Leukocytospermia: Overview of diagnosis, implications, and management of a controversial finding

BackgroundThe progress in assisted reproductive techniques over the last 30 years has raised interest in studying what in 1992 the World Health Organization (WHO) defined as abnormal: the presence of >1 × 106 leukocytes/mL in a semen sample. Leukocytospermia is found in both fertile and infertile men with and without evidence of infections of the genital tract. However, despite extensive research done in this subject, the clinical implications of this condition remain unclear.ResultsThe accuracy that the cut-off value that defines leukocytospermia has in predicting clinical significance remains unclear. Furthermore, there are conflicting data supporting a physiologic and pathologic role of leukocytes in a semen sample through the generation of reactive oxygen species. Although some authors describe no effects on fertilization and pregnancy outcomes after in vitro fertilization with or without intra-cytoplasmic sperm injection, others suggest the exact opposite. Finally, research on treatment of leukocytospermia with vitamin E, COX-2 inhibitors and antibiotics has also shown contradicting data.ConclusionsThus, it seems reasonable to agree that there is no agreement on the diagnosis, implications, and management of leukocytospermia in patients without evidence of genital tract infection.