Pyospermia: Background and Controversies

Overview

Journal F S Rep

Specialty Reproductive Medicine

Date 2021 Jul 5

PMID 34223265

Citations 6

Authors

Danielle Velez

Samuel Ohlander

Craig Niederberger

Affiliations

Soon will be listed here.

Abstract

Pyospermia (or leukocytospermia) is suspected based on the presence of >1 × 10 round cells/mL of ejaculate and diagnosed using peroxidase stain revealing >1 × 10 white blood cells/mL. The presence of white blood cells is a concern for overt infections or excessive inflammation, both of which have been postulated to negatively impact bulk semen parameters and fertilization capability. The threshold for pyospermia has been debated upon in the literature, as has the optimal treatment method. In the absence of clinical infectious symptoms, it appears that antibiotics, anti-inflammatory agents, and/or frequent ejaculation may improve bulk semen parameters in men with pyospermia. Further research is needed to adequately assess the effect of these methods on pregnancy and live birth outcomes, especially among couples attempting natural conception compared to those attempting intrauterine insemination or in vitro fertilization.

Citing Articles

Tackling somatic DNA contamination in sperm epigenetic studies.

Kumari A, Singh R Front Reprod Health. 2025; 7:1506117.

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Understanding the Associations of Urogenital Microbiomes With Fertility and In Vitro Fertilization.

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Leukocytospermia and/or Bacteriospermia: Impact on Male Infertility.

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Leukocytospermia does not negatively impact outcomes in in vitro fertilization cycles with intracytoplasmic sperm injection and preimplantation genetic testing for aneuploidy: findings from 5435 cycles.

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Effect of leukocytes on semen quality in men from primary and secondary infertile couples: A cross-sectional study.

Fan S, Zhao Y, Zhang Z, Wang H, Hou Y, Bai S Health Sci Rep. 2023; 6(11):e1683.

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References

Branigan E, Muller C . Efficacy of treatment and recurrence rate of leukocytospermia in infertile men with prostatitis. Fertil Steril. 1994; 62(3):580-4. View

Sigman M, Lopes L . The correlation between round cells and white blood cells in the semen. J Urol. 1993; 149(5 Pt 2):1338-40. DOI: 10.1016/s0022-5347(17)36386-3. View

Schober J, Dulabon L, Gor R, Woodhouse C . Pyospermia in an adult cohort with persistent lower urinary tract symptoms and a history of ablated posterior urethral valve. J Pediatr Urol. 2010; 6(6):614-8. DOI: 10.1016/j.jpurol.2010.09.003. View

Barraud-Lange V, Pont J, Ziyyat A, Pocate K, Sifer C, Cedrin-Durnerin I . Seminal leukocytes are Good Samaritans for spermatozoa. Fertil Steril. 2011; 96(6):1315-9. DOI: 10.1016/j.fertnstert.2011.09.035. View

Gambera L, Serafini F, Morgante G, Focarelli R, De Leo V, Piomboni P . Sperm quality and pregnancy rate after COX-2 inhibitor therapy of infertile males with abacterial leukocytospermia. Hum Reprod. 2007; 22(4):1047-51. DOI: 10.1093/humrep/del490. View

Nickel J . Prostatitis. Can Urol Assoc J. 2011; 5(5):306-15. PMC: 3202001. DOI: 10.5489/cuaj.11211. View

Punab M, Loivukene K, Kermes K, Mandar R . The limit of leucocytospermia from the microbiological viewpoint. Andrologia. 2003; 35(5):271-8. View

Ricci G, Granzotto M, Luppi S, Giolo E, Martinelli M, Zito G . Effect of seminal leukocytes on in vitro fertilization and intracytoplasmic sperm injection outcomes. Fertil Steril. 2015; 104(1):87-93. DOI: 10.1016/j.fertnstert.2015.04.007. View

Hamada A, Agarwal A, Sharma R, French D, Ragheb A, Sabanegh Jr E . Empirical treatment of low-level leukocytospermia with doxycycline in male infertility patients. Urology. 2011; 78(6):1320-5. DOI: 10.1016/j.urology.2011.08.062. View

10.

Aziz N, Agarwal A, Lewis-Jones I, Sharma R, Thomas Jr A . Novel associations between specific sperm morphological defects and leukocytospermia. Fertil Steril. 2004; 82(3):621-7. DOI: 10.1016/j.fertnstert.2004.02.112. View

11.

Domes T, Lo K, Grober E, Mullen J, Mazzulli T, Jarvi K . The incidence and effect of bacteriospermia and elevated seminal leukocytes on semen parameters. Fertil Steril. 2012; 97(5):1050-5. DOI: 10.1016/j.fertnstert.2012.01.124. View

12.

Fathy A, Chen S, Novak N, Schuppe H, Haidl G, Allam J . Differential leucocyte detection by flow cytometry improves the diagnosis of genital tract inflammation and identifies macrophages as proinflammatory cytokine-producing cells in human semen. Andrologia. 2013; 46(9):1004-12. DOI: 10.1111/and.12188. View

13.

Yamamoto M, Hibi H, Katsuno S, Miyake K . Antibiotic and ejaculation treatments improve resolution rate of leukocytospermia in infertile men with prostatitis. Nagoya J Med Sci. 1995; 58(1-2):41-5. View

14.

Filipiak E, Marchlewska K, Oszukowska E, Walczak-Jedrzejowska R, Swierczynska-Cieplucha A, Kula K . Presence of aerobic micro-organisms and their influence on basic semen parameters in infertile men. Andrologia. 2014; 47(7):826-31. DOI: 10.1111/and.12338. View

15.

Weng S, Chiu C, Lin F, Huang W, Liang C, Yang T . Bacterial communities in semen from men of infertile couples: metagenomic sequencing reveals relationships of seminal microbiota to semen quality. PLoS One. 2014; 9(10):e110152. PMC: 4207690. DOI: 10.1371/journal.pone.0110152. View

16.

Lackner J, Herwig R, Schmidbauer J, Schatzl G, Kratzik C, Marberger M . Correlation of leukocytospermia with clinical infection and the positive effect of antiinflammatory treatment on semen quality. Fertil Steril. 2006; 86(3):601-5. DOI: 10.1016/j.fertnstert.2006.01.032. View

17.

Yilmaz S, Koyuturk M, Kilic G, Alpak O, Aytoz A . Effects of leucocytospermia on semen parameters and outcomes of intracytoplasmic sperm injection. Int J Androl. 2005; 28(6):337-42. DOI: 10.1111/j.1365-2605.2005.00562.x. View

18.

Jungwirth A, Giwercman A, Tournaye H, Diemer T, Kopa Z, Dohle G . European Association of Urology guidelines on Male Infertility: the 2012 update. Eur Urol. 2012; 62(2):324-32. DOI: 10.1016/j.eururo.2012.04.048. View

19.

Johanisson E, Campana A, Luthi R, De Agostini A . Evaluation of 'round cells' in semen analysis: a comparative study. Hum Reprod Update. 2000; 6(4):404-12. DOI: 10.1093/humupd/6.4.404. View

20.

Henkel R, Kierspel E, Stalf T, Mehnert C, Menkveld R, Tinneberg H . Effect of reactive oxygen species produced by spermatozoa and leukocytes on sperm functions in non-leukocytospermic patients. Fertil Steril. 2005; 83(3):635-42. DOI: 10.1016/j.fertnstert.2004.11.022. View