title: Empirical treatment of low-level leukocytospermia with doxycycline in male infertility patients.
abstract: OBJECTIVE
  To design a retrospective study in which infertile men with a seminal leukocyte count of 0.2-1 × 10(6) white blood cells [WBC]/mL were given doxycycline to examine the potential benefits of the treatment on the improvement of semen parameters and natural pregnancy outcomes. It has been reported that even low-level leukocytospermia (0.2-1.0 × 10(6) WBC/mL) could be harmful to male reproductive function and achievement of pregnancy.
  
  
  METHODS
  The records of 223 patients were reviewed and 61 patients were identified with a leukocyte count of 0.2-1.0 × 10(6) WBC/mL. Of the 61 patients, 27 presented before 2006 and were not routinely treated for this level of leukocytospermia. These patients were our historic control population. Since 2006, 34 patients met these criteria and received empirical antibiotic therapy (treatment group).
  
  
  RESULTS
  The treatment of low-level leukocytospermia with doxycycline did not show statistically significant differences in the semen parameters among the treated patients. Although the therapy did not alter the semen parameters, low-level leukocytospermia resolved in 56% of the treatment group, well above the spontaneous resolution rate of 25% observed in historic controls. The natural pregnancy rate among the treatment group (15 of 32 [47%]) was significantly greater than that among the controls (5 of 25 [20%]). The odds ratio for pregnancy outcome was 3.7 (95% confidence interval 1.1-11.7; P = .04).
  
  
  CONCLUSIONS
  Low-level leukocytospermia might have deleterious effects on male fertility, and antibiotic therapy for such a condition might improve the natural pregnancy rate among infertile couples.
authors.affiliation: Center for Reproductive Medicine and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
authors.forename: Alaa
authors.initials: A
authors.lastname: Hamada
authors.forename: Ashok
authors.initials: A
authors.lastname: Agarwal
authors.forename: Reecha
authors.initials: R
authors.lastname: Sharma
authors.forename: Dan B
authors.initials: DB
authors.lastname: French
authors.forename: Ahmed
authors.initials: A
authors.lastname: Ragheb
authors.forename: Edmund S
authors.initials: ES
authors.lastname: Sabanegh
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004318:Doxycycline / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007248:Infertility, Male / Q000188:drug therapy* / Q000473:pathology; D007964:Leukocytosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies; D012661:Semen / Q000166:cytology*; D013076:Sperm Count; D013081:Sperm Motility; D013094:Spermatozoa / Q000166:cytology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D004318:Doxycycline