Introduction 

Pyospermia is when there is a high amount of white blood cells in the semen. These white blood cells help to get rid of abnormal cells in the semen. However, there can be an increase in the quantity of these white blood cells in the semen, which can lead to sperm damage, affecting fertility. There are various treatment options for pyospermia, and they are usually based on the cause, diagnosis, and medical history. 

What is Pyospermia? 

Pyospermia, also known as Leukocytospermia, is a medical condition in men where their semen contains a high amount of leukocytes.³ The semen contains different cells such as immature germ cells and epithelial cells. Leukocytes are white blood cells found in the body, including the reproductive tract of men. These white blood cells help to defend the body from infections and in the semen, they detect and get rid of abnormal cells.^{1, 9} In healthy men, white blood cells are found in small amounts, however, men with pyospermia have more than a million per milliliter of white blood cells in their semen.²

What causes Pyospermia? 

Pyospermia is most often caused by an inflammation in the reproductive structure which may be infectious or noninfectious.⁷ This is an inflammation in pyospermia caused by infections. These infections can be viral, bacterial or other pathogens which can result in inflammation within the reproductive glands.^{7, 8}

Some of these infections are mostly found in the genital and urinary tract. They include: 

• Escherichia coli 
• Chlamydia 
• Gonorrhoeae 
• Staphylococcus 
• Ureaplasma 
• Mycoplasma¹³ 

Non infectious inflammation 

This type of inflammation is not caused by an infection. The inflammatory response happens from certain conditions and factors. 

Some of these factors include: 

• Environmental toxins⁸
• Smoking (tobacco, marijuana) and alcohol intake^{1, 7}
• Varicocele, a condition where the veins within the scrotum are swollen^{1, 7, 9}
• Autoimmune disorders^{1, 8}
• Trauma like a spinal cord injury⁹
• Being obese or having excess scrotal fat¹⁵
• Having diabetes⁸
• Congenital genitourinary malformations (birth defects that affect the urinary or reproductive system)¹
• Not ejaculating frequently 

How is Pyospermia diagnosed? 

Pyospermia is primarily diagnosed when there is a high number of white blood cells found in the semen.⁸

One of the basic tests for quantifying the number of white blood cells in the semen is the Peroxidase test.^1,12

• Peroxidase test 

This is a staining test done to count the number of white blood cells in the semen. It uses the enzyme peroxidase that is present in white blood cells which produces a coloured reaction.¹² The coloured white blood cells are then counted under a light microscope.⁸ Further tests and stains may be used to differentiate the white blood cells from other cells that look similar.¹

• Immunocytochemistry test

This is a more detailed test that differentiates between the different white blood cells found in the semen.¹² All the types of white blood cells in the body have specific antigens in them. Immunocytochemistry test involves using antibodies that detect these specific antigens in sperm cells.^8,12

• Flow cytometry test 

Flow cytometry test is a rapid and highly sensitive test that analyzes and detects the white blood cells in the semen.⁸ Before a medical practitioner diagnoses pyospermia using any test, the patient’s history is obtained, and physical examination is done to rule out any underlying medical condition.⁸

Treatment of Pyospermia Can Pyospermia be treated? 

Yes, pyospermia can be treated. The treatment of pyospermia is based on the cause, diagnosis and patient’s medical history. There are various treatment options for pyospermia, some of which are: 

• Use of prescribed antibiotics for bacterial infection (sometimes combined with frequent ejaculation)¹
• Use of prescribed antiviral or antifungal medications for infection 
• Use of antioxidants or anti inflammatories⁷ 
• Corticosteroids for autoimmune diseases⁸ 

Assisted reproductive technology (ART) methods like in vitro fertilization (IVF) when necessary^7,8

How do I prevent pyospermia?
You can prevent pyospermia by making certain lifestyle changes. 

Some lifestyle changes you can make to prevent pyospermia include: 

• Eating a healthy diet⁸
• Reducing stress⁸
• Avoid being exposed to heat⁸ 
• Reducing smoking and excessive alcohol intake⁸
• Exercising regularly 

These lifestyle changes can also help improve treatment in pyospermia.⁸ 

Sperm motility 

What is sperm motility? 

Sperm motility is the efficient movement of sperm. The sperm is a structured cell formed in the male testes. It moves with a whip-like tail called a flagellum (flagella - plural). The flagellum helps move the sperm to carry out one of its major functions, which is transferring the male genes into the female egg during fertilization.^5,10,11

What are the factors influencing sperm motility? 

There are different factors that influence the movement of sperm. These factors can be genetic, lifestyle choices, exposure to certain environments and some health conditions. 

The factors include : 

• Being obese¹⁵
• Use of marijuana¹⁵
• Diet and nutrition high in carbohydrates and refined sugars¹⁵
• Infections 
• Work related stress¹⁵ 
• Exposure to heat^12,15 
• Varicocele, a condition where the veins within the scrotum are swollen¹⁵

How do white blood cells affect sperm motility?

Although white blood cells in the semen help to check and get rid of abnormal cells in the semen.^1,9 A higher amount of white blood cells increases the oxidative stress level which causes damage to sperm morphology, motility and overall function.^1,2 In the semen, white blood cells produce molecules that contain oxygen. These molecules are called reactive oxygen species and they help improve sperm quality.⁴ However, when these molecules are overproduced in the semen, the cell's antioxidant defense system cannot keep up. Oxidative stress thereby occurs which can cause damage to the sperm and accessory sex organs.^4,5

Summary

Pyospermia, also known as Leukocytospermia, is a condition in men where there is a high amount of white blood cells in their semen. It is most often caused by an inflammation in the reproductive structure which may be infectious or noninfectious. There are most often no symptoms for pyospermia caused by noninfectious inflammation, hence, regular checkups are advised for men. Pyospermia can be diagnosed using different tests like peroxide test, immunocytochemistry test and flow cytometry test. These tests are done to count the white blood cells in the semen and differentiate them from other cells. Pyospermia can be treated using prescribed antimicrobial medications if caused by an infection, and prescribed antioxidants to reduce inflammation. Assisted reproductive technology methods can also be used in the treatment of pyospermia to aid fertilization. Pyospermia can be prevented by making certain lifestyle changes like eating a healthy diet, exercising regularly, reducing smoking and alcohol intake. Regular checkups are advised to help diagnose and treat pyospermia early, to improve fertility. 

Frequently Asked Questions (FAQs) 

How can I improve the quality of my sperm? 

You can improve the quality of your sperm by: 

• Eating a healthy diet high in fiber, and rich in fruits and vegetables 
• Exercising regularly 
• Reducing alcohol consumption 
• Reducing the use of marijuana and tobacco 
• Taking necessary rest

Can I still have my biological children if I am diagnosed with pyospermia?

Yes, but it usually depends on how severe the sperm is affected. You can have your biological children if pyospermia is diagnosed and treated early. If not, there are other reproduction methods your doctor would discuss with you. 

What are the symptoms of pyospermia? 

Pyospermia caused by an infected inflammation shows symptoms like fever, tiredness, pain and discomfort in the groin area. Most cases of pyospermia have no symptoms, that is why regular checkups are usually advised. 

Does pyospermia affect fertility? 

Yes, pyospermia can affect fertility depending on the extent of sperm damage and time of treatment. When diagnosed and treated early, fertility can be improved.