Male infertility workup needs additional testing of expressed prostatic secretion and/or post-massage urine

PLoS One. 2013 Dec 9;8(12):e82776. doi: 10.1371/journal.pone.0082776. eCollection 2013.

Abstract

The male factor accounts for almost 50% of infertility cases. Inflammation may reduce semen quality via several pathways, including oxidative stress (OxS). As male infertility routinely is assessed using semen analysis only, the possible presence of non-leukocytospermic asymptomatic inflammatory prostatitis may be overlooked. We compared local and systemic OxS levels in male partners of infertile couples with different inflammation patterns in their genital tract and/or oligospermia. Subjects (n=143) were grouped according to inflammation in their semen, expressed prostatic secretion (EPS), and/or post-massage urine (post-M). Systemic (8-isoprostanes in urine) and local (diene conjugates and total antioxidant capacity in seminal plasma) OxS was measured The levels of OxS markers were significantly elevated in both severe inflammation groups--leukocytospermic men and subjects whose inflammation was limited only to EPS and/or post-M. Comparison between oligospermic and non-oligospermic men with genital tract inflammation, and oligozoospermic men with or without inflammation in the genital tract indicated that inflammation but not oligospermia status had significant impact on the measured OxS markers. Hence, a high leukocyte count in prostate-specific materials (EPS, post-M), even in absence of clear leukocytopsermia, is an important source of local and systemic OxS that may be associated with male infertility and affect general health. We suggest including the tests for detection of inflammation of the prostate into the workup of infertile men as was suggested in the WHO 1993 recommendation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Humans
  • Infertility, Male / diagnosis*
  • Infertility, Male / etiology
  • Inflammation / complications
  • Leukocyte Count
  • Male
  • Oligospermia / diagnosis
  • Oligospermia / etiology
  • Oxidative Stress
  • Prostate / metabolism*
  • Semen / cytology
  • Young Adult

Grants and funding

This study was supported by Estonian Science Foundation (grant no. 8022) and by Estonian Ministry of Education and Research (target financing no. SF0180132s08) - regular financing of academic research (including salary for researchers and technicians and cost of laboratory materials). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.