What does the analysis result mean?
In addition to sperm, other cells are present in the ejaculate: leukocytes, immature germ cells, epithelial cells. With conventional microscopy, they are easy to confuse, so if the indicator is elevated, the laboratory is asked to perform a special stain that distinguishes true leukocytes from immature forms. This is fundamental: immature cells do not indicate inflammation and do not require antibiotics. Only a confirmed excess of the leukocyte threshold is considered leukocytospermia. In addition, a single result does not prove anything: the analysis is repeated after a few weeks, following the preparation rules.
- Leukocytes must be distinguished from immature germ cells
- Special painting is required for high levels
- Diagnosis is made by repeat analysis
- Proper preparation for the test is important
- The threshold is determined by generally accepted laboratory criteria
Possible reasons
The most common cause is chronic inflammation of the prostate gland, seminal vesicles or epididymis, including without significant complaints. In second place are sexually transmitted infections: chlamydia, mycoplasma genitalium, trichomonas, gonococcus. White blood cells may increase during urethritis and after urinary tract infections. There are also non-infectious causes: varicocele, autoimmune processes, smoking and alcohol abuse, long-term abstinence, regular overheating in baths and saunas, wearing tight underwear. Sometimes the cause cannot be determined.
- Chronic prostatitis and vesiculitis
- Epididymitis and orchitis
- Sexually transmitted infections
- Urethritis
- Varicocele
- Smoking, alcohol, overheating, prolonged abstinence
How does it affect fertility?
Leukocytes produce reactive oxygen species, which in moderate quantities are needed for normal sperm maturation, and in excess damage their membranes and DNA. Because of this, motility decreases, morphology deteriorates, and sperm DNA fragmentation increases. This may reduce the chances of natural conception and the success of assisted reproduction programs, and also increase the risk of early miscarriage. At the same time, in some men with moderate leukocytospermia, the rest of the spermogram remains normal, and pregnancy occurs without problems.
- Damage to sperm membranes by reactive oxygen species
- Decreased mobility
- Deterioration of morphology
- Increased sperm DNA fragmentation
- Possible decrease in IVF results
- Doesn't always lead to infertility
Survey
They start with a repeat spermogram, performed after 2–5 days of abstinence in a laboratory with experience in such studies. If an increase in leukocytes is confirmed, a sperm culture is performed to determine sensitivity to antibiotics, a smear is taken from the urethra and PCR for major sexually transmitted infections. Urine is analyzed in several portions to understand the level of inflammation. TRUS of the prostate and seminal vesicles reveals structural changes, ultrasound of the scrotum reveals varicocele and pathology of the appendages. When planning a pregnancy, your doctor may prescribe a DNA fragmentation test.
- Repeated spermogram with proper preparation
- Staining for leukocyte differentiation
- Culture of sperm with antibiotic sensitivity
- PCR for sexually transmitted infections
- TRUS of the prostate and ultrasound of the scrotum
- Sperm DNA fragmentation test according to indications
Treatment
They treat not the number in the analysis, but the found cause. If a bacterial infection is confirmed, an antibiotic is prescribed based on the culture results, over a course of sufficient duration; for sexually transmitted infections, both partners are treated. For chronic prostatitis without infection, anti-inflammatory drugs, drugs that improve the outflow of secretions, and physical therapy are used. Lifestyle correction is important: quitting smoking and alcohol, limiting baths and saunas, regular sex life, exercise during sedentary work. Antioxidants may be recommended by your doctor, but they are not a substitute for treating inflammation.
- Antibiotic based on culture results for bacterial infection
- Simultaneous treatment of the partner for infections
- Anti-inflammatory therapy for abacterial prostatitis
- Quitting smoking and alcohol
- Limiting overheating and tight clothing
- Control spermogram after 2–3 months
