Fertility Problems and Chronic Prostatitis
Chronic prostatitis is a somewhat mysterious condition with unclear etiology. The diagnosis is made by excluding known sources of lower urinary tract pain, such as neurologic disorders, infectious disease, kidney stones, and benign prostatic hyperplasia. Chronic prostatitis is categorized as inflammatory (abacterial prostatitis) or non-inflammatory (prostatodynia), based on whether leukocytes can be found in expressed prostatic secretions, post-massage urine specimens, or semen.
Some men with infertility also have chronic prostatitis, raising suspicions of a causal relationship. One possibility is that the leukocytic infiltration found in inflammatory prostatitis may have deleterious effects on semen quality and sperm function. The mechanism may be mediated by leukocyte production of reactive oxygen species (ROS), which are known to impair sperm function when produced in excess.
We studied the possible association between chronic prostatitis and oxidative stress in 44 patients with chronic prostatitis. These men had sperm counts and sperm morphology similar to those of healthy sperm donors, but they had lower percentages of motile sperm. Patient samples had much lower total antioxidant capacity (TAC) than donor samples. In addition, patient samples with leukocytospermia also had elevated ROS levels.
We have shown previously that combining these two measures of oxidative stress into a single ROS-TAC score is an excellent method of distinguishing between fertile and infertile men, and of predicting subsequent fertility in subfertile. We found that all of our chronic prostatitis patients had depressed ROS-TAC score similar to the scores found in populations of infertile men.
It therefore appears that chronic prostatitis patients with leukocytospermia may be at higher risk of infertility than similar patients without leukocytospermia. The problem may stem from the increase in ROS produced by leukocytes, combined with the depressed TAC found in all chronic prostatitis patients. Our observations may help explain the possible relationship between prostatitis and infertility, and suggest that empiric antioxidant supplementation may benefit this category of patients.
Center for Reproductive Medicine
The Cleveland Clinic
9500 Euclid Avenue, Desk A19
Cleveland OH 44195