Definition + False Diagnosis + Possible Causes + Treatment Options

Computer illustraton of sperm swimming, unlike with necrozoospermia where sperm don't move
Necrozoospermia is a very rare case of male infertility.. SCIEPRO / Science Photo Library / Getty Images

Quick definition: Necrozoospermia – or necrospermia – is the medical term for when all the sperm are dead in a fresh semen sample.

Incomplete necrozoospermia is 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 is when all the sperm in a semen sample are dead.

Complete necrozoospermia is very rare. It’s estimated that only 0.2% to 0.5% of infertile men suffer from complete necrozoospermia.

Necrozoospermia shouldn’t be confused with asthenozoospermia.

Asthenozoospermia is when sperm motility – or how the sperm swim – is abnormal. In this case, the sperm don’t move, but they are not dead.

Absolute asthenozoospermia is when no sperm move at all. It occurs in 1 in 5,000 men.

Both asthenozoospermia and necrozoospermia are potential causes of male infertility. There are usually no outward symptoms. They only way to diagnosis the problem is with a semen analysis.

The treatment options are different for absolutely asthenozoospermia and necrozoospermia. With asthenozoospermia, IVF with ICSI is a potential treatment. (IVF with ICSI is when a single sperm is injected into an egg.)

With necrozoospermia, IVF with ICSI can’t be done with fresh ejaculate. You can’t inject a dead sperm into an egg. The most successful treatment for necrozoospermia is testicular sperm extraction with ICSI, or TESE-ICSI.

More on this below.

False-Diagnosis of Necrozoospermia

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 non-fertility friendly lubricant. When masturbating for a semen analysis, it’s very important you either use a “dry rub” (no lubricant) or only use a fertility friendly option.

Regular lubricants can kill sperm.

Always ask your doctor what lubricant you can use safely for the test.

The container to collect sperm was dirty. The semen sample should be collected in a dry, sterile cup.

If the cup was contaminated, it’s possible whatever was in the cup could kill the sperm.

You tried to collect the sperm inside a regular condom. Some men have great difficulty getting a semen sample via masturbation. For them, getting the sample through sexual intercourse can be easier.

However, if you are going to try this, you must use a special condom made for medical collection! Even if the condom isn’t advertised as having spermicide, the latex material can kill the sperm.

If you received a diagnosis of necrozoospermia, your doctor will repeat the test and may send your next semen sample to a specialty lab.

When redoing the test, you may also be asked to provide two samples in one day.

The reason is that the next ejaculation will have fresher sperm, and those sperm will not have spent as much time waiting to be ejaculated.

This can help diagnosis the problem.

What Causes Necrozoospermia?

It’s not entirely clear what causes necrozoospermia. Because it is so rare, there are a lot of unknowns.

Some possible causes and theories behind necrozoospermia include...

Treatment for Necrozoospermia

In cases where the cause for necrozoospermia is found, treatment of that cause is the first step.

For example, if there is infection, antibiotics may be prescribed.

If necrozoospermia is caused by drug abuse, treatment of drug addiction may be recommended.

The most common treatment for complete necrozoospermia is testicular sperm retrieval with IVF-ICSI. Also known as TESE-ICSI.

TESE-ICSI stands for testicular / epididymal sperm extraction with intracytoplasmic sperm injection.

Even though there are no live sperm cells in the ejaculate, there are frequently living immature sperm cells found in the testicles.

To get to those young germ cells, local anesthesia is used to numb the testis. Then, a needle is inserted and a sample of testis tissue is biopsied (or extracted). 

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.

A less common but possible treatment for necrozoospermia is repeated ejaculation the week of treatment. For those with spinal cord injuries, this may be carried out through electroejaculation. (Electroejaculation involves the use of electrical shocks to force ejaculation, in order to retrieve semen.)

A very small study found that repeated ejaculation – in this case, twice a day for four to five days – increased the number of live, mobile sperm. The increase was significant. The percentage increased three to seven times compared to prior treatment.

The live sperm found in these samples could then be used during IVF or IVF-ICSI.

However, studies have compared IVF pregnancy rates after TESE-ICSI -- against IVF-ICSI with the few sperm found via repeat ejaculations. They found that pregnancy and live birth rates tend to be better with TESE-ICSI.

Another possible treatment option is to use a sperm donor.

More on male infertility:


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Chavez-Badiola A1, Drakeley AJ, Finney V, Sajjad Y, Lewis-Jones DI. “Necrospermia, antisperm antibodies, and vasectomy.” Fertil Steril. 2008 Mar;89(3):723.e5-7. Epub 2007 Jul 5.

Chemes EH1, Rawe YV. “Sperm pathology: a step beyond descriptive morphology. Origin, characterization and fertility potential of abnormal sperm phenotypes in infertile men.” Hum Reprod Update. 2003 Sep-Oct;9(5):405-28.

Electroejaculation. Weill Cornell Medical College. Accessed February 15, 2016.

Negri L1, Patrizio P, Albani E, Morenghi E, Benaglia R, Desgro M, Levi Setti PE. “ICSI outcome is significantly better with testicular spermatozoa in patients with necrozoospermia: a retrospective study.” Gynecol Endocrinol. 2014 Jan;30(1):48-52. doi: 10.3109/09513590.2013.848427. Epub 2013 Oct 22.

Ortega C1, Verheyen G, Raick D, Camus M, Devroey P, Tournaye H. “Absolute asthenozoospermia and ICSI: what are the options?” Hum Reprod Update. 2011 Sep-Oct;17(5):684-92. doi: 10.1093/humupd/dmr018. Epub 2011 Aug 3.

Vicari E1. [Diagnostic approach and therapeutic strategy in 133 infertile patients with astheno-necrozoospermia]. [Article in Italian] Arch Ital Urol Androl. 1999 Feb;71(1):19-25.

Wilton LJ1, Temple-Smith PD, Baker HW, de Kretser DM. “Human male infertility caused by degeneration and death of sperm in the epididymis.” Fertil Steril. 1988 Jun;49(6):1052-8.

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