SCREENING FOR SUBCLINICAL INFLAMMATION IN EJACULATES

Objective: To determine the clinical significance of albumin determina tion in ejaculates by means of an easy office test to screen semen sam ples for subclinical infection-inflammation. Patients: One hundred fif ty-nine randomly chosen males of couples with longstanding infertility (median duration of infertility 4 years (range 1 to 19 years) without clinical signs or symptoms of genital tract infection. Setting: Outpa tient Infertility Clinic of the University of Heidelberg, Germany. Mai n Outcome Measures: Screening of ejaculates for subclinical infection- inflammation by means of a ready-to-use kit for semiquantitative detec tion of albumin in addition to determination of leukocytes rates by me ans of monoclonal antibodies for differentiation of round cells and me asurement of granulocyte elastase concentration in semen samples. Eval uation of sperm quality by means of standard sperm analysis including determination of local antisperm antibodies with the mixed antiglobuli n reaction, evaluation of sperm functional capacity in vitro with the standardized sperm-cervical mucus (CM) penetration test, and semen cul tures. All tests were performed from aliquots of the same ejaculates.R esults: Screening of semen samples for elevated albumin with the modif ied paper strips proved to be very easy, quick, and suitable for routi ne use. Positive results were not related markedly to medical history and outcome of clinical examination as well as to standard parameters of sperm analysis and were not influenced by local antisperm antibodie s of the immunoglobulin (Ig)G and/or IgA class and microbial colonizat ion. However, albumin-positive semen samples were significantly less f requent in case of very good outcome of the sperm-CM penetration test. A significant relationship was found with high rates of leukocytes of the round cells in semen samples (total range 0% to 96%) and the conc entration of granulocyte elastase (total range 1 to 880 mu g/L). Concl usions: The results of this prospective study suggest that the determi nation of albumin in semen samples with ready-to-use test kits might b e a valuable additional marker for subclinical infection-inflammation of the male genital tract and therefore suitable for screening during infertility investigation.