Pyospermia Treatment | Infertility Causes & Diagnosis
Pyospermia is characterised by the presence of unusually high levels of white blood cells (WBC) in the sperm sample ( Pyospermia treatment ). When a semen examination indicates more than one million white blood cells (WBC) per millilitre (.033 ounces) of semen, this medical condition is referred to as leukocytospermia, and it is verified by a doctor.
Having a little number of white blood cells in the sperm of a man is completely natural for him. When abnormally high numbers are present, however, this may indicate the presence of an underlying health issue or contributing behaviour. Because of this, more assessment and therapy are needed.
This section discusses possibly reversible male-factor issues that may be discovered by carefully reviewing the semen assay results: Low ejaculate volume, acidic sperm pH or fructose deficiency, irregular viscosity or liquefaction, and pyospermia are all symptoms of pyospermia (elevated numbers of white blood cells in the semen).
What Causes Pyospermia?
There are a variety of circumstances that may contribute to pyospermia. It is essential to have a complete checkup performed by a competent medical practitioner in order to establish the source of the problem. The following are examples of possible causes:
- It is normal for white blood cells to grow in number while targeting and battling an infection, and this is true for urogenital infections as well as any other illness.
- Infections of the genital tract that are linked with certain sexually transmitted disorders
- Autoimmune illnesses are diseases that are caused by the immune system. Autoimmune disorders are characterised by the fact that they affect healthy tissue. This assault has the potential to enhance WBC production.
- Varicocele
- It is an inflammation or swelling of the female vaginal organs.
- Urethral stricture is a condition that affects the urethra.
- Personal habits such as smoking cigarettes, using marijuana, or abusing alcohol are examples of such behaviours.
- Ejaculation occurs rather seldom.
Male infertility
Men who are infertile may have difficulties conceiving as a result of genital inflammation or a urogenital infection. It is also possible that problems may worsen if a big number of white blood cells in the semen assault and harm the sperm.
Sperm deformities, a detrimental influence on sperm integrity, and damage to the sperm acrosome are all possible consequences of sperm damage.
Diagnosis And Pyospermia Treatment
Identification of the underlying aetiology of leukocytospermia is critical in order to ensure that the condition is correctly treated.
A Urologist should anticipate the patient to undergo a complete review of their current and previous medical histories, a physical examination, a urine study as well as an in-depth chat about their social habits and sexual health when they visit the office.
For anyone interested in learning more about the illness, more diagnostic instruments may be obtained. Imaging of the genitourinary tract, a semen culture, and a urine flow test are some of the procedures that are used.
The practitioner may recommend a course of wide-spectrum antibiotics, over-the-counter antioxidants, or surgical repair of a varicocele or stricture, depending on the patient’s findings.
They may also advise the patient to reduce or eliminate their use of cigarettes, marijuana, and alcoholic beverages.
Abnormal Ejaculate Volume
The majority of laboratories indicate a normal ejaculate volume of more than 1.0 cc to 2.0 cc, while the 2010 WHO recommendations define 1.5 cc as the lower limit of normal.
Personally, I use the 1.5 cc cutoff level for normal, although I’m not too concerned with an occasional borderline low volume (1.1-1.4cc), particularly if the abstinence duration is short (2 days or less).
On a guy’s first semen analysis, I regularly notice borderline low ejaculate quantities, which I believe is typically due to the male feeling apprehensive and constrained by the unfamiliar experience of presenting a specimen sample in a cup. I have them aim for 3-4 days of abstinence time and come in properly hydrated for the ensuing analysis (since hydration status can potentially play a role as well).
They know what to anticipate on their second analysis and are typically a bit more at ease with the scenario, and the ejaculate volume is usually in the normal range (1.5cc). However, if it remains consistently low, additional investigation is required (see below).
Labs often state an upper limit on typical volume (for example, 6.0 cc), although ejaculate levels greater than this do not normally bother me.
If I notice a very large ejaculate volume (for example, 20 cc) in someone with neurologic disease or past urethral surgery, I suspect that the ejaculate contains some pee that is seeping out with the ejaculate (in which case the pH should be acidic, reflecting that acidity of the urine).
This is an unusual occurrence, and large ejaculate quantities are usually normal, indicating a more robust generation of fluid volume by the prostate and seminal vesicles.
A low ejaculate volume is a more concerning result. A failure to collect the complete specimen in the collection cup is the most prevalent cause of a low ejaculate volume.
