title: Reactive oxygen species and sperm DNA damage in infertile men presenting with low level leukocytospermia.
abstract: BACKGROUND
  Leukocytes contribute directly and indirectly to reactive oxygen species (ROS) production. Although leukocytospermia is defined as the presence of ≥ 1 × 106 white blood cells/mL (WBC/mL) in a semen sample, the presence of less than 1×10(6) WBC/mL (low-level leukocytospermia) can still produce a detectable amount of ROS, impairing sperm function and lowering the chances of pregnancy. Our objective was to assess the effect of low-level leukocytospermia on semen quality, ROS levels, and DNA damage in infertile men.
  
  
  METHODS
  Semen samples were examined from 472 patients and divided into 3 groups: no seminal leukocytes; group 2, men with low-level leukoctyospermia (0.1-1.0 × 106 WBC/mL); and group 3, frank leukocytospermia, (>1.0 × 106. WBC/mL). Semen analysis, leukoctyospermia, reactive oxygen species and DNA fragmentation was tested.
  
  
  RESULTS
  Conventional semen parameters between the 3 groups were similar. Group 2 patients had significantly higher levels of ROS and sperm DNA fragmentation (1839.65 ± 2173.57RLU/s; DNA damage: 26.47 ± 19.64%) compared with group 1 (ROS: 1101.09 ± 5557.54 RLU/s; DNA damage: 19.89 ± 17.31%) (ROS: p=0.002; DNA damage: p=0.047). There was no significant difference in ROS levels between groups 2 and 3.
  
  
  CONCLUSIONS
  Patients presenting with low-level leukocytospermia have seminal oxidative stress. Although these patients are not categorized as leukocytospermic by current World Health Organization (WHO) guidelines, these men may benefit by treatment with antibiotics, testing for bacterial cultures, or antioxidant supplements to reduce ROS-induced sperm DNA fragmentation and improve their chances of fertility. The WHO guidelines for leukocytospermia may need to be revised accordingly.
authors.affiliation: Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH 44195, USA. agarwaa@ccf.org.
authors.forename: Ashok
authors.initials: A
authors.lastname: Agarwal
authors.forename: Aditi
authors.initials: A
authors.lastname: Mulgund
authors.forename: Saad
authors.initials: S
authors.lastname: Alshahrani
authors.forename: Mourad
authors.initials: M
authors.lastname: Assidi
authors.forename: Adel M
authors.initials: AM
authors.lastname: Abuzenadah
authors.forename: Rakesh
authors.initials: R
authors.lastname: Sharma
authors.forename: Edmund
authors.initials: E
authors.lastname: Sabanegh
mesh_terms: D000328:Adult; D004249:DNA Damage; D053938:DNA Fragmentation; D005434:Flow Cytometry; D006801:Humans; D007248:Infertility, Male / Q000150:complications / Q000235:genetics* / Q000378:metabolism; D007958:Leukocyte Count; D007964:Leukocytosis / Q000209:etiology / Q000235:genetics* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D018384:Oxidative Stress; D017382:Reactive Oxygen Species / Q000378:metabolism*; D012661:Semen / Q000166:cytology / Q000378:metabolism; D055101:Semen Analysis; D013076:Sperm Count; D013094:Spermatozoa / Q000378:metabolism*
chemical_list: D017382:Reactive Oxygen Species