The presence of a high number of leukocytes or white blood cells in semen is an abnormality parameter called leucospermia. This amount is assessed by means of a spermiogram or semen analysis.
The amount of leukocytes per milliliter of semen is calculated to recount leukocytes. According to the World Health Organization (WHO), the presence of more than 1 million leucocytes per milliliter of semen is the reference value to indicate that a man is suffering from leucospermia.
The alteration in which values exceed 10 million leukocytes/ml is called prospermia.
The presence of leukocytes in semen often reflects an infection that may cause temporary sterility. It is necessary to treat the infection to avoid it becoming permanent.
The number of leukocytes in semen may increase due to other causes as well. It has been studied that sexual abstinence may have an influence, since the longer the sperm remains in the epididymis, the more macrophages and granulocytes are attracted by the aging sperm, which can cause an increased amount of leukocytes in the ejaculate.
Regarding vasectomy, it has been shown that men who have undergone this operation have a lower concentration of leukocytes if compared with men who have not undergone it.
However, in patients who have completed a vasectomy reversal, there is often an abnormal parameter in semen and a sperm dysfunction, primarily caused by high levels of reactive oxygen species (ROS). There is an association between increased ROS and the presence of leukocytes in semen, although it is not considered to be an absolute one.
Presence of leukocytes in sperm
When values above one million leukocytes/ml are detected, a bacteriological study that consists of semen culture is performed. Semen or sperm culture consists of analyzing semen in search of infections caused by bacteria, fungi, etc. Different culture media can be used for such purpose:
- Blood Agar
- Chocolate Agar
- EMB Agar
Samples are incubated at the suitable temperature for each medium and, subsequently, an evaluation and a re-counting of colonies will be carried out. The color of the colony indicates from which microorganism it is made up.
Stainings and observations can be made under the microscope to determine the microorganism that is causing it. Some of the most common are: Escherchia coli, Klebsiella pneumoniae, Proetus mirabilis, Pseudomonas aeruginosa, Staphylococcus aureus, etc.
Bacteria can nest in any organs of seminal ducts such as testicles, by causing orchitis, epididymus that provokes epididymitis, or prostatitis if it occurs in the prostate.
In case the presence of some organism is detected, the specialist will provide a treatment to eradicate the infection.
Antibiotics used in the treatment depend on the sensitivity of the identified causative pathogen.
Leucospermia and pregnancy
Genital tract inflammation represents between 4 and 10% of all cases of male infertility. The inflammation causes the seminal fluid to be infiltrated by leukocytes, which decreases the motility of the spermatozoids, triggers an acrosome reaction and decreases the fertilizing capacity of the spermatozoids. All of this causes trouble conceiving.
Approximately 50% of the leukocytes that inflitrate the seminal fluid come from the prostate and seminal vesicles. Infections of these glands result in an increase of inflammatory leukocytes in the ejaculate.