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

Necrozoospermia—or necrospermia—is the medical term for when all the sperm is 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 moves 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. The only way to diagnosis the problem is with a semen analysis.

The treatment options are different for absolute 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.


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 diagnose the problem.


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...

  • Infection in the male reproductive tract
  • Prolonged periods of no ejaculation
  • Spinal cord injuries
  • Problems with the testicles
  • Problems with the epididymis (which is a long, coiled tube just above each testicle, where sperm are collected and mature before ejaculation)
  • Hormonal cause, as with hypogonadotropic hypogonadism (HH)
  • Early testicular cancer
  • Abnormally high body temperature (high temperatures kill sperm)
  • Anti-sperm antibodies (where the body’s immune symptom attack its own healthy, normal cells — sperm cells, in this case)
  • Varicocele
  • Exposure to toxins (environmental toxins present at home or at work)
  • Street drug use
  • Advanced age (yes, age matters for male fertility)


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 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.

Other 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 very small study performed in 1988 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, in 2013, researchers 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.