It is beneficial when the lab reports whether a portion of the material was lost during collection. However, if the ejaculate volume is low and no record of a missed specimen collection is there, I usually question the patient whether they collected all of the specimens since the lab does not always report it (and the patient does not always tell the lab).
Possible Cause Of Low Ejaculate Volume
If no specimens were missing during collection, the following are the most prevalent causes of a low ejaculate volume:
1) A brief period of abstinence. Before submitting a specimen for sperm analysis, you should refrain from any sexual activity, including masturbation, for two to five days. If you abstain for fewer than two days, the seminal vesicles may not have enough time to recharge, resulting in a lower-than-normal ejaculate volume.
2) Low amounts of testosterone. Testosterone levels alter the seminal vesicles and prostate gland functioning. In certain men, low testosterone levels might cause a reduction in ejaculate volume.
3) Ejaculation in reverse. This is a condition in which the bladder neck does not contract as it should after ejaculation, allowing some or all of the ejaculate to leak backward into the bladder. The existence of retrograde ejaculation may be determined via post-ejaculatory urinalysis tests. See “Ejaculatory Dysfunction” for more information “part of this page for further information.
EJACULATORY DEFICIENCY
4) Impaired ejaculatory function. This happens when the muscular vas deferens fails to transfer sperm from the epididymis to the urethra. Anejaculation is a severe variant of this in which no fluid enters the urethra at all. Neurologic issues (such as spinal cord damage or diabetes mellitus) and certain drugs are common causes of ejaculatory dysfunction (such as antidepressants). Using the link above, go to the “Ejaculatory Dysfunction” section for further information.
5) Obstruction of the ejaculatory duct (EDO). Fluid from the vas deferens and seminal vesicles is prevented from entering the urethra in males with EDO. This might be a partial or total obstruction. Examine “Ejaculatory Dysfunction.” “part (highlighted above) for further information on EDO.
6) Seminal vasculitis Seminal vesicles may become dysfunctional and fail to contract, resulting in less seminal vesicle fluid entering the ejaculate. Seminal vasculopathy is most often caused by neurological issues such as diabetes mellitus.
7) Water deficiency. If a guy is very dehydrated at the time of specimen collection, it may have a role in decreasing ejaculate quantities, albeit this has not been fully investigated. I recommend that men with borderline ejaculate volume come in well hydrated for any follow-up semen analysis testing, drinking enough fluids to keep the urine pale yellow (generally a good sign of adequate hydration).
Acidic Semen PH Or Fructose Negative
The ejaculate’s pH is generally alkaline, with a pH of 7.5 or higher (the seminal vesicles produce a large volume of alkaline fluid, substantially more than the acidic fluid produced by the prostate).
Fructose is also produced by the seminal vesicles. When the ejaculate has an alkaline pH and includes fructose, fluid from the seminal vesicles enters the ejaculate successfully.
The fluid from the vas deferens and seminal vesicles is carried to the urethra through the ejaculatory ducts, where it is joined by the prostatic fluid.
Complete obstruction of the ejaculatory ducts prevents all fluids from the testicles and seminal vesicles from entering the ejaculate, allowing only fluid from the prostate to enter. (For further information on ejaculatory duct blockage, see the “Ejaculatory Dysfunction” section of this page.)
EJACULATORY DEFICIENCY
Men with total ejaculatory duct blockage often have no sperm in the ejaculate (azoospermia), a low ejaculate volume (less than 1.0 cc), an acidic sperm pH (less than 7.5), and no fructose in the sperm.
Other possible reasons of aberrant semen pH and fructose levels include:
1) Mistake in the laboratory. Because of this possibility, I propose repeat testing when the findings of the semen analysis do not line up with what seems to be going on in the man’s body.
2) Inadequate collection. The majority of the seminal vesicle fluid is found in the latter section of the ejaculated semen. As a consequence, if the final portion of the material was not gathered in the container, the findings might be anomalous.
3) Inflammation of the seminal vesicle This generally results in an increase in the number of white blood cells in the sperm.
Many fertility specialists believe that semen fructose testing should never be used since poor volume, a total lack of sperm, and an acidic pH should be enough to clearly show the presence or absence of ejaculatory duct obstruction.
Abnormal Semen Liquefaction And Viscosity
The fluid from the seminal vesicles causes seminal fluid to coagulate, or cling together, in order to keep the sperm close to the cervical opening and protect them from the hostile vaginal environment. The enzymes in the prostatic fluid subsequently force the sperm to liquefy, enabling it to enter the cervical canal. The rate at which the semen liquefies is often assessed as viscosity (normally less than 2) or liquefaction time (with normal ranging between 5 and 25 minutes).
