Analysis of the amount of leukocytes in semen

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.

Causes

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.

Treating leucospermia

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.

13 comments

  1. usuario
    Chuck L.

    Hello, unfortunately I can say I’m an expert on this topic. After several years trying to conceive unsuccessfully, I decided to resort to an specialist. My doctor advised me to perform a seminogram, so that’s what I did. And the result was that I had more than 10 million leukocytes in semen and that was our problem. Luckily I followed an antibiotic-based treatment and the improvement was considerable. We did an artificial insemination and finally got pregnant. So my conclusion is: it’s very important to have these kind of health issues controlled! Thanks for letting me participate.

  2. usuario
    Ehsan

    Volume 3.5 mL
    Color Grey
    PH 8.0
    Liquefaction Time 30 Min

    Motility (%) 65-70

    Progress Motility 3+
    Spermatozoa Count 200 x10^6/L
    Spermatozoa vitality (%) 80
    Morphology-Abnormal 25

    RBC /hpf 6-8
    WBC /hpf 15-20
    Crystals are Nil

    Clumping is 3+

    Normal functional Sperm x10^6/L is 365

    • avatar
      Sandra F.Fertility counselor

      Hello Ehsan,

      Volume is ok. As regards motility, it is kind of difficult for me to provide an answer, as I don’t know which type of motility is being measured here. However, it seems to be fine in principle. Concentration and vitality are ok, too.

      Given that your WBC are above 2-5, it indicates the presence of an infection on your semen. Red blood cells are also above the normal values, which indicates the presence of some blood traces on your sample as well. Sperm agglutination is also present.

      If the infection is confirmed by your doctor, you’d be prescribed antibiotics and advised to repeat the semen analysis.

      Hope this helps,

      Regards

  3. usuario
    prashun

    My semen report says I have leukocytes 10 to 12/HPF (High Power Field) noted and absence of spermatozoa… Pls help, what treatment to take and which doctor to consult.

    • avatar
      Sandra F.Fertility counselor

      Dear prashun,

      First of all, the doctor you should consult is an andrologist ideally. Secondly, I’m afraid in principle there is no treatment to take or follow. With azoospermia, patients should go for a second semen analysis to confirm the diagnosis. If so, the next step would be to find what is causing it by means of a testicular biopsy if you want to find out whether you’ll be able to conceive in the future. If nothing is found through a biopsy, I’m afraid it is a case of secretory azoospermia, and there’s nothing to be done. Conversely, if sperm are found, it is obstructive azoospermia and you might still have chances with ICSI.

      I hope this helps,

      Best

      • usuario
        Mugarisha

        I did a sperm analysis and the results were as follows:
        Volume – about 1 ml
        Viscosity- Normal viscous
        Motility- about 50 % progressive forward – about 15 % sluggish movement – about 35 % dead

        Count – < 20 millions/ umm
        Leucocytes – 30 – 50 hpf

        Please can you help to analyse the information and give me some prescriptions?

  4. usuario
    Tony

    Hello, the result of my semen analysis reads:

    Appearance: greyish-white & non viscous fluids

    volume: 2.5ml
    motility: 2% sluggishly motile

    cell count: 900,000 cells/ml

    morphology: few normal cells seen

    leukocytes: numerous

    culture: yielded scanty growth of staphylococcus Aureus

    please kindly help me to explain the result, can I father children under such conditions? if there’s any problem kindly mention it with possible solutions.
    I need your urgent reply. Thanks

    • avatar
      Andrea A.Assisted Reproduction Specialist

      Dear Tony,
      Your semen analysis shows several seminal alterations that affect your possibilities of conceiving naturally. Motility, concentration and morphology are strongly altered with values way lower than the ones that are considered normal and that allow natural pregnancy. The recommendation is to consult an assisted reproduction specialist in order to determine which would be the best treatment and technique in your case.

      On the other hand, on the culture has been detected an infection that may need antibiotic treatment. The appropriate antibiotic will be prescribed by your doctor.

      I hope I have been able to help.
      Best regards,

  5. usuario
    Sophie Mendham

    Can anybody help? My doctor is now on leave and the private clinic want another £100 to tell me what these results actually mean!

    Volume ml – 2.40
    pH – 7.50
    Appearance – Clear
    Viscosity – Normal
    Liquefaction – Complete
    Density x106 /ml – 44.00
    Total count x106 – 105.60
    Motility %
    Progressive – 72.0
    Non progressive – 1.0
    Immotile – 17.0
    Normal forms % – 4.00

    Other Parameters
    Agglutination – Nil
    Aggregation – Nil
    Round Cells (x106 /ml) – >5.0×10/6/ml

    Conclusions:
    Normozoospermia. All parameters above the lower reference limits, therefore this sample is suitable for any form of treatment.
    High density round cells
    Increased round cells please discuss with the clinicians. Please call the contact centre on —– to book a follow-up appointment with the clinical team.

    • avatar
      Sandra F.Fertility counselor

      Dear Sophie,

      As the conclusions of this analysis indicate, your partner is normozoospermic, which means his semen results are within the normal results and in principle there should be no problem to achieve a pregnancy naturally.

  6. usuario
    Sami hak

    Hello,
    The semen analysis:
    Volume: 2
    pH: 9
    Count: 45 million / ml
    Ejaculate: 90 million / ml
    Motility: 45%
    White cells: 2
    Motility 80%

  7. usuario
    Kallu

    What if wbc count is 2.50? If this is a real concern??
    Total volume: 3 ml
    Sperm concentration: 28 mill per ml
    Active: 20
    Mod active: 20
    Sluggish:30
    Dead:30
    Normal morphology:80%
    Abnormal morphology:20%
    Wbc:2.50
    Rbc: 0.4
    Madam please give your feedback! Thanks

    • avatar
      Sandra F.Fertility counselor

      Dear Kally,

      What unit of measure have they used for measuring WBC in this semen analysis? And what are the reference values used? I can’t give you an answer without that.