الفهرس 
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Abstract
The physical and psychological impact of infertility is a widespread and growing problem which frequently results in anger, depression, anxiety and feeling of worthlessness.
Male infertility is contributing about 40% of infertility problem and the infections of genitourinary tract play an important causative role in male factor infertility. Male reproductive tract infections have been acknowledged for decades until recently, the condition of leukocytospermia has been used as an indicator of genital tract infection.
The present study was therefore conducted aiming to highlights the relation between leukocytospermia and possible compromised genital tract infections and to compare individual impact of leukocytospermia with combined impact of leukocytospermia and bacteriospermia against semen parameters and sperm characteristics through monitoring specified seminological and bacteriological investigation of all study sample group (n=50) which showed seminal leukocytes exceed 106/ml semen and control group (n=50) of proven fathers with seminal leukocytes never exceeded106/ml.
All samples were obtained from men distributed in Qualubia governorate, Egypt. This study was carried out during period extended from June 2012 to July 2013.
The sampling equipment and all facilities of accurate seminological analysis of semen samples were supplied by Hawaa fertility center, Benha, Egypt. The facilities for bacteriological investigations were supported by Botany Dept., Fac. Sc., Benha Univ. and Clinical Pathology Dept., Fac. Medicine, Benha Univ.
Seminological assessment of semen samples included: semen parameters (volume, viscosity and PH) and sperm characteristics (concentration, motility, vitality and morphology).
Bacteriological assessment of semen samples included: Enumeration of total viable bacterial count (TVBCs), isolation and identification of isolates according to Bergey’s Manual of Determinative Bacteriology basing on isolates’ morphological and biochemical characteristics. Statistical analysis was applied to determine the statistical significantly affected semen or sperm parameters by the two main components of the study (leukocytospermia & bacteriospermia).
Antibiotic sensitivity test was carried out in this study on isolates from each case separately against all recommended antibiotics for genitourinary tract infection treatment to define the most suitable antibiotic for treatment of each case and to avoid randomized antibiotic usage with patients.
Silver nanoparticles were additionally tested on example from Gram positive isolates (Staph. aureus) and another one from Gram negative isolates (E. coli) to see their bactericidal effect.
Randomized Selected ten patients from the study group were subjected to treatment plan included antibiotic and prolonged antioxidant treatment to evaluate the power of this plan to treat patients.
Seminological analysis results when comparing study (n=50) and control group (n=50) showed that leukocytospermia statistically deteriorated semen viscosity (1.05 ± 1.245 vs. 0.16 ± 0.083cm; P<0.01), sperm count with progressive motility( 33.72 ± 15.17 vs43.80 ± 15.20 106/ml , 42.76 ± 15.4vs49.90 ± 07.26 % ; P<0.01) and increased sperm numbers with abnormalities and non-progressive motility(81.62 ± 6.08 vs 79.00 ± 4.35 % , 25.50 ± 0.091 vs 20.64 ± 08.55 %; P<0.05), whereas Semen volume , PH, sperm vitality and total motility showed no significant difference in both groups (P> 0.05).
Bacteriological analysis results of semen samples after standard plate count method _ according to CFU/ml in each case, case considered pathologically infected when no. of bacteria/ml exceeds 103/ml of semen sample_ showed that control group (n=50) showed 86% (n=43) with no evidence of bacterial growth whereas the remaining 14% (n=7) showed non-significant bacterial growth which didn’t rise to the level that known to be pathological so considered negative too.
Study group (n-50) showed 62% (n=31) with pathological bacterial growth, whereas only 6% (n=3) showed non-significant bacterial growth even with fresh sample without dilution so classified to the bacteriological negative group with the remaining percent 32% (n=16) which didn’t show any evidence of bacterial growth.
The most common bacterial strains isolated from semen samples of infertile patients with leukocytospermia were in order of appearance: the highest count recorded for genera Staph. aureus (32.35%), E. coli (26.47%), Staph. epidermidis (17.64%), K. pneumonia (14.70%) and Strept. Pyogenes(8.82%).
Results of comparing leukocytospermic infertile patients’ two cohorts 1st group: with GTI (n=31) and 2nd groups: without GTI(n=19) against controls showed that all 1st group’s seminological characters except for (PH, total motility and morphology) were statistically deteriorated whereas 2nd group showed deterioration in viscosity, concentration, PR motility and NP motility. The concentration of sperm cells and its ability for rabid and slow progression was significantly diminished in both cohorts of infertile patients with leukocytospermia but in the group of infertile patients with genital tract infection the detrimental influence of bacterial infection have been demonstrated at higher statistical significance(p<0.01; 1st group Vs. P<0.05;2nd group).
In ejaculated samples 1st group it was observed that there were statistical significant correlations between E. coli and Staph. aureus against selected semen parameters, the presence of E. coli and Staph. aureus were associated with the lower semen density and diminished progressive motility (negative correlation). Additionally, Staph. aureus had been positively correlated with count of abnormal sperm cells.
In vitro antibiotic sensitivity results showed that Vancomycin is the best drug for treatment of staphylococcal infections; Imepinem, doxycycline and ciprofloxacin remain the best broad-spectrum drugs for treatment of Staphylococcal, streptococcal and enterobacteriacea infections:
Sensitivity to Imipenem was made by all the isolates (100%) of streptococcus, (90%) of S. aureus and (87.5%) of E.coli, whereas klebsilla showed (50%) and S. epidermidis showed (66.67%). Sensitivity to Doxycycline was shown by (80%) of S. aureus isolates and (83.34%) of S. epidermidis isolates whereas isolates of E. coli, Klebsilla and Streptococcus showed 62.5%, 75%, 66.67% susceptibility to Doxycycline respectively.
Susceptibility to Ciprofolxacin was shown by (70%) of S. aureus isolates and (83.34%) of S. epidermidis isolates whereas isolates of E.coli and Klebsilla showed 62.5%, 50% susceptibility to ciprofloxacin respectively.
The rest of the antibiotics were not able to show very significant zones of inhibition against the pathogens confirming earlier report of the existence bacterial resistance against the drugs. Indiscriminate use of antibiotics and production of plasmids by bacteria are some of the reasons adduced for bacterial resistance of antibiotics.
Basing on this in vitro antibiotic test results, the best drug for treatment was selected for each case and ten patients who participate in this additional part of the study showed statistically significant decrease in no. of leukocytes and bacteria/ml ejaculate after exposure to the antibiotics (P<0.01). Sperm characteristics (sperm count and progressive motility) were improved after prolonged antioxidant treatment for 3 months with statistical significance (P<0.05).