Necrozoospermia - Meaning, Causes and Treatment | Severe Asthenospermia

Necrozoospermia is an uncommon diagnosis. This is the rare condition in which all of the sperm in a man's semen is dead. Because this is so uncommon, there's still a lot of confusion about the right way to manage this.

Step number 1 is to confirm the diagnosis.

Often, this diagnosis is made incorrectly, usually because the semen sample was not collected properly:

  • This may be because the man used a spermicidal lubricant while masturbating
  • The container may have been dirty, and this contamination could kill the semen
I remember a man who spilled his semen sample while collecting it. Rather than tell us what happened, he scooped it up from the floor and added the sample to the container - the result being that the lab reported that all his sperm were dead!

This can also be a problem for men who have difficulty in producing a semen sample by masturbating. If you try to collect your semen for the semen analysis by having sex using a regular condom, the spermicidal lubricant in the condom will kill all the sperm! This is why you need to use a special non-toxic Silastic condom for sperm collection if you want to do a semen analysis.

If one semen analysis test is reported as Necrozoospermia, simple common sense suggests that you need to repeat this again - from a reliable lab!
  • In the lab, the technician needs to differentiate immotile sperm ( which are alive but are not moving); and dead
  • This can be done using special supravital stains, such as eosin-nigrosin
  • It is essential that these tests be done properly, which is why a reference andrology lab is the best place to get this diagnosis confirmed
  • It’s a good idea to provide a sequential ejaculate ( a second semen sample 1 hour after the first). This will often contain a few live sperm, even when the first does not, because it is "fresher”
  • The lab needs to centrifuge the semen sample and check the pellet for sperm.
Severe asthenospermia

If the sperm are live but immotile, then the diagnosis is not necrozoospermia, but severe asthenospermia. This is a condition which is easier to manage because it’s possible to do ICSI after identifying the live sperm using special techniques such as the hypoosmotic swelling test ( HOS.)

However, if all the sperm are dead, then it’s not possible to do ICSI using the ejaculated semen sample.Unfortunately, there no medical or surgical treatment for this condition. We do not know what causes this necrozoospermia, which is why we cannot treat it. However, we do have a very effective treatment solution for these patients, with a very high success rate!

The best option is TESE-ICSI - testicular sperm extraction with ICSI. Since the sperm are being directly extracted from the testes, they all have to be alive, since all cells in the body are alive! With TESE-ICSI, fertilization is guaranteed - and the success rate is very high because the wives of these men are usually young ( since the diagnosis is made quite early during the infertility workup). Because we have such high success rates with this condition , we can also offer a guaranteed pregnancy treatment option.

Unfortunately, a lot of doctors still waste a lot of the patient’s time and money by "treating " them with herbs and ayurvedic medicines and varicocele surgery. The truth is that none of these interventions help at all!
Authored by : Dr Aniruddha Malpani, MD and reviewed by Dr Anjali Malpani.