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      Relevance of Leukocytospermia and Semen Culture and Its True Place in Diagnosing and Treating Male Infertility

      review-article
      1 , 1 , 1 , , 1 , 2 , 3 , 1 , 4 , 5 , 1 , 6 , 12 , 7 , 8 , 9 , 10 , 11 , 6 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 6 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 6 , 44 , 45
      The World Journal of Men's Health
      Korean Society for Sexual Medicine and Andrology
      Culture, Endtz, Infections, Inflammation, Leukocytes, Spermatozoa

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          Abstract

          The current WHO 2010 manual for human semen analysis defines leukocytospermia as the presence of peroxidase-positive leukocytes at a concentration >1×10 6/mL of semen. Granular leukocytes when activated are capable of generating high levels of reactive oxygen species in semen resulting in oxidative stress. Oxidative stress has been correlated with poor sperm quality, increased level of sperm DNA fragmentation and low fertility potential. The presence of leukocytes and pathogens in the semen may be a sign of infection and/or localized inflammatory response in the male genital tract and the accessory glands. Common uro-pathogens including Chlamydia trachomatis, Ureaplasma urealyticum, Neisseria gonorrhoeae, Mycoplasma hominis, and Escherichia coli can cause epididymitis, epididymo-orchitis, or prostatitis. The relationship between leukocytospermia and infection is unclear. Therefore, we describe the pathogens responsible for male genital tract infections and their association with leukocytospermia. The review also examines the diagnostic tests available to identify seminal leukocytes. The role of leukocytospermia in male infertility and its management is also discussed.

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          Genital tract infections and infertility.

          Infectious agents can impair various important human functions, including reproduction. Bacteria, fungi, viruses and parasites are able to interfere with the reproductive function in both sexes. Infections of male genito-urinary tract account for about 15% of the case of male infertility. Infections can affect different sites of the male reproductive tract, such as the testis, epididymis and male accessory sex glands. Spermatozoa themselves subsequently can be affected by urogenital infections at different levels of their development, maturation and transport. Among the most common microorganisms involved in sexually transmitted infections, interfering with male fertility, there are the Chlamydia trachomatis and Neisseria gonorrhoeae. Less frequently male infertility is due to non-sexually transmitted epididymo-orchitis, mostly caused by Escherichia coli. In female, the first two microorganisms are certainly involved in cervical, tubal, and peritoneal damage, while Herpes simplex cervicitis is less dangerous. The overall importance of cervical involvement is still under discussion. Tubo-peritoneal damage seems to be the foremost manner in which microorganisms interfere with human fertility. C. trachomatis is considered the most important cause of tubal lacerations and obstruction, pelvic inflammatory disease (PID) and adhesions. N. gonorrhoeae, even though its overall incidence seems to decline, is still to be considered in the same sense, while bacterial vaginosis should not be ignored, as causative agents can produce ascending infections of the female genital tract. The role of infections, particularly co-infections, as causes of the impairment of sperm quality, motility and function needs further investigation. Tropical diseases necessitate monitoring as for their diffusion or re-diffusion in the western world.
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            Role of oxidative stress, infection and inflammation in male infertility

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              Effect of cigarette smoking on levels of seminal oxidative stress in infertile men: a prospective study.

              To investigate levels of seminal oxidative stress (OS) and sperm quality in a group of infertile men with a history of cigarette smoking. A prospective clinical study. Male infertility clinic, Urological Institute, the Cleveland Clinic Foundation, Cleveland, Ohio. Infertile men who smoked cigarettes (n = 20), infertile men who were nonsmokers (n = 32), and healthy nonsmoking donors (n = 13). Genital examination, standard semen analysis, sperm DNA damage. Levels of seminal reactive oxygen species (ROS) and total antioxidant capacity (TAC) measured by a chemiluminescence assay and seminal OS assessed by calculating a ROS-TAC score. Sperm DNA damage was measured by sperm chromatin structure assay. Smoking was associated with a 48% increase in seminal leukocyte concentrations (P<.0001), a 107% increase in ROS levels (P=.001), and a 10-point decrease in ROS-TAC scores (P=.003). Differences in standard sperm variables and DNA damage indices between the infertile smokers and infertile nonsmokers were not statistically significant. Infertile men who smoke cigarettes have higher levels of seminal OS than infertile nonsmokers. Given the potential adverse effects of seminal OS on fertility, physicians should advise infertile men who smoke cigarettes to quit.
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                Author and article information

