A semen analysis assesses sperm count, motility, and shape. During this evaluation, “round cells” are sometimes observed in the semen sample. While sperm are elongated, the presence of these round cells can raise questions about male reproductive health.
Identifying Round Cells in Semen
The term “round cells” in a semen analysis describes any non-sperm cell that appears circular under a microscope. This category primarily includes two distinct cell types: leukocytes (white blood cells) and immature germ cells, which are precursor cells in sperm development. Laboratories differentiate these cells through specialized techniques, such as peroxidase staining, which specifically identifies leukocytes.
Leukocytes are immune system components normally present in small numbers to protect the reproductive tract. However, an elevated concentration, typically exceeding 1 million white blood cells per milliliter of semen, is considered abnormal and is referred to as leukocytospermia or pyospermia. Immature germ cells are developing sperm cells that have not yet matured into their elongated form. Their presence can indicate a disruption in sperm production.
Understanding the Origins of Round Cells
The causes behind the presence of round cells vary depending on whether they are leukocytes or immature germ cells. When leukocytes are elevated, a common underlying reason is an infection within the male genital tract, such as prostatitis (prostate inflammation), epididymitis (epididymis inflammation), or urethritis (urethra inflammation). Sexually transmitted infections (STIs) like Chlamydia trachomatis or Neisseria gonorrhoeae can also contribute to increased leukocyte counts.
Inflammation without a clear infection can also lead to higher leukocyte levels. This may stem from physical trauma, autoimmune conditions where the immune system attacks healthy tissues, or urethral strictures, which are narrowings in the urethra. Varicocele, a condition involving enlarged veins in the scrotum, is another factor associated with increased leukocytes due to potential inflammation and impaired testicular function.
Lifestyle choices, including smoking, alcohol consumption, and marijuana use, have been linked to elevated leukocyte levels, as they can induce inflammation. Additionally, infrequent ejaculation can lead to the accumulation of white blood cells in semen. In some instances, the cause of elevated leukocytes remains unidentified, a situation termed idiopathic.
The presence of immature germ cells points to issues with spermatogenesis, the process of sperm formation. This can occur due to blockages in the reproductive tract, hormonal imbalances, or other forms of testicular dysfunction. Conditions such as viral illnesses, exposure to certain toxicants, chemotherapy, or underlying genetic problems can disrupt the normal maturation of sperm, leading to an increased release of these undeveloped cells into the ejaculate.
Impact on Male Fertility
The presence of round cells, particularly elevated levels of leukocytes, can negatively affect male fertility. High concentrations of white blood cells (leukocytospermia) increase reactive oxygen species (ROS) in the semen. This imbalance leads to oxidative stress, which damages sperm.
Oxidative stress can cause lipid peroxidation, damaging the sperm’s outer membrane. This damage reduces sperm motility, making it harder for sperm to move effectively and reach the egg. Furthermore, ROS can fragment sperm DNA, compromising its genetic integrity and potentially impacting fertilization success and embryo development. Sperm function, including the ability to penetrate an egg, can be impaired by these oxidative changes.
While immature germ cells do not directly harm mature sperm, their presence indicates an underlying problem with sperm production quality or quantity. A significant number of immature sperm suggests a disruption in the testes or epididymis, indirectly affecting fertility by reducing healthy, functional sperm available for conception.
What to Do Next
If round cells are identified in a semen analysis, further diagnostic steps are typically recommended to determine their specific type and underlying cause. If leukocytes are confirmed, a semen culture may be performed to identify any bacterial or fungal infections and determine appropriate antibiotic treatments.
Hormonal assays, measuring levels of hormones like Follicle-Stimulating Hormone (FSH), Luteinizing Hormone (LH), testosterone, and prolactin, can help assess the hormonal environment supporting sperm production. These tests can reveal imbalances that might contribute to the presence of immature germ cells or other reproductive issues. In some cases, testing for reactive oxygen species (ROS) levels can quantify the degree of oxidative stress impacting sperm.
Consulting with a urologist or a fertility specialist is an important next step. Based on the diagnostic findings, treatment approaches may include antibiotics for confirmed infections or anti-inflammatory medications for non-infectious inflammation. Antioxidant supplements may be suggested to counteract oxidative stress. Lifestyle adjustments, such as avoiding smoking and excessive alcohol, and increasing ejaculation frequency, can also contribute to improving semen quality. If an underlying condition like varicocele is identified, surgical correction might be considered.