Prostatitis and Male Infertility: A Pilot Study. Possible Increase in Sperm Motility with Antibacterial Chemotherapy

Treatment with levofloxacin does not resolve asymptomatic leucocytospermia--a randomized controlled study

The manual of the World Health Organization defines leucocytospermia as the presence of >1 x 10(6) white blood cells per ml semen. Most authors consider leucocytospermia to be a consequence of inflammation due to bacterial infection. However, the efficacy of antibiotic therapy was not unequivocally demonstrated until now. We started a prospective, randomized, controlled study in 36 patients, who consulted our department for infertility with leucocytospermia. None of the patients reported any symptoms of genital infection. The patients were assigned randomly to two groups: group 1 received 250 mg levofloxacin once a day over 10 days, patients of group 2 received no therapy. Semen analysis was repeated 2 weeks later. After administration of levofloxacin, a mean decrease of leucocyte count of 45.8 +/- 72.2% compared with a decrease of only 3 +/- 109.2% in the untreated group was observed. However, this difference is not statistically significant. There were no significant differences between the two groups with respect to leucocyte count, sperm count and sperm cell after treatment. We conclude from our study that antibiotic therapy does not provide benefit for treatment of asymptomatic leucocytospermia.

Effect of antibiotic therapy in asthenozoospermic men associated with increased agglutination and minimal leukospermia

Thirteen patients with asthenozoospermia and semen analysis suggestive of infection were studied and divided at random into 2 groups according to the antibiotic treatment they received: (I) ciprofloxacine 250 mg every 12 hours by 14 days per os (n = 7) and (II) trimethoprim 160 mg and sulfamethoxazole 800 mg every 12 hours by 14 days per os (n = 6). Their couples received the same treatment. Changes in sperm density, morphology, viability, motility, agglutination, pH, and presence of leukocytes were analyzed before and after treatment. The average of morphologically normal sperms significantly decreased after treatment in the ciprofloxacine group; sperm with grade III motility increased in the trimethoprim-sulfamethoxazole group, but without statistical significance. With these preliminary results, it can be concluded that antibiotic administration modifies some of the spermatic parameters, particularly motility and morphology, in patients whose semen analysis parameters suggested infection.

Nonsperm cells in human semen: with special reference to seminal leukocytes and their possible influence on fertility

Nonspermatozoal cells (NSC) in semen, including immature germ cells, leukocytes (WBC) and epithelial cells, are normally found in a concentration less than 15% of the sperm concentration. Cytological staining methods and immunoenzymatic assays for characterization of seminal WBC and methods for detection of various enzymes from WBC are evaluated. Criteria for abnormally high levels of WBC in semen, caused by exogenic factors (e.g., infection) and possibly by endogenic factors (e.g., abnormal sperm), are discussed. Leukocytospermia is associated with reduced in vitro fertilization rate, and experimentally-measured sperm functions (e.g., motility) are inhibited by high concentrations of certain WBC products (e.g., reactive oxygen species and interferon-gamma). At the present stage, the following procedures could be used to evaluate WBC in ejaculates from infertile patients: (1) count the number of NSC using a hemocytometer. (2) Determine the number of WBC in percentage of NSC in smears using the Papanicolaou staining technique, or an immuno-enzymatic assay using monoclonal antibodies to the different kinds of WBC. (3) If, abnormally high levels of WBC (according to the WHO criteria or based on a percentile determined from examination of normal, fertile men) is detected, a second ejaculate should be examined 3 months later. (4) Persistent leukocytospermia should indicate physical and microbiological examinations, after which antibiotic treatment may be indicated.

Effect of urogenital infections on sperm parameters and hypofertility in man

Urogenital infections can notably reduce the sperm's capacity of fecundation by affecting the spermatozoa directly. The aim of this study was to compare the main parameters of the spermogram of 2 groups of hypofertile subjects, the first group presenting negative semen cultures, the second one positive semen cultures. The only significantly different parameter between these 2 groups of hypofertile patients studied was motility. This anomaly alone could explain some states of hypofertility.

Culture of seminal fluid in infertile men and relationship to semen evaluation

Bacterial flora of the seminal fluid and its influence on semen quality, was examined in 225 asymptomatic unselected men. Each semen sample was cultured aerobically, anaerobically, for genital mycoplasmas, and for Chlamydia trachomatis. Semen analysis was made according to standard methods recommended by the W.H.O. All 225 semen samples had microbial isolates. All isolates had colony counts of 10(2) colony forming units (cfu/ml). Thirty-three cases had greater than 10(2) cfu/ml, 85 cases had greater than 10(3) cfu/ml and 78 cases greater than 10(5) cfu/ml. The most common organisms isolated were Ureaplasma urealyticum in 86 samples and C. trachomatis in 26 samples. The most frequent abnormal parameters were viability (117 of 212, 52%), motility (85 of 212, 40%) and number of sperm cells (74 of 225, 32.8%). No significant correlation was found between abnormal semen parameters and presence of U. urealyticum, and C. trachomatis. We concluded that asymptomatic bacteriospermia (infection) in the semen did not significantly affect the count, motility or morphologic features of the specimen.

Value of intraprostatic injection of zinc and vitamin C and of ultrasound application in infertile men with chronic prostatitis

Seventy infertile men with chronic prostatitis were treated by prostatic massage and wide-spectrum chemotherapy as basic treatment to which intraprostatic injection of zinc or vitamin C with or without ultrasound application was added as a new line of treatment. Comparison showed no significant improvement of the additive treatment over the conventional treatment used alone. Pus cells in the expressed prostatic smear diminished significantly after treatment, which was associated with significant increase of percentage of motile spermatozoa and significant decrease of abnormal forms. Bacterial flora was studied in comparison with findings in 20 cases of infertile males without prostatitis; staphylococci predominated in both patient and control groups.

A controlled trial of the use of erythromycin for men with asthenospermia

A double-blind crossover controlled trial of Erythromycin was conducted in 78 men with asthenospermia (mean pretreatment sperm concentration greater than or equal to 20 X 10(6)/ml and motility less than 60%). Sperm motility increased above the pretreatment mean after the first one month course of treatment for both Erythromycin (7.9 +/- 2.6% P less than 0.01; mean +/- SEM) and the placebo group (7.5 +/- 2.2% P less than 0.01) and also after the second one month course of treatment, given one month after the first, for both Erythromycin (11.8 +/- 2.7% P less than 0.001) and placebo (11.4 +/- 2.8% P less than 0.001). There was no significant difference between the changes in sperm motility with Erythromycin and placebo. Twelve pregnancies occurred during the four month trial time--eight with Erythromycin and four with placebo (chi 2 = 2.51 P = NS). It is concluded that in infertile men, sperm motility tends to increase spontaneously with time. Erythromycin treatment has no significant effect on semen quality and a larger trial will be required to determine if Erythromycin increases fertility.