World J Mens Health.  2019 May;37(2):128-137. 10.5534/wjmh.180078.

Review of Guidelines for the Evaluation and Treatment of Leukocytospermia in Male Infertility

• Brunner RJ
• Demeter JH
• Sindhwani

• KMID: 2443228
• DOI: http://doi.org/10.5534/wjmh.180078

Abstract

Leukocytospermia is an ill-defined and poorly understood condition affecting up to 30% of male factor infertility. Current guidelines on leukocytospermia vary significantly, although it has been linked to increased rates of infertility, uncertainty about its clinical significance, diagnosis, and treatment remains. The guidelines are conflicting with sparse data scattered across different specialties and continents. This study aims to compare and contrast available international guidelines and recommendations. In addition to these guidelines, we sought to consolidate the findings of trials over the last several decades. English language articles on human observational studies, retrospective, prospective, clinical trials and randomized control trials were searched for using the following terms: "leukocytospermia, pyospermia, and male infertility." Articles about treatment and management of leukocytospermia that were published between January 2010 and April 2018 were included, as well as four articles referenced in best practice and guideline statements from urological and andrological associations. Disagreements on this topic are highlighted as some guidelines describe no correlation between leukocytospermia and infertility while others show that treatment leads to improvement of sperm quality by many measures including improved pregnancy rate. Various treatments have been suggested including antibiotics, anti-inflammatory medications, and frequent ejaculation. There is a need for definitive characterization of Leukocytospermia as an infectious or inflammatory marker and a re-evaluation of the leukocyte concentration threshold. Additional studies investigating rates of conception as a measure of outcome are needed, to provide greater level of evidence and generalizability of leukocytopsermia management.

Keyword

Andrology; Infection; Infertility, male; Leukocytes; Semen

MeSH Terms

Andrology
Anti-Bacterial Agents
Diagnosis
Ejaculation
Fertilization
Humans
Infertility
Infertility, Male*
Leukocytes
Male
Male*
Practice Guidelines as Topic
Pregnancy Rate
Prospective Studies
Retrospective Studies
Semen
Spermatozoa
Uncertainty
Anti-Bacterial Agents

Figure

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  Fig. 1 Flow diagram for the systematic review of leukocytospermia clinical trials. Figure is a flow diagram depicting the search algorithm and results. PubMed, Embase, and Cochrane library was searched for English language articles on human observational studies, clinical trials and randomized control trials using the following terms: “leukocytospermia, pyospermia, and male infertility.” Also included was 4 articles referenced by the various guidelines discussed in the paper. The remaining articles were screened for duplicates and non-english articles were excluded of which there was 4. Another article was deemed ineligible as this study's seminal collection method varied so dramatically from that of the others studied. In total 11 articles are included in this review. N/A: not available.

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