Necrozoospermia Causes and Treatment

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
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Necrozoospermia—or necrospermia—is the medical term that describes when the sperm is dead (or necrotic) in a fresh semen sample. Necrozoospermia can be classified as moderate (50% to 80% necrotic sperm) or severe (80% or more of sperm are necrotic). A sperm sample is considered "normal" if 30% of the sperm or fewer are necrotic.

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

Causes of Necrozoospermia

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

  • Abnormally high body temperature (such as in men who use wheelchairs or hot tubs)
  • Advanced paternal age
  • Anti-sperm antibodies (where the body’s immune symptom attack its own healthy, normal sperm cells)
  • Early testicular cancer
  • Exposure to toxins, such as lead, pesticides, mercury, or cadmium
  • Hormonal causes, as with hypogonadotropic hypogonadism (HH)
  • Infection in the male reproductive tract
  • Problems with the testicles or epididymis (which is a long, coiled tube just above each testicle, where sperm are collected and mature before ejaculation)
  • Prolonged periods of no ejaculation
  • Spinal cord injuries
  • Street drug use
  • Varicocele (abnormally dilated veins in the scrotum)

Necrozoospermia vs. Asthenozoospermia

Necrozoospermia shouldn’t be confused with asthenozoospermia, which describes when sperm motility (how sperm swim) is abnormal. In that case, the sperm don’t move, but they are not dead. Absolute asthenozoospermia is when 100% of the sperm in a sample is unable to move, a condition occurring in 1 in 5,000 men.

Both asthenozoospermia and necrozoospermia are potential causes of male infertility. There are usually no outward symptoms. The only way to diagnose the problem is with a semen analysis. Even with testing, 50% of male infertility causes are left undetermined.

The treatment options are different for absolute asthenozoospermia and necrozoospermia. With asthenozoospermia, in vitro fertilization (IVF) with intracytoplasmic sperm injection (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, because you can’t inject a dead sperm into an egg.

False Diagnosis

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 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.

If you are going to try collecting sperm inside a condom, 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 diagnose the problem.

Necrozoospermia Treatment

In cases where the cause for necrozoospermia is found, treatment of that cause is the first step. For example, if there is an infection, antibiotics may be prescribed. If necrozoospermia is caused by drug abuse, treatment for drug addiction is recommended.

The most successful treatment for necrozoospermia is testicular/epididymal sperm extraction with ICSI (TESE-ICSI). In this procedure, local anesthesia is used to numb the testis. Then, a needle is inserted and a sample of testis tissue is biopsied (or extracted).

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

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. The immature sperm cell is injected directly into an egg.

Other Treatment Options

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 Word From Verywell

Infertility is a challenging issue that affects 10% to 15% of couples. When fertility treatments are unsuccessful, using a sperm donor or considering alternative family options (like fostering or adoption) might be the right next step. Although infertility is difficult and upsetting, there are always options for becoming a parent. Speak to your fertility doctor or about whether it's time to explore a different approach.

8 Sources
Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Centers for Disease Control and Prevention. Infertility FAQs. Updated January 16, 2019.

  3. John Hopkins Medicine. Varicocele.

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  5. NIH Eunice Kennedy Shriver National Institute of Child Health and Human Development. How common is male infertility, and what are its causes? Updated December 1, 2016.

  6. Samaritan Health. Collecting a semen sample for analysis.

  7. Negri L, Patrizio P, Albani E, et al. ICSI outcome is significantly better with testicular spermatozoa in patients with necrozoospermia: A retrospective study. Gynecol Endocrinol. 2014;30(1):48-52. doi:10.3109/09513590.2013.848427

  8. Meng X, Fan L, Wang T, Wang S, Wang Z, Liu J. Electroejaculation combined with assisted reproductive technology in psychogenic anejaculation patients refractory to penile vibratory stimulationTransl Androl Urol. 2018;7(Suppl 1):S17–S22. doi:10.21037/tau.2018.01.15

By Rachel Gurevich, RN
Rachel Gurevich is a fertility advocate, author, and recipient of The Hope Award for Achievement, from Resolve: The National Infertility Association. She is a professional member of the Association of Health Care Journalists and has been writing about women’s health since 2001. Rachel uses her own experiences with infertility to write compassionate, practical, and supportive articles.