The extended examination of semen samples may help to diagnose treatable causes of male infertility. The assessment of ejaculate for the presence of leukocytes and analysis of pH levels could improve fertility outcomes for couples who have been unable to conceive.
Leukocytes Reduce Fertility Potential
Chronic inflammatory conditions of the male genital tract (MGT) are an important factor to consider in male patients with fertility disorders. The confirmation of leukocytes in a semen sample is therefore helpful in identifying patients who may have inflammation or infection of the MGT.
The WHO 2021 manual states that excessive numbers of leukocytes in the ejaculate may be associated with infection, poor sperm quality and impaired motility. In this 6th edition, a cut off of 1.0×106 peroxidase-positive cells per milliliter is maintained as the threshold for clinical significance.
In patients with peroxidase-positive leukocytes at a concentration of >1×106/mL of semen, the risk of oxidative stress is higher because granular leukocytes can generate high levels of reactive oxygen species within the semen. Writing in the World Journal of Men’s Health, Rakesh Sharma et al highlight that oxidative stress correlates with “poor sperm quality, increased level of sperm DNA fragmentation and low fertility potential”.
While WHO 6th edition states that there has not been a landmark study regarding leukocytes and oxidation, the manual makes clear that oxidative stress is likely to have a negative impact on both natural and assisted conception.
Leukocytospermia is therefore a useful clinical finding when assessing male fertility potential, especially as around 50% of men are asymptomatic for infections such as chlamydia or gonorrhea. In this case, semen parameters, and fertility potential, may be improved with antibiotics.
Sharma’s article concludes that further investigation into the cause of leukocytospermia can support the formation of an appropriate treatment plan for the management of infertility.
The Impact of Semen pH
Maintaining optimal pH of semen is vital to ensuring the normal function of spermatozoa. This is achieved by the semen buffering system supporting sperm function once it leaves the male body.
In 2015, Ji Zhou et al studied 136 healthy men who were known to be fertile with normal semen quality based on WHO 2010 criteria. When the samples were exposed to more acidic sperm nutrition solutions, the team reported decreased sperm movement and capacitation. They concluded that a low pH could be a mechanism of male infertility.
Similar results were seen in a 2021 study of subfertile men. Sanketh Satya Dhumal and colleagues noted that semen pH correlated with motility and sperm count. A high pH (>8.0) is often associated with an infection, whereas a low pH (<7.2) could be a sign of blocked seminal vesicles. The team agreed that the semen buffering system is an essential part of maintaining seminal quality.
Performing an assessment of semen pH may therefore indicate a potential cause for infertility in couples presenting for fertility assistance. This could aid diagnosis, and treatment, of certain male factors.
The extended examination of a semen sample to include investigation of peroxidase-positive leukocytes and pH may give rise to additional information to explain a couple’s infertility. Analyzing pH and checking for the presence of leukocytes is simple with QuickCheck WBC/pH Test Strips, the only FDA cleared test strip designed specifically for semen.
Successful treatment of a silent infection or inflammatory cause of subfertility could lead to improvements in sperm quality and overall fertility potential, which may in turn help to improve conception outcomes for couples.
To find out more about QwickCheck semen analysis test kits and sperm quality analyzer accessories, click here.