre of the European Academy of Andrology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
²⁶ Department of Urology and Renal Transplantation, University of Foggia Policlinico Riuniti of Foggia, Foggia, Italy.
²⁷ IVF Clinic "Akeso-Embryo ART", Athens, Greece.
²⁸ Department of Andrology, Uromedica Polyclinic, Belgrade, Serbia.
²⁹ Department of Anatomy & Unit for Multidisciplinary Research in Biomedicine (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal.
³⁰ Department of Environmental, Biological and Pharmaceutical Sciences and Technologies (DiSTABiF), University of Campania Luigi Vanvitelli, Caserta, Italy.
³¹ Department of Andrology, Sexology & STIs, Faculty of Medicine, Cairo University, Cairo, Egypt.
³² Centro ANDROGEN, La Coruña, Spain.
³³ Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA, USA.
³⁴ Department of Andrology and Reproductive Medicine, Jindal Hospital, Meerut, India.
³⁵ Department of Obstetrics and Gynaecology, Alexandria University Faculty of Medicine, Alexandria, Egypt.
³⁶ Centerf Technological Innovation, and Reproductive Medicine (CITMER), Mexico City, Mexico.
³⁷ Examenlab Ltd., Weavers Court Business Park, Linfield Road, Belfast, Northern Ireland, UK.
³⁸ Department of Urology, Haceppete University, Ankara, Turkey.
³⁹ Department of Urology, Pusan National University School of Medicine, Busan, Korea.
⁴⁰ Medical Research Institute of Pusan National University Hospital, Busan, Korea.
⁴¹ Department of Andrology, Hammersmith Hospital, London, UK.
⁴² Avant Concierge Urology & University of Central Florida, Winter Garden, FL, USA.
⁴³ Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.
⁴⁴ Department of Obstetrics Gynaecology and Reproductive Medicine, Flinders University, Adelaide, South Australia.
⁴⁵ Department of Physiology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia.
⁴⁶ Andrology and IVF Unit, Procrea Institute, Lugano, Switzerland.

Abstract

The current WHO 2010 manual for human semen analysis defines leukocytospermia as the presence of peroxidase-positive leukocytes at a concentration >1×10⁶/mL of semen. Granular leukocytes when activated are capable of generating high levels of reactive oxygen species in semen resulting in oxidative stress. Oxidative stress has been correlated with poor sperm quality, increased level of sperm DNA fragmentation and low fertility potential. The presence of leukocytes and pathogens in the semen may be a sign of infection and/or localized inflammatory response in the male genital tract and the accessory glands. Common uro-pathogens including Chlamydia trachomatis, Ureaplasma urealyticum, Neisseria gonorrhoeae, Mycoplasma hominis, and Escherichia coli can cause epididymitis, epididymo-orchitis, or prostatitis. The relationship between leukocytospermia and infection is unclear. Therefore, we describe the pathogens responsible for male genital tract infections and their association with leukocytospermia. The review also examines the diagnostic tests available to identify seminal leukocytes. The role of leukocytospermia in male infertility and its management is also discussed.

Keywords: Culture; Endtz; Infections; Inflammation; Leukocytes; Spermatozoa.

Publication types

Review