White Blood Cells in Semen and IVF

The clinical significance of white blood cells in semen, often called pus cells, has been debated for a long time. If they are caused by infection, then they can interfere with sperm function and cause infertility. However, pus cells can also be cause by “inflammation” and are often an incidental finding in a semen analysis.

Pus cells can interfere with fertilization. So, what should be done when they are seen in the semen sample at the time of fertilization during IVF? Should the IVF cycle be cancelled? Should the eggs be frozen (cryo preserved) instead? Or, is it okay to proceed with the cycle?

Ricci and collegues from the University of Trieste, Trieste, Italy, addressed these very questions in a recent publication (Fertil Steril 2015;104:87 – 93). They analyzed data from 164 couples and used a highly precise technique (flow cytometry) to count white blood cells (WBCs) in the semen sample produced on the day of egg retrieval and assessed their impact on success rates. They compared outcomes between couples with and without WBCs in the semen sample.

Background

WBCs (another term is “seminal leucocytes”) are often found in semen and detected during a semen analysis. There could be up to one million per milliliter of specimen. However, more than one million raises concerns for infections; potentially damaging the testis and sperm DNA.

The most common method for detecting WBCs is a peroxidase test. However, compared to other reliable methods, it sensitivity is around 47%-60%. Since the World Health Organization (WHO) still recommends this test, it is often used as an initial screening method. The authors of this article found flow cytometry to be highly precise at counting seminal leukocytes in addition to being rapid and simple. Also, it is what sets their study apart from previous studies because of its accuracy and precision.

Results

They found the number of eggs retrieved, the fertilization and cleavage rates, the median number and grade of embryos transferred, the median number of good-quality embryos transferred, and the median percentage of good-quality embryos from the total embryos transferred was not significantly different between the two groups.

They made sophisticated statistical adjustments for the various variables that could impact outcome (female age, infertility diagnosis, number of previous attempts, treatment protocol, assisted reproductive procedure and ART outcome). In order to determine if the cut off range for leukocytes would have any impact on results, they varied the cut-off value starting from 0.2 million and ending in 2 million. Varying the cut-off range and analyzing fertilization rates and cleavage rates for couples undergoing IVF or ICSI, the amount of WBCs did not affect IVF outcomes.

Discussion

WBCs have been shown to have a negative impact on pregnancy rates when couples are trying naturally and also with intrauterine inseminations (IUI). Why doesn't pus cells in semen have an impact on IVF success rates?

During IVF, semen samples are processed before IVF or ICSI procedures. Sperm preparation procedures include density-gradient centrifugation or swim-up. These procedures lower the concentration of WBCs and clean the specimen. Also, during ICSI a single sperm is activated per egg and not its surrounding contents.

Overall, the authors have demonstrated that WBCs (pus cells) without the presence of a genital infection do not influence ART outcomes.

At InVia Fertility Specialists, we will generally screen couples for infections before starting an IVF cycle. Once an infection is ruled out, the source of the WBCs is usually an inflammation. Patients with WBCs in the semen sample can then be treated with an anti-inflammatory medicine (e.g. DayPro (oxaprozin) 600 mg tablet, two tablets daily for 14 days).

To work knowledgable and experienced fertility team dedicated to helping you get pregnant, make an appointment at one of InVia’s four Chicago area fertility clinics.