Blood in Semen

What is blood in the semen?

The presence of blood in the semen (ejaculate) is also called hematospermia. Hematospermia is an uncommon condition.

What are the causes of blood in the semen?

Rumke and Wilson first reported the presence of antisperm antibodies in infertile men in 1954. The incidence of sperm autoimmunity in infertile couples is 9-36% in contrast to 0.9-4% in the fertile population. The incidence of detection of sperm antibodies in the fertile male is 8-21% and in the female 6-23%. Immunological cause may contribute to 5-15% of the male infertility factors.

Blood in semen can be caused by many conditions affecting the male genitourinary system. Areas affected include the bladder, urethra, the testicles, the tubes that distribute semen from the testicles (known as the seminal vesicles), the epididymis (a segment of the spermatic ducts that serves to store, mature and transport sperm), and the prostate gland.

Blood in the semen is most commonly a result of a prostate-gland biopsy. More than 80% of men who undergo a prostate biopsy may have some blood in their semen that persists for three to four weeks. Likewise, vasectomy can lead to bloody semen for about one week after the procedure.

In men with hematospermia who have not had a recent prostate biopsy or vasectomy, a number of benign and malignant conditions of the male genital system may be the cause. In many situations, no definitive cause is found.

The following conditions have been reported in association with hematospermia:

benign or malignant tumors of the prostate, bladder, testes, or seminal vesicles,

  • infections (including, but not limited to, chlamydia, herpes, cytomegalovirus, and trichomoniasis),

  • inflammation of the prostate (prostatitis), epididymis (epididymitis), or urethra (urethritis),

  • calculi (stones similar to kidney stones) in the seminal vesicles or prostate,

  • polyps in the urethra,

  • ejaculation-duct obstructions,

  • metastatic cancers (that have spread from other sites in the body) located in the genitourinary system, and

  • cysts, hemorrhage, or other abnormalities in the seminal vesicles.

What are the symptoms of blood in the semen?

The symptoms that accompany blood in the semen may be any of the following, depending upon the cause (these are not all inclusive):

  • painful urination

  • pain with ejaculation

  • blood in urine

  • lower back pain

  • fever

  • tenderness in the testes and/or scrotum

  • swelling in the testes and/or scrotum, or

  • swelling or tenderness in the groin area.

How is blood in the semen evaluated?

A number of diagnostic tests may be performed after the clinical history is evaluated and a physical examination is performed. Some of the most commonly performed diagnostic tests are a urinalysis and cultures to identify any sexually transmitted or other infections. When indicated, imaging studies such as ultrasound or MRI may reveal tumors or other abnormalities. In some cases, a semen analysis may be recommended.

What is the prognosis (outlook) for patients with blood in the semen?

The prognosis relates to the underlying cause of blood in the semen if a cause can be identified. However, most cases of hematospermia are benign and resolve without treatment. While cancer is a rare cause of blood in the semen, the majority of cases are not related to cancer, especially in younger men.

Blood in Semen At A Glance

  • Blood in the semen is known as hematospermia

  • Prostate biopsy is the most common cause of blood in the semen

  • Blood in the semen can be caused by tumors, infections, anatomical abnormalities

  • stones, or inflammation in many sites throughout the genitourinary system

  • Usually blood in the semen is benign and resolves on its own

  • Treatment, if indicated, depends upon the underlying cause

White Blood Cells and Semen

If you and your partner are having trouble getting pregnant, then you may already be undergoing fertility testing or treatment. Male infertility accounts for up to 50% of all fertility issues, so it is a wise idea to have yourself tested. A semen analysis often brings to light fertility issues. In particular, many men discover that they have an elevated number of white blood cells in their semen. These white blood cells can negatively affect your fertility and may indicate an underlying health problem.

What Are White Blood Cells?

White blood cells are an essential part of the body's immune system. They help us to fight off invading cells and bacteria, keeping our bodies healthy and infection-free. Also known as leukocytes, white blood cells are produced in our bone marrow. They move throughout our bloodstream, attacking any foreign bacteria, fungi, or viruses. During an infection, an increased number of white blood cells can be found in certain areas of your body.

White Blood Cells in the Semen

White blood cells are found in pretty much any area of the body at any given time. They are typically found in small quantities in your semen and ejaculate. At low levels, white blood cells cannot affect your semen quality, and will thus have no impact on your fertility. However, high levels of white blood cells in your semen can cause serious fertility problems. Known as leukocytospermia, a high white blood cell count in semen is typically over one million leukocytes per milliliter.

How Common is Leukocytospermia?

Leukocytospermia is actually not that uncommon. It affects anywhere between 5% and 10% of the population, and may affect as many as 20% of those men currently seeking fertility treatment. Men who have undergone vasovasostomy tend to have more leukocytes in their semen than normal.

What Causes Leukocytospermia?

Leukocytospermia is typically the result of a genital tract infection. The presence of high levels of white blood cells is needed to help fight off the infection. STDs are commonly associated with leukocytospermia, particularly chlamydia and gonorrhea. Other genital tract infections may also cause an increase in white blood cells.

How Do White Blood Cells Affect Fertility?

In large quantities, white blood cells can have a detrimental effect on male fertility. This is because leukocytes cause the oxidation of cells. If you have high numbers of white blood cells in your sperm, this could result in the oxidation of sperm cells, damaging their ability to fertilize an egg.

Reactive Oxygen Species (ROS)

Leukocytes trigger oxidation by releasing reactive oxygen species. These molecules cause cellular damage by changing the makeup of individual cells. In particular, reactive oxygen species change the makeup of sperm cells, affecting motility and morphology. This can make it very difficult for you and your partner to achieve pregnancy.

The more white blood cells you have in your semen, the more likely it is that you sperm have been affected by the reactive oxygen species. However, every man has a different threshold regarding the amount of reactive oxygen species his sperm cells can hold. This is because the body has specific antioxidants that fight against the damage caused by the reactive oxygen species. Some men simply have lower levels of these antioxidants, leaving them more susceptible to oxidative damage.

Testing and Treatment of High White Blood Cell Levels

If you are dealing with male factor infertility, your reproductive endocrinologist will be sure to test and treat you for high white blood cell levels.

Testing for High White Blood Cells Levels

Testing is typically performed at your fertility clinic. A semen analysis can detect the levels of white blood cells in your ejaculate. You will also be given a urethral swab to determine if you are suffering from an active infection.

Treating High White Blood Cells in Semen

Treatment typically involves medicating any active infections with the use of antibiotics. You may also be advised to ejaculate frequently, in order to move excess white blood cells out of the seminal tract. White blood cells levels tend to drop on their own, however, they can increase again at a later date, so active treatment is suggested.

Treatment

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