                Journal
                World J Mens Health
                World J Mens Health
                WJMH
                The World Journal of Men's Health
                Korean Society for Sexual Medicine and Andrology
                2287-4208
                2287-4690
                April 2022
                09 June 2021
                : 40
                : 2
                : 191-207
                Affiliations
                [1 ]American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.
                [2 ]Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
                [3 ]Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa.
                [4 ]Department of Urology, Cleveland Clinic, Cleveland, OH, USA.
                [5 ]Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt.
                [6 ]Department of Urology, Hamad Medical Corporation, Doha, Qatar.
                [7 ]Department of Urology, Loma Linda University Health, Loma Linda, CA, USA.
                [8 ]Department of Surgery, McGill University, Montreal, Canada.
                [9 ]Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA.
                [10 ]Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India.
                [11 ]Department of Urology, Centro Universitario em Saude do ABC/Andrology Group at Ideia Fertil Institute of Human Reproduction, Santo André, Brazil.
                [12 ]Department of Urology, Weill Cornell Medical-Qatar, Doha, Qatar.
                [13 ]Department of Physiology, Faculty of Medicine, Bioscience and Nursing, MAHSA University, Jenjarom, Selangor, Malaysia.
                [14 ]Section of Urology, University of Santo Tomas Hospital, Manila, Philippines.
                [15 ]Reproductive Biology, Fertility Preservation, Andrology, CECOS, Poissy Hospital, Poissy, France.
                [16 ]Paris Saclay University, UVSQ, INRAE, BREED, Jouy-en-Josas, France.
                [17 ]Department of Physiology, School of Medicine, National & Kapodistrian University of Athens, Maroussi, Athens, Greece.
                [18 ]Andromed Health & Reproduction, Fertility Diagnostics Laboratory, Maroussi, Greece.
                [19 ]Departamento de Biología, Universidad Autónoma de Madrid, Madrid, Spain.
                [20 ]Austin Fertility and Reproductive Medicine/Westlake IVF, Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
                [21 ]Fakih IVF Fertility Center, Abu Dhabi, UAE.
                [22 ]Department of Biochemistry, College of Medicine, University of Garmian, Kalar, Iraq.
                [23 ]Departamento Docencia e Investigación, Hospital Militar Campo de Mayo, Universidad Barcelo, Buenos Aires, Argentina.
                [24 ]Clinical and training Centre of the European Academy of Andrology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
                [25 ]Department of Urology and Renal Transplantation, University of Foggia Policlinico Riuniti of Foggia, Foggia, Italy.
                [26 ]IVF Clinic “Akeso-Embryo ART”, Athens, Greece.
                [27 ]Department of Andrology, Uromedica Polyclinic, Belgrade, Serbia.
                [28 ]Department of Anatomy & Unit for Multidisciplinary Research in Biomedicine (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal.
                [29 ]Department of Environmental, Biological and Pharmaceutical Sciences and Technologies (DiSTABiF), University of Campania Luigi Vanvitelli, Caserta, Italy.
                [30 ]Department of Andrology, Sexology & STIs, Faculty of Medicine, Cairo University, Cairo, Egypt.
                [31 ]Centro ANDROGEN, La Coruña, Spain.
                [32 ]Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA, USA.
                [33 ]Department of Andrology and Reproductive Medicine, Jindal Hospital, Meerut, India.
                [34 ]Department of Obstetrics and Gynaecology, Alexandria University Faculty of Medicine, Alexandria, Egypt.
                [35 ]Centerf Technological Innovation, and Reproductive Medicine (CITMER), Mexico City, Mexico.
                [36 ]Examenlab Ltd., Weavers Court Business Park, Linfield Road, Belfast, Northern Ireland, UK.
                [37 ]Department of Urology, Haceppete University, Ankara, Turkey.
                [38 ]Department of Urology, Pusan National University School of Medicine, Busan, Korea.
                [39 ]Medical Research Institute of Pusan National University Hospital, Busan, Korea.
                [40 ]Department of Andrology, Hammersmith Hospital, London, UK.
                [41 ]Avant Concierge Urology & University of Central Florida, Winter Garden, FL, USA.
                [42 ]Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.
                [43 ]Department of Obstetrics Gynaecology and Reproductive Medicine, Flinders University, Adelaide, South Australia.
                [44 ]Department of Physiology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia.
                [45 ]Andrology and IVF Unit, Procrea Institute, Lugano, Switzerland.
                Author notes
                Correspondence to: Ashok Agarwal. Andrology Center and American Center for Reproductive Medicine, Cleveland Clinic, Mail Code X-11, 10681 Carnegie Avenue, Cleveland, OH 44195, USA. Tel: +1-216-444-9485, Fax: +1-216-445-6049, agarwaa@ 123456ccf.org , Website: www.Clevelandclinic.org/ReproductiveResearchCenter
                Author information
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                Article
                10.5534/wjmh.210063
                8987138
                34169683
                ae7ef189-182c-4b35-9b2f-d825426edb7b
                Copyright © 2022 Korean Society for Sexual Medicine and Andrology

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 31 March 2021
                : 17 April 2021
                : 21 April 2021
                Categories
                Review Article
                Male Reproductive Health and Infertility

                culture,endtz,infections,inflammation,leukocytes,spermatozoa
                culture, endtz, infections, inflammation, leukocytes, spermatozoa

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