A semen assay may reveal a prolonged liquefaction period (more than 30 minutes) or anomalous viscosity (over 2). In most cases, a second analysis—especially one conducted at a fertility-specific lab—will provide normal findings, and no further action is required.
A chronically abnormal result, on the other hand, might indicate one of the following issues:
1) Water deficiency. Dehydration may cause increased viscosity in the sperm. As previously said, I urge repeat testing while paying close attention to sufficient hydration prior. A decent target is to drink enough water to maintain your urine light yellow.
2) Inflammation or infection In certain cases, illness or inflammation of the genital duct (particularly the prostate) may cause an increase in semen viscosity. When there is an active infection or inflammation, high quantities of white blood cells (pyospermia) are usually present. More information about pyospermia may be found below.
3) Inadequate sperm collection. The majority of the prostate fluid is in the first third of the ejaculate, whereas the seminal vesicle fluid is usually in the latter third. If a portion of the collection is omitted, the coagulation and liquefaction of the specimen may be affected, depending on which portion was omitted.
In the absence of dehydration or illness, persistently high sperm viscosity or higher liquefaction times are uncommon. Repeat semen analysis testing with the patient well-hydrated and obtaining the whole specimen generally results in the liquefaction/viscosity normalizing.
However, if the anomaly continues (as shown by testing at a fertility-specific lab), the couple’s reproductive potential may be reduced by preventing sperm release from the coagulated ejaculate.
This issue may usually be solved using low-tech female therapies such as sperm washing along with intrauterine insemination/IUI (see “Female Fertility Treatments” section).
If there are concerns about the reproductive implications of aberrant sperm liquefaction, post-coital testing may be performed to determine if sperm are efficiently entering the cervical canal (see “Post-Coital Testing” in the “Uncommonly Used Sperm Tests” section of this page).
Elevated White Blood Cells ( Pyospermia )
Pyospermia, or an increase in the amount of white blood cells (WBCs) in the sperm, indicates inflammation in the male genital duct system.
Pyospermia may be difficult to diagnose in the laboratory because immature sperm cells resemble WBCs in a sperm specimen (both of which are referred to as “round cells”).
See the “Other Semen Analysis Parameters” section of this website for further information on how to determine if an increase in the number of so-called round cells in the semen truly indicates the existence of pyospermia.
ADDITIONAL SEMEN ANALYSIS PARAMETERS
While an increase in the number of immature sperm cells is not usually considered clinically relevant, inflammation in the vaginal duct system may have a major detrimental influence on certain men’s reproductive potential.
Inflammation may occur as a result of an infection (bacterial, viral, or fungal) or from a non-infectious source (for example, nonspecific inflammation of the prostate or epididymis). Infection is responsible for only around 20% of genital duct irritation reported in male infertility patients.
PYOSPERMIA’S IMPACT ON FERTILITY
The production of reactive oxygen species (ROS), also known as free radicals, is a typical byproduct of the body’s metabolic activities (for more information, see the “Oxidative Stress” section of this website).
STRESS FROM OXIDATIVES
Under normal conditions, the body is well-equipped to clear up these ROS before they do any harm to cells, tissues, or organs.
Although sperm create a little quantity of ROS, white blood cells produce a considerable number of these harmful chemicals. With increasing quantities of white blood cells in pyospermia, increased levels of ROS may exceed the body’s cleaning processes, leading in oxidative stress.
Because of the compact shape of their DNA (genetic material), their inherent lack of antioxidants, and their inability to efficiently repair damage, sperm are particularly vulnerable to oxidative stress-related damage.
Pyospermia/inflammation has been linked to an increased risk of a variety of male reproductive issues, including:
1) A reduction in sperm density, motility, and morphology
2) Increased fragmentation of sperm DNA
3) Low pregnancy rates and embryo development with IVF
4) Anti-sperm antibody production caused by inflammation
Treatment Of Asymptomatic Pyospermia
As previously stated, most men being examined for fertility who have increased amounts of WBCs in their sperm have asymptomatic pyospermia.
In about 80 percent of these cases, the pyospermia is from non-infectious causes, meaning that somewhere in the genital duct system (most commonly the prostate) there is some inflammation not caused by an infection. Asymptomatic prostatitis, or prostate inflammation, is quite prevalent, with no known aetiology.
