Significance of Positive Semen Culture in Relation to Male Infertility and the Assisted Reproductive Technology Process

Joshua S. Jue, Ranjith Ramasamy

Disclosures

Transl Androl Urol. 2017;6(5):916-922. 

In This Article

Relationship Between Bacteriospermia and Leukocytospermia

The presence of leukocytes in sperm is associated with the production of ROS. ROS destroys mitochondrial DNA and inhibits intracellular ATP production to affect sperm function and motility.[2–5] The resultant oxidative stress has been shown to decrease the success of both IVF and ICSI.[6,7] The WHO defines leukocytospermia as more than 1×106 WBC/mL, but seminal oxidative stress has been demonstrated at lower leukocyte levels.[8] The WHO does not provide a reference range for peroxidase-positive cells in a fertile man.[1] The terms leukospermia and pyospermia may be used interchangeably with leukocytospermia.[1] Figure 1 outlines the workup once leukocytes have been seen within semen.

Figure 1.

Male infertility work-up when infectious physical exam findings present.

Instead of protecting sperm, the presence of leukocytes may actually decrease semen quality. A retrospective study found genetic sequence homologies between human B-tubulin and proteins of different bacterial species, suggesting that infection may induce immunomediated damage.[9] In spite of the proposed mechanism, the genetic similarities may be coincidental and more a result of functional similarities. After all, the study that suggested this mechanism found no significant differences between bacteria positive and negative fertile men.[9] In contrast, a retrospective study concluded that leukocytospermia has little diagnostic value in the detection of bacteriospermia and impaired semen quality.[10] Rather than simply being a response to bacteria, leukocytospermia has also been attributed to cigarette smoking, heavy alcohol use, and age.[11–13]

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