Even Very Low Seminal WBCs Problematic
Rakesh K.Sharma, Ph.D., and Ashok Agarwal, Ph.D., HCLD

Men are generally not diagnosed with leukocytospermia unless their semen sample contains more than one million white blood cells (WBCs) per milliliter, a criterion set by the World Health Organization. WBCs are the primary producers of the reactive oxygen species (ROS) that damage sperm. But new research conducted at the Cleveland Clinic Urological Institute reveals that semen samples that contain any number of WBCs--regardless of how few--have higher oxidative stress levels than samples that contain no WBCs. These findings suggest that semen samples that are used for assisted reproduction should be immediately washed clean of all WBCs.

We measured semen characterestics in specimens obtained from 271 men who were seen in the Urological Institute's infertility clinic for a variety of indications, and compared them with those of 28 healthy controls. Myeloperoxidase staining (Endtz test) was used to count WBCs. We measured oxidative stress according to the ROS-TAC index, a novel composite score that was recently developed at the Cleveland Clinic. This index incorporates ROS levels and total antioxidant capacity (TAC); both are measured with chemiluminescence assays.

We found that 203 of the 271 men (75%) had no seminal leukocytes, 43 (16%) had fewer than 1 million/mL, and 25 (9%) had more than 1 million/ mL. Although most semen characterestics were not affected by the presence or number of seminal leukocytes, the two measures of oxidative stress--the ROS and the ROS-TAC scores--were significantly lower in patients who had no seminal leukocytes. Samples that contained high WBC counts yielded higher ROS and ROS- TAC scores.

Analysis of receiver operating characteristics revealed that using a WBC cutoff point of 1 million/mL provided the best opportunity for a diagnostic test to predict oxidative stress as indicated by ROS- TAC. A cutoff of O WBCs was almost as good. Therefore, we believe that no WBC cutoff point can be considered safe in terms of affecting fertility.

We conclude that patients who have very low seminal WBCs experience oxidative stress, and that this stress level rises as WBCs rise.



This receiver operating characterestics curve shows that the ROS-TAC score is superior to both ROS and TAC individually in distinguishing men without seminal leukocytes from men with leukospermia ( 1x106WBC/mL)


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