Empirical treatment of low-level leukocytospermia with doxycycline in male infertility patients.

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).

Conclusion: 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.