Role of Leukocytospermia in the Management of Male Infertility: Decoding a Mystery for the Busy Clinicians

Leukocytospermia, defined as a leukocyte concentration in semen exceeding 1×10⁶leukocytes/mL, significantly impacts male reproductive health by affecting sperm functionality and fertility outcomes. This condition arises from various etiological factors, including infections, autoimmune responses, lifestyle factors, and other physiological conditions. Adverse effects on sperm associated with leukocytospermia include acrosome damage and abnormalities in the sperm midpiece and tail. The review explores the complex interplay between leukocytospermia and oxidative stress, emphasizing the harmful effects on sperm DNA integrity and overall sperm quality. Due to the multifactorial nature of leukocytospermia, diagnosing this condition presents several challenges. Effective management strategies discussed include the use of antibiotics, anti-inflammatory agents, and assisted reproductive technologies. Diagnostic methods range from traditional peroxidase staining to more advanced techniques such as immunocytochemistry and flow cytometry, which offer higher sensitivity and specificity. Infections of the male genital tract, particularly male accessory gland infection and male genital tract infection, play a significant role in the etiology of leukocytospermia. These infections lead to an inflammatory response, resulting in leukocyte infiltration into the semen. Systemic conditions like diabetes mellitus and autoimmune disorders also contribute to leukocytospermia by provoking inflammatory responses that facilitate leukocyte presence in semen. This review underscores the importance of a comprehensive diagnostic approach that includes patient history, physical examination, and advanced laboratory tests. Treatment is tailored to the identified underlying cause, whether infectious or non-infectious. Lifestyle modifications, such as reducing stress, improving diet, and avoiding environmental toxins, are also recommended to enhance semen quality. For clinicians, this review provides a concise yet thorough overview of leukocytospermia, integrating the latest research findings and clinical insights to aid in the effective management of this condition, ultimately aiming to improve patient care in male reproductive health.