Editing Infertility: Diagnosis and Evaluation (section)

===== <span style="color:#ff0000">Semen WBC staining</span> =====
*'''<span style="color:#ff0000">Increased levels of round cells in the semen may result from</span>''' 
*#'''<span style="color:#ff0000">Presence of elevated levels of white blood cells in the semen (pyospermia)</span>'''
*#*White blood cells in the semen may result from infection or inflammation in the proximal or distal male genital tract.
*#'''<span style="color:#ff0000">Spermatogenic problem where immature germ cells</span>''' (spermatocytes and/or round spermatids) '''<span style="color:#ff0000">are present in the ejaculate</span>''' 
*#*No evidence that elevated levels of immature sperm in the semen is deleterious to fertility, and they may be present in semen of infertile men and fertile men with high sperm counts.
*#'''<span style="color:#ff0000">Idiopathic</span>'''
*#*Most common cause
*'''Important to know whether men with elevated levels of round cells in the semen have immature germ cells or an infectious or inflammatory etiology for subsequent management (see below)'''
*'''Leukocytes and immature germ cells are not differentiable with light microscopy'''
**'''Papanicolaou staining may be used'''
***Immunocytochemical staining provides more information to aid in distinguishing between inflammation and those subtypes involved in fighting off infection
*'''<span style="color:#ff0000">Indications</span>[https://pubmed.ncbi.nlm.nih.gov/33295257/ ★]'''
**'''<span style="color:#ff0000">Increased round cells on semen analysis (>1million/mL)</span>''' 
***'''Upper limit of normal as <1 million white blood cells/mL of semen'''
*'''<span style="color:#ff0000">Management</span>'''
**'''<span style="color:#ff0000">If staining suggestive of</span>'''
***'''<span style="color:#ff0000">Pyospermia, evaluate for the presence of infection</span>[https://pubmed.ncbi.nlm.nih.gov/33295257/ ★]'''
****'''<span style="color:#ff0000">Sexual transmitted infections can also lead to leukocytes in semen and this needs to be ruled-out</span>''' 
****'''Chronic prostatitis due to bacterial infection may require long courses of antibiotic treatment''', and some cases of elevated levels of white blood cells may result from chronic nonbacterial prostatitis.
****Leukocytes can occur with UTIs, but unless urine is in the semen, this is an unlikely source.
****Inflammation may be medically treated with anti-inflammatory drugs.
***'''<span style="color:#ff0000">Immature germ cells is a condition that cannot be treated</span>'''