Correlation between leukocytospermia and oxidative stress in male partners of infertile couples with leukocytospermia

Richa Aggarwal, Manju Puri, Rima Dada, Gyan Saurabh


Background: The last century has seen rapid advances in the diagnosis and management of male infertility but still the cause eludes us in a majority of cases. The World Health Organization (WHO) has defined leukocytospermia as >1 million WBC/mL of semen. However, the clinical significance of increased leukocyte infiltration in semen, that is, leukocytospermia, is currently a subject of controversy. Evidence from several recent studies indicates that leukocytospermia could significantly contribute to male infertility. Of the many causes of male infertility, oxidative stress has been identified as one factor that affects fertility status and thus, has been extensively studied in recent years. A study was conducted to evaluate the relationship between leukocytospermia and oxidative stress.  

Methods: 88 men with leukocytospermia were included in the study. Semen parameters, no. of pus cells present and oxidative stress were noted. The correlation between leukocytospermia and ROS level was found using Pearson correlation coefficient.

Results: Significant positive correlation (r = 0.882, P <0.001) was observed between leukocytospermia and oxidative stress suggesting leukocytes are the main source of Reactive Oxygen Species (ROS) in semen.  

Conclusions: Significant positive correlation between oxidative stress and leukocytospermia was found in this study suggesting the need of further robust clinical trials to evaluate the role of antioxidants in improving the fertility outcome in infertile men with pyospermia.


Leukocytospermia, Oxidative stress, Male infertility, Reactive oxygen species

Full Text:



Rowe PJ, Compaire FH, Hargereave TB. WHO manual for standard investigation and diagnosis of the infertile couple. In: Rowe PJ, Compaire FH, Hargereave TB, eds. WHO Manual. Cambridge: Cambridge University Press; 1993.

World Health Organization. Recent advances in medically assisted conception. WHO Tech Res Ser. 1992;2:820-2.

World Health Organization. The world health report. Geneva: WHO; 1996. Available at:

Thonneau P, Marchand S, Tallec A, Ferial ML, Ducot B, Lansac J, et al. Incidence and main causes of infertility in a resident population (1850000) of three French regions (1988-1989). Hum Reprod. 1991;6:811-816.

Baratt CLR, Bolton AE, Cooke ID. Functional significance of white blood cells in the male and female reproductive tract. Hum Reprod. 1990;5:639-48.

World Health Organization. Cervical Mucus Interaction. In: WHO, eds. WHO Laboratory Manual for the Examination of Human Sperm and Semen. 4th ed. New York, NY: Cambridge University Press; 1999: 128.

Thomas J, Fishel SB, Hall JA, Green S, Newton TA, Thornton SJ. Increased polymorphonuclear granulocytes in seminal plasma in relation to sperm morphology. Hum Reprod. 1997;12:2418-21.

Arata de Bellabarba G, Tortolero I, Villarroel V, Molina CZ, Bellabarba C, Velazquez E. Nonsperm cells in human semen and their relationship with semen parameters. Arch Androl. 2000;45:131-6.

Garrido N, Meseguer M, Simon C, Pellicer A, Remohi J. Pro-oxidative and anti-oxidative imbalance in human semen and its relation with male infertility. Asian J Androl. 2004;6:59-65.

Sies H. Strategies of antioxidant defense. Eur J Biochem. 1993;215:213-9.

Agarwal A, Nallella KP, Allamaneni SS, Said TM. Role of antioxidants in treatment of male infertility: an overview of the literature. Reprod Biomed Online. 2004;8:616-27.

Griveau JF, Le Lannou D. Reactive oxygen species and human spermatozoa: physiology and pathology. Int J Androl. 1997;20:61-9.

Alvarez JG, Storey BT. Differential incorporation of fatty acids from phospholipids of human spermatozoa. Mol Reprod Dev. 1995;42:334-45.

Storey BT, Alvarez JG, Thompson K. Human sperm glutathione reductase activity in situ reveals limitation in the glutathione antioxidant defense system due to supply of NADPH. Mol Reprod Dev. 1998;49:400-7.

Iwasaki A, Gagnon C. Formation of reactive oxygen species in spermatozoa of infertile patients. Fertil Steril. 1992;57:409-16.

Sikka SC, Rajasekaran M, Hellstrom WJG. Role of oxidative stress and antioxidants in male infertility. J Androl. 1995;16:464-8.

Kodama H, Yamaguchi R, Fukuda J, Kasai H, Tanaka T. Increased oxidative deoxyribonucleic acid damage in the spermatozoa of infertile male patients. Fertil Steril. 1997;68:519-24.

Fisher H, Aitken R. Comparative analysis of the ability of precursor germ cells and epididymal spermatozoa to generate reactive oxygen metabolites. J Exp Zool. 1997;277:390-400.

Shekarriz M, Sharma RK, Thomas AJ Jr, Agarwal A. Positive myeloperoxidase staining (Endtz test) as an indicator of excessive reactive oxygen species formation in the semen. J Assist Reprod Genet. 1995;12:70-4.

Eggert-Kruse W, Bellman A, Rohr G, Tilgen W, Runnebaum B. Differentiation of round cells in semen by means of monoclonal antibodies and relationship with male infertility. Fertil Steril. 1992 Nov;58(5):1046-55.

Tomlinson MJ, Barrat GLR, Cooke ID. Prospective study of leukocytes and leukocyte sub-populations in semen suggests that they are not a cause of male infertility. Fertil Steril. 1993;60:1069-75.

Saleh RA, Agarwal A, Kandirali E, Sharma RK, Thomas AJ, Nada EA, et al. Leukocytospermia is associated with increased reactive oxygen species production by human spermatozoa. Fertil Steril. 2002;78(6):1215-24.

Sharma RK, Pasqualotto Fabio, Nelson DR. Relationship between seminal white blood cell counts and oxidative stress in men treated at an infertility clinic. J Androl. 2001;22:575-83.