GLOBAL ANDROLOGY FORUM

Publications

Sperm Vitality and Necrozoospermia: Diagnosis, Management, and Results of a Global Survey of Clinical Practice

June 18, 2023

Sperm Vitality and Necrozoospermia: Diagnosis, Management, and Results of a Global Survey of Clinical Practice.

Agarwal A, Sharma RK, Gupta S, Boitrelle F, Finelli R, Parekh N, Durairajanayagam D, Saleh R, Arafa M, Cho CL, Farkouh A, Rambhatla A, Henkel R, Vogiatzi P, Tadros N, Kavoussi P, Ko E, Leisegang K, Kandil H, Palani A, Salvio G, Mostafa T, Rajmil O, Banihani SA, Schon S, Le TV, Birowo P, Çeker G, Alvarez J, Molina JM, Ho CC, Calogero AE, Khalafalla K, Duran MB, Kuroda S, Colpi GM, Zini A, Anagnostopoulou C, Pescatori E, Chung E, Caroppo E, Dimitriadis F, Pinggera GM, Busetto GM, Balercia G, Elbardisi H, Taniguchi H, Park HJ, Maldonado Rosas I, de la Rosette J, Ramsay J, Bowa K, Simopoulou M, Rodriguez MG, Sabbaghian M, Martinez M, Gilani MA, Al-Marhoon MS, Kosgi R, Cannarella R, Micic S, Fukuhara S, Parekattil S, Jindal S, Abdel-Meguid TA, Morimoto Y, Shah R. 
World J Mens Health. 2022 Apr;40(2):228-242. 

https://doi.org/10.5534/wjmh.210149

 CAPSULE: 
Necrozoospermia, also known as necrospermia, is a condition characterized by the presence of a high percentage of non-motile or immotile sperm in semen. In normal circumstances, a certain percentage of sperm in semen should exhibit progressive motility to ensure successful fertilization. However, in necrozoospermia, a significant proportion of the sperm are non-motile, dead, or have impaired motility. The management of necrozoospermia involves addressing contributory factors, lifestyle modifications, and specific interventions based on the condition's severity. Avoidance of heat exposure, lifestyle changes, urogenital infection treatment, and correcting hyperthyroidism are initial management steps. Repeated ejaculations can improve sperm vitality affected by infrequent ejaculations and prolonged epididymal storage. Absolute asthenozoospermia should be differentiated from necrozoospermia by assessing sperm vitality. If a large proportion of live but immotile spermatozoa is present, structural defects in the flagellum may be indicated. Sperm vitality testing methods, such as E-N stain or HOS test, are recommended when total motility is below 40%. The HOS test can aid intracytoplasmic sperm injection (ICSI) by selecting viable spermatozoa. Activation substances such as pentoxifylline (PTX) or theophylline can improve sperm motility but require rinsing before injection. Testicular sperm extraction is recommended for absolute necrozoospermia. 
Necrozoospermia correlates with sperm DNA fragmentation (SDF), emphasizing the need for SDF testing to determine nuclear integrity and guide treatment decisions. Antioxidants may be considered to reduce SDF in severe cases, but further research is needed. Our survey shows diverse vitality testing approaches and limited management strategies for necrozoospermia, underscoring the need for guidelines in this area.

Christine Wyns, MD, PhD

Head of the Cliniques universitaires Saint-Luc's

Gynaecology and Andrology Department

Medical Director of the Reproductive Tissue and Cell Bank

Professor at Université Catholique de Louvain (UCL)

Brussels, Belgium

https://www.international-saintluc.be/en/medecin/professor-christine-wyns