Hooman Sadri-Ardekani
- Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
Mohammad Mehdi Akhondi Corresponding Author
1- Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
2- Monoclonal Antibody Research Center, Avicenna Research Institute (ACECR), Tehran, Iran

Received: 1/1/2007 Accepted: 1/1/2007 - Publisher : Avicenna Research Institute

Related Articles


Other Format



Leukocytes in the male genital tract and seminal fluid play a complex and dynamic role. Leuko-cytes are found in virtually every ejaculate and function at multiple levels. Presence of high leuko-cyte counts in seminal fluid is an important indicator of male genital tract infection or inflamma-tion. In many studies, leukocytospermia has been associated with male infertility. Decreased sperm count and motility, as well as increased abnormal sperm morphology and a high frequency of immature germ cells, have been reported in men with leukocytospermia. According to the World Health Organization, leukocytospermia is defined as the presence of 1 x 106 WBCs per milliliter of semen. Methodological problems have been found to interfere in differentiating WBCs from immature germ cells that are present in the seminal fluid. For clinical purposes, peroxidase staining is the most practical method of leukocyte detection in semen. A large number of studies have shown a wide range of leukocytospermia incidence in infertile men (from 2% to 35%). The majority of studies with the largest number of cases have estimated the prevalence of leukocytospermia to be between 12 and 20% among all infertile men. The assumption that leukocytospermia is merely the result of a subclinical male genital tract infec-tion is not correct. Environmental factors such as smoking, alcohol consumption, and marijuana use, increase the number of WBCs in semen. Prolonged abstinence and certain sexual practices, such as anal sex, may also cause leukocytospermia. Nowadays, numerous scientific evidences refer to leukocytes and their products as effective factors on sperm and their functions. It is thus strongly believed that diagnosis of leukocytospermia and its causative agents as well as its treat-ment play a crucial role in evaluation of infertile couples.

Keywords: Leukocytospermia, Infertility, Peroxidase, Seminal fluid, WBCs, Urogenital tract infections

To cite this article:


