The presence of white blood cells (WBCs), or pus cells, during semen analysis often causes concern to infertile couples and their doctors. There are several reasons why WBCs might be present in the semen.
Infectious Diseases and STDs
Infectious diseases were common in the past. Smallpox, for instance, used to result in azoospermia--the absence of motile (and hence viable) sperm-- and this infection injured the epididymis, leading to ductal obstruction. Tuberculosis can also affect the epididymis, also causing azoospermia.
Gonorrhea, chlamydia and syphilis, along with other STDs (sexually transmitted diseases), are also capable of damaging the man's genital system, resulting in irreparable injury. Mumps is another viral disease known to cause inflammation of the testis, particularly when it strikes young men. This could even result in testicular failure if it damages both testes. However, the mere presence of white pus cells in the semen is not sufficient to make a diagnosis of a genital tract infection.
Laboratory Reporting Errors
This condition, known as pyospermia or leucocytospermia, occurs commonly, Many laboratories make an error in reporting because they do not have the expertise to differentiate between pus cells and sperm precursor cells. Erroneous reports by such labs may result in the doctor resorting to antibiotic treatment, which just wastes the patient’s time and money, because these cells are normal and will persist!
Even the semen culture report can be very misleading. It’s common for the lab to grow bacteria such as E. coli when they culture the semen. These are actually commensals, which are found normally on the skin, even in fertile men. However, unsophisticated doctors who will try to “treat” this with antibiotics often mistake this for a pathogenic organism!
The question a patient needs to ask is: can these bacteria actually cause male infertility? Can fertility be improved by treating such infections? In my opinion, treating most of these "abnormal reports" does not help to improve the man's fertility at all.
Dr. Aniruddha Malpani is an IVF specialist with a brilliant career with numerous awards, educational distinctions and prizes. Dr. Malpani completed his postgraduate degree in Gynecology from the University of Bombay in 1986. He received further training in IVF from UCSF, San Francisco, and U.S.A. As a medical student, he studied at Harvard, Johns Hopkins and Yale. He practices in Mumbai, India along with his wife Anjali. He can be contacted at firstname.lastname@example.org, or learn more at http://www.drmalpani.com.