A thorough history and physical exam by a male infertility specialist can help determine if there is an obvious source of infection. The andrologist examines the semen under a microscope and counts the number of white blood cells and calculates an estimate of the number of white blood cells per mL of semen. Leukocytospermia is diagnosed by an andrologist during a semen analysis. There is no evidence that leukocytospermia has any negative impact on in vitro fertilization (IVF) outcomes, including rates of fertilization, embryo development, quality of embryos, and pregnancy following embryo transfer. Some studies show an increased pregnancy rate through natural conception in men who have been treated adequately for leukocytospermia. Leukocytes can cause sperm clumping and affect the motility of sperm, which can make it harder to become pregnant. Leukocytes can increase DNA damage of sperm (DNA fragmentation). Leukocytes can release substances called reactive oxygen species, which can negatively impact sperm. Leukocytes can weaken the sperm and damage its genetic material. The presence of leukocytes in the semen can affect overall sperm health. These symptoms include urinary frequency, painful urination, pelvic pain, testicular pain, and pain with ejaculation. However, sometimes they will show symptoms of an infection in the bladder, prostate, epididymis, or testicle, consistent with cystitis, prostatitis, epididymitis, or orchitis, respectively. Often times, patients diagnosed with leukocytospermia will have no symptoms. What are the symptoms of leukocytospermia? Leukocytospermia is often idiopathic, which means that we don’t know where these leukocytes are coming from. Some studies have shown that long periods of abstinence from ejaculation can increase the number of leukocytes in the semen. The presence of these leukocytes is not completely understood, but they can be seen in the following conditions: urinary tract infection, sexually transmitted infections, autoimmune conditions, urethral strictures, varicoceles (dilated veins around the testicle), systemic illness, and use of tobacco, marijuana, or alcohol. Leukocytospermia can be a result of infection or inflammation anywhere along the genitourinary tract, particularly the prostate gland, seminal vesicles, testicles, and bulbourethral glands, which produce the fluid in semen. Leukocytospermia, or pyospermia, is defined as the presence of more than 1 million white blood cells in 1 mL of ejaculate. These leukocytes are commonly found in semen samples. An increase in leukocytes in the body can be a sign of infection or inflammation. Leukocytes are white blood cells, which protect the body against infectious diseases and foreign invaders. Is my semen infected? Everything you need to know about leukocytospermia
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