  1. Tomlinson MJ, White A, Barratt CL, Bolton AE, Cooke ID. The removal of morphologically abnormal sperm forms by phagocytes: a positive role for seminal leukocytes? Hum Reprod. 1992;7(4):517-522.   [PubMed]
  2. Comhaire F, Verschraegen G, Vermeulen L. Diagnosis of accessory gland infection and its possible role in male infertility. Int J Androl. 1980:3:32-45.   [PubMed]
  3. World Health Organization. WHO Laboratory Manual for the Examination of Human Semen and Sperm-Cervical Mucus Interaction. Cambridge University Press, Cambridge, UK. 1992.
  4. Barratt CL, Robinson A, Spenser RC, Kinghorn GR, White A, Harrison PE, et al. Seminal peroxidase posi-tive cells are not an adequate indicator of asympto-matic urethral genital infection. Int J Androl. 1990;13 (5):361-8.   [PubMed]
  5. Wolff H, Politch JA, Martinez A, Haimovici F, Hill A, Anderson DJ. Leukocytospermia is associated with poor semen quality. Fertil Steril. 1990;53(3):528-36.   [PubMed]
  6. Sigman M, Lopes L. The correlation between round cells and white blood cells in the semen. J Urol. 1993; 149:1338-1340.   [PubMed]
  7. Hill JA, Haimovici F, Politch JA, Anderson DJ. Effects of soluble products of activated lymphocytes and macrophages (lymphokines and monokines) on human sperm motion parameters. Fertil Steril. 1987;47:460-5.   [PubMed]
  8. Tjioe DY, Steinberger E. Spermiophages in human testes. Fertil Steril. 1967;18:807-811.   [PubMed]
  9. Hermo L, Lalli M. Monocytes and mast cells in the limiting membrane of human seminiferous tubules. Bioi Reprod. 1978;19:92-100.   [PubMed]
  10. Pollanen P, Cooper TG. Immunology of the testicular excurrent ducts. J Reprod Immunol. 1994;26:167-216.   [PubMed]
  11. Yeung CH, Nashan D, Sorg C, Oberpenning F, Schulze H, Nieschlag E, et al. Basal cells of the human epididymis-antigenic and ultrastructural similarities to tissue fixed macrophages. Biol Reprod. 1994;50(4): 917-26.   [PubMed]
  12. Ritchie AWS, Hargreave TB, James K, Chisholm GD. Lntraepitheliallymphocytes in the norrnal epididymis: a mechanism for tolerance to sperrn-autoantigens. Br J Urol. 1984;56:79-84.   [PubMed]
  13. Phadke AM. Sperrniophage cells in man. Fertil Steril. 1975;26:760-764.   [PubMed]
  14. Olsen GP, Sheilds JW. Seminal lymphocytes, plasma and AIDS. Nature. 1984;309:116-7.   [PubMed]
  15. eI-Demiry MI, Hargreave TB, Busuttil A, James K, Ritchie AW, Chisholm GD. Lymphocyte sub-popula-tions in the male genital tract. Br J UroI. 1985;57(6): 769-74.   [PubMed]
  16. McClinton S, Eremin O, Miller ID. Inflammatory infiltrate in prostatic hyperplasia evidence of a host response to intraprostatic sperrnatozoa? Br J Urol. 1990;65:606-610.   [PubMed]
  17. Maroni MS, Symon DNK, Wilkinson PC. Chemotaxis of neutrophil leukocytes towards spermatozoa and seminal fluid. J Reprod Fertil. 1972; 28:359-68.   [PubMed]
  18. Pandya IJ, Cohen J. The leukocyte reaction of the human uterine cervix to spermatozoa. Fertil Steril. 1985;43(3):417-21.   [PubMed]
  19. Wang AW, Politch J, Anderson DJ. Leukocytosper-mia in male infertility patients in China. Andrologia. 1994;26:167-172.   [PubMed]
  20. Kung AWC, Ho PC, Wang C. Seminal leukocytes subpopulations and sperm function in fertile and infertile Chinese men. Int J Androl. 1993;16:189-194.   [PubMed]
  21. Barratt CLR, Bolton AE, Cooke ID. Functional signi-ficance of white blood cells in the male and female reproductive tract. Hum Reprod. 1990;5:433-451.   [PubMed]
  22. Couture M, Ulstein M, Leonard J, Paulsen JA. Im-proved staining method for differentiating immature germ cells from white blood cells in human seminal fluid. Andrologia. 1976;8:61-66.   [PubMed]
  23. Endtz AW. A rapid staining method for differentiating granulocytes from “germinal cells” in Papanicolaou stained semen. Acta Cytol. 1974;18:2-7.   [PubMed]
  24. Nahoum CRD, Cardozo D. Staining for volumetric count of leukocytes in semen and prostate vescular fluid. Fertil Steril. 1980;34:68-69.   [PubMed]
  25. Eggert-Kruse W, Bellmann A, Rohr G, Tilgen W, Runnebaum B. Differentiation of round cells by means of monoclonal antibodies and relationship with male infertility. Fertil Steril. 1992;25:1046-55.   [PubMed]
  26. Wolff H, Anderson DJ. Immunohistologic character-rization and quantitation of leukocyte subpopulations in human semen. Fertil Steril. 1988;49:497-504.   [PubMed]
  27. Wolff H, Panhans A, Zebhauser M, Meurer M. Comparison of three methods to detect white blood cells in semen: leukocyte esterase dipstick test, granu-locyte elastase enzymeimmunoassy and peroxidase cytochemistry. Fertil Steril. 1992;58:1260-1262.   [PubMed]
  28. Politch JA, Wolff H, Hill JA, Anderson DJ. Compa-rison of methods to enumerate white blood cells in semen. Fertil Steril. 1993;60:372-375.   [PubMed]
  29. Hillier SL, Rabe LK, Muller CH, Zarutskie P, Kuzan FB, Stenchever MA. Relationship of bacteriologic characteristics to semen indicates in men attending an infertility clinic. Obstet Gynecol. 1990;75:800-804.   [PubMed]
  30. Brunner H, Weidner W, Schiefer HG. Studies on the role of Ureaplasma urealyticum and Mycoplasma hominis in prostatitis. J Infect Dis. 1983;147:807-813.   [PubMed]
  31. Krause W, Herbstreit F, Slenzka W. Are viral infec-tions the cause of leukocytospermia? Andrologia. 2002;34(2):87-90.   [PubMed]
  32. Close CE, Roberts PL, Berger RE. Cigarettes, alcohol and marijuana are related to pyospermia in infertile men. J Urol. 1990;144:900-903.   [PubMed]
  33. Toth A, Lesser ML. Asymptomatic bacteriospermia in fertile and infertile men. Fertil Steril. 1981;36:85-91.   [PubMed]
  34. Aitken RJ, West K, Buckingham D. Leukocyte infilt-ration into human ejaculate and its association with semen quality, oxidative stress, and sperm function. J Androl. 1994;15:343-352.   [PubMed]
  35. Purvis K, Christiansen E. Infection in the male repro-ductive tract. Impact, diagnosis and treatment in rela-tion to male infertility. Int J Androl. 1993;16:1-13.2   [PubMed]
  36. Naessens A, Foulon W, Debrucker P, Devroey P, Lauwers S. Recovery of microorganisms in semen and the relationship to semen evaluation. Fertil Steril. 1986;45(1):101-5.   [PubMed]
  37. Makler A, Urbach Y, Lefler E, Merzbach D. Factors affecting sperm motility. Sperm viability under the influnce of bacterial grown in Human ejaculates. Fertil Steril. 1981;35:666-670.   [PubMed]
  38. Berger RE, Karp LE, Williamson RA, Koehler J, Moore DE, Holmes KK. The relationship of pyosper-mia and seminal fluid bacteriology to sperm function as reflected in the sperm penetration assay. Fertil Steril. 1982;37(4):557-64.   [PubMed]
  39. Berger RE, Smith WD, Critchlow CW, Stenchever MA, Moore DE, Spadoni LR, et al. Improvement in the sperm penetration (hamster ova) assay (SPA) result after doxycycline treatment of infertile men. J Androl. 1983;4(2):126-30.   [PubMed]
  40. Maruyama DK, Hale RW, Rogers BJ. Effects of white blood cells on the in vitro penetration of zona-free hamster eggs by human spermatozoa. J Androl. 1985; 6:127-35.   [PubMed]
  41. Talbert LM, Hammond MG, Halme J, ORand M, Fryer JG, Ekstrom RD. Semen parameters and fertili-zation of human oocytes in-vitro: a multivariable ana-lysis. Fertil Steril. 1987;48(2):270-7.   [PubMed]
  42. De Geyter C, De Geyter M, Behre HM, Schneider HP, Nieschlag E. Peroxidase-positive round cells and microorganisms human semen together with antibiotic treatment adversely influence the outcome of in-vitro fertilization and embryo transfer. Int J Androl. 1994;17 (3):127-34.   [PubMed]
  43. Smith DC, Barratt CLR, Williams MA. The charac-terization of non-sperm cells in the ejaculates of fertile men using transmission election microscopy. Andro-logia. 1989;21:319-33.   [PubMed]
  44. Weiss SJ, Tissue destruction by neutrophils. N Engl J Med. 1989;320-365-76.   [PubMed]
  45. Aitken RJ, Clarkson JS, Fishel S. Generation of reactive oxygen species. Lipid peroxidation and human sperm function. Biol Reprod. 1989;40:183-97.   [PubMed]