Because most men with pyospermia do not have an infection, several reproductive doctors avoid using antibiotics and instead depend only on anti-inflammatory drugs to eliminate the WBCs from the vaginal canal.
I prefer not to overlook the 20% of men who have pyospermia due to an infection, therefore I treat all instances of pyospermia with a mix of antibiotics and anti-inflammatory drugs. These drugs often take many weeks to adequately enter and treat the vaginal duct system.
My normal program is as follows:
1) Three weeks of antibiotic (doxycycline 100 mg twice a day). A lengthier treatment (6 weeks or more) is often required, as is switching to another medicine (such as ciprofloxacin 500 mg twice a day).
2) Anti-inflammatory medicine should be used while taking the antibiotic; I usually prescribe naproxen (Aleve) 220mg, 2 tablets twice a day by mouth (with breakfast and dinner).
Naproxen is a cheap over-the-counter medication. In addition to ibuprofen, prescription anti-inflammatory medicines such as oxaprozin (Daypro) and celecoxib are available (Celebrex).
These have the benefit of requiring less frequent administration than naproxen. They are, however, substantially more costly and are not thought to be any more effective than ibuprofen in terms of anti-inflammatory action. Celecoxib, for example, is promoted as having less gastrointestinal side effects, but it has been linked to an increased risk of cardiovascular events with long-term usage.
If you have a history of stomach ulcers, gastroesophageal reflux disease (GERD), or impaired kidney function or kidney disease, you should see your doctor before using anti-inflammatories. Mild stomach distress may be controlled with over-the-counter Pepcid or Prilosec. However, if your symptoms persist or worsen, you should discontinue your anti-inflammatory medication and see your doctor.
Because inflammation takes time to resolve, I suggest a repeat sperm examination four to six weeks after completing pyospermia therapy. I’m hoping for a typical WBC count of less than 1 million per cc.
If WBC levels are decreasing but are higher than normal at the time of the retest, a third sperm study ten to twelve weeks later may be recommended.
Treatment Of Symptomatic Pyospermia
As previously stated, most men being examined for fertility who have increased amounts of WBCs in their sperm have asymptomatic pyospermia.
In about 80% of these cases, the pyospermia is caused by non-infectious causes, which means that there is some inflammation somewhere in the genital duct system (most commonly the prostate) that is not caused by an infection. Asymptomatic prostatitis, or prostate inflammation, is quite prevalent, with no known etiology.
Because most men with pyospermia do not have an infection, several reproductive doctors avoid using antibiotics and instead depend only on anti-inflammatory drugs to eliminate the WBCs from the vaginal canal.
I prefer not to overlook the 20% of men who have pyospermia due to an infection, therefore I treat all instances of pyospermia with a mix of antibiotics and anti-inflammatory drugs. These drugs often take many weeks to adequately enter and treat the vaginal duct system.
My normal program is as follows:
1) Three weeks of antibiotic (doxycycline 100 mg twice a day). A lengthier treatment (6 weeks or more) is often required, as is switching to another medicine (such as ciprofloxacin 500 mg twice a day).
2) Anti-inflammatory medicine should be used while taking the antibiotic; I usually prescribe naproxen (Aleve) 220mg, 2 tablets twice a day by mouth (with breakfast and dinner).
Naproxen is a cheap over-the-counter medication. In addition to ibuprofen, prescription anti-inflammatory medicines such as oxaprozin (Daypro) and celecoxib are available (Celebrex). These have the benefit of requiring less frequent administration than naproxen.
They are, however, substantially more costly and are not thought to be any more effective than ibuprofen in terms of anti-inflammatory action. Celecoxib, for example, is promoted as having less gastrointestinal side effects, but it has been linked to an increased risk of cardiovascular events with long-term usage. If you have a history of stomach ulcers, gastroesophageal reflux disease (GERD), or impaired kidney function or kidney disease, you should see your doctor before using anti-inflammatories.
Mild stomach distress may be controlled with over-the-counter Pepcid or Prilosec. However, if your symptoms persist or worsen, you should discontinue your anti-inflammatory medication and see your doctor.
Because inflammation takes time to resolve, I suggest a repeat sperm examination four to six weeks after completing pyospermia therapy.
I’m hoping for a typical WBC count of less than 1 million per cc. If WBC levels are decreasing but are higher than normal at the time of the retest, a third sperm study ten to twelve weeks later may be recommended.
