Necrospermia is a condition where a high percentage of sperm in the ejaculate are non-viable, or dead. This is different from conditions characterized by low sperm count or poor movement in living sperm. A diagnosis of necrospermia is made when more than 42% of the sperm in a sample are found to be non-viable.
Causes of Necrospermia
The factors leading to sperm death are varied. Infections of the reproductive tract, such as epididymitis or prostatitis, can create an environment that damages sperm. Physical conditions like a varicocele (swelling of veins in the scrotum) can increase testicular temperature and harm sperm health. Hormonal imbalances and spinal cord injuries are other medical issues linked to this condition.
Environmental exposures and personal habits also play a part. Excessive heat from frequent hot tub use, laptops on the lap, or tight clothing can raise scrotal temperature and harm sperm. Lifestyle choices like smoking, heavy alcohol consumption, or drug use introduce toxins that are detrimental to sperm viability. Exposure to radiation, chemotherapy, and certain industrial chemicals are also risk factors.
Problems with sperm storage and transport can contribute to necrospermia. The epididymis is a coiled tube where sperm mature and are stored, and issues within this structure can lead to sperm death. Similarly, long periods of sexual abstinence may increase the proportion of dead sperm in the ejaculate, as older sperm degrade over time.
The Diagnostic Process
Diagnosing necrospermia begins with a semen analysis, which measures sperm concentration, motility, and morphology. When a high percentage of sperm are immotile, further investigation is needed to determine if these sperm are alive but not moving, or if they are non-viable. This distinction is necessary for an accurate diagnosis.
To differentiate between dead and live, non-motile sperm, a sperm vitality test is performed. The most common method is the eosin-nigrosin staining technique, where a special dye is mixed with the semen sample. Live sperm have intact cell membranes that prevent the dye from entering, while dead sperm have compromised membranes that allow the dye to penetrate, causing them to appear colored.
Another method is the hypo-osmotic swelling (HOS) test, which assesses the sperm’s membrane integrity. Live sperm placed in a special solution will absorb water, causing their tails to swell and curl, while dead sperm with damaged membranes will not react. A vitality result showing less than 58% live sperm confirms a necrospermia diagnosis.
Fertility and Treatment Pathways
A diagnosis of necrospermia does not eliminate the possibility of fathering a biological child. It is often possible to find enough healthy, living sperm to achieve fertilization through assisted reproductive technologies (ART). These procedures bypass the natural barriers that immotile sperm cannot overcome.
The primary treatment for overcoming infertility from necrospermia is Intracytoplasmic Sperm Injection (ICSI). This procedure is performed as part of an in vitro fertilization (IVF) cycle. An embryologist selects a single, viable sperm from the sample and injects it directly into a retrieved egg. Because ICSI requires only one healthy sperm per egg, it circumvents the need for motility.
If a specific underlying cause for necrospermia is identified, addressing it may improve sperm quality. For example, treating a reproductive tract infection with antibiotics or surgically correcting a varicocele can increase the percentage of live sperm. These interventions may improve the chances of success with ART or, in some cases, restore natural fertility.
Lifestyle changes can also be beneficial. Reducing or eliminating exposure to factors known to harm sperm, such as quitting smoking, limiting alcohol, and avoiding excessive heat, can improve overall sperm health. These modifications can enhance the quality of the sperm available for ART procedures, contributing to a better outcome.