Necrozoospermia, also called necrospermia occurs when all the sperm is dead in a fresh semen sample. There are two types of necrozoospermia:
- Incomplete necrozoospermia occurs when many but not all of the sperm in a semen sample are dead. Typically, when less than 45%, but more than 5%, are viable.
- Complete necrozoospermia occurs when all the sperm in a semen sample are dead.
Cases of complete necrozoospermia is very rare, with only about 0.2% to 0.5% of infertile men suffering from it.
Most people mix up necrozoospermia with asthenozoospermia, though both conditions are potential causes of male infertility.
Asthenozoospermia occurs when sperm motility or how the sperm swim, is abnormal. In asthenozoospermia, the sperm are not dead, but they are immobile.
Absolute asthenozoospermia is when no sperm moves at all. It occurs in 1 in 5,000 men. There are usually no outward symptoms. The only way to diagnosis the problem is with a semen analysis. The treatment for asthenozoospermia and necrozoospermia are different.
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Asthenozoospermia can be treated with IVI and ICSI (with ICSI is when a single sperm is injected into an egg.)
However, IVF with ICSI can’t be done in necrozoospermia, using a fresh ejaculate because a dead sperm cannot be injected into an egg. The most successful treatment for necrozoospermia is testicular sperm extraction with ICSI or TESE-ICSI.
It’s not totally clear what causes necrozoospermia. However, some possible causes according to experts are:
- Lengthy periods of no ejaculation
- Spinal cord injuries
- Infection in the male reproductive tract
- Testicular problems
- Problems with a long, coiled tube just above each testicle, where sperm are collected and mature before ejaculation called epididymis.
- Hormonal cause, hypogonadotropic hypogonadism (HH)
- Testicular cancer
- Abnormally high body temperature (high temperatures kill sperm)
- Anti-sperm antibodies (where the body’s immune symptom attack its own healthy, normal cells — sperm cells, in this case)
- Use of illegal drugs
- Advanced age
- Exposure to toxins (environmental toxins present at home or at work)
Most of the time, when a lab diagnoses necrozoospermia in a semen sample, it is a mistake.
A false-diagnosis may occur if:
- You used a dirty container to collect sperm instead of a sterile cup
- You used a non-fertility friendly lubricant which can kill sperm
- You tried to collect the sperm inside a regular condom
You may be asked for a test repeat if you’ve been diagnosed of necrozoospermia. Your doctor may also be asked to provide two samples in one day when repeating the test. This is because the next ejaculation will have fresher sperm, and those sperm will not have spent as much time waiting to be ejaculated. This can help to properly diagnose the sperm.
Necrozoospermia can be treated easily if the underlying cause is diagnosed. If necrozoospermia is caused by drug abuse, treatment of drug addiction may be recommended. If caused by an infection, antibiotics will be administered.
The most common treatment for complete necrozoospermia is testicular sperm retrieval with IVF-ICSI. It is also known as TESE-ICSI (testicular/epididymal sperm extraction with intracytoplasmic sperm injection).
Though live sperm cells may not be found in the ejaculate, but there are frequently living immature sperm cells found in the testicles. A local anesthesia may be used to numb the testis in order to get to those young germ cells. A needle is then inserted and a sample of testis tissue is extracted for examination. These immature sperm cells are cultured in the fertility clinic lab. The sperm are not able to penetrate and fertilize an egg on their own. That’s why IVF with ICSI is required. ICSI involves injecting a sperm cell directly into an egg.
Another treatment for necrozoospermia is repeated ejaculation the week of treatment. For those with spinal cord injuries, this may be carried out through electroejaculation which involves the use of electrical shocks to force ejaculation, in order to retrieve semen.
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