  46. Alvarez JG, Touchstone JC, Blasco L, Storey BT. Spontaneous lipid peroxidation and production of hydrogen peroxide and superoxide in human sperma-tozoa. Superoxide dismutase as major enzyme protect-tant against oxygen toxicity. J Androl. 1987;8:338-48.   [PubMed]
  47. Krausz C, Mills C, Rogers S, Tan SL, Aitken RJ. Stimulation of oxidant generation by human sperm suspensions using phorbol esters and formyl peptides: relationships with motility and fertilization in vitro. Fertil Steril. 1994;62(3):599-605.   [PubMed]
  48. Schopf RE, Schramm P, Morsches B. Seminal plasma induced suppression of the respiratory burst of poly-morphonuclear leukocytes and monocytes. Andrologia. 1984;16:124-8.   [PubMed]
  49. Kovalski NN, de Lamirande E, Gagnon C. Reactive oxygen species generated by human neutrophils inhibit sperm motility: protective effect of seminal plasma scavengers. Fertil Steril. 1992;58:809-16.   [PubMed]
  50. Comhair F, Bosmans E, Ombelet W, Punjabi U, Schoonjans F. Cytokines in semen of normal men and of patients with andrological diseases. Am J Reprod Immunol. 1994;31(2-3):99-103.   [PubMed]
  51. Hill JA, Cohen J, Anderson DJ. The effect of lympho-kines and monokines on sperm fertilizing ability in the zona-free hamster egg penetration test. Am J Obstet Gynecol. 1989;160:1154-59.   [PubMed]
  52. Eisermann J, Register KB, Strickler RC, Collins JL. The effect of tumor necrosis factor on human sperm motility in vitro. J Androl. 1989;10:270-4.   [PubMed]
  53. Paschke R, Schulze- Bertelsbeck D, Bahrs S, Heine-cke A, Behre HM. Seminal sperm antibodies exhibit an unstable spontaneous course and an increased inci-dence of leukocytospermia. Int J Androl. 1994;17(3): 135-9.   [PubMed]
  54. Kortebani G, Gonzales GF, Barrera C, Mazzolli AB. Leukocyte populations in semen and male accessory gland function: relationship with antisperrn antibodies and seminal quality. Andrologia. 1992;24:197-204.   [PubMed]
  55. Fedder J, Askjaer SA, Hjort T. Nonsperrnatozoal cells in semen: relationship to other semen parameters and fertility status of the couple. Arch Androl. 1993; 31:95-103.   [PubMed]
  56. Alvarez JG, Sharma RK, Ollero M, Saleh RA, Lopez MC, Thomas AJJr, et al. Increased DNA damage in sperrn from leukocytosperrnic semen samples as deter-mined by the sperrn chromatin assay. Fertil Steril. 2002:78:319-29.   [PubMed]
  57. Thomas J, Fishel SB, Hall JA, Green S, Newton TA, Thornton SJ. Increased polymorphonuclear granulo-cytes in seminal plasma in relation to sperrn morpho-logy. Hum Reprod. 1997;12(11):2418-21.   [PubMed]
  58. Patton PE, Battaglia DE. Office Andrology. 2005 Humana Press Inc.196-7.
  59. Lackner JE, Herwig R, Schmidbauer J, Schatzl G, Kratzik C, Marberger M. Correlation of leukocyte-spermia with clinical infection and the positive effect of anti inflammatory treatment on semen quality. Fertil Steril. 2006;86(3):601-5.   [PubMed]
  60. Oliva A, Multigner L. Ketotifen improves sperm motility and sperm morphology in male patients with leukocytospermia and unexplained infertility. Fertil Steril. 2006;85(1):240-3.   [PubMed]
  61. Baker HW, Brindle J, Irvine DS, Aitken RJ.Protective effect of antioxidants on the impairment of sperm motility by activated polymorphonuclear leukocytes. Fertil Steril. 1996;65(2):411-9.   [PubMed]


Home | About Us | Current Issue | Past Issues | Submit a Manuscript | Instructions for Authors | Subscribe | Search | Contact Us

"Journal of Reproduction & Infertility" is owned, published, and managed by Avicenna Research Institute .
Creative Commons License

This work is licensed under a Creative Commons Attribution –NonCommercial 4.0 International License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.

Journal of Reproductoin and Infertility (JRI) is a member of COMMITTEE ON PUBLICATION ETHICS . Verify here .

©2024 - eISSN : 2251-676X, ISSN : 2228-5482, For any comments and questions please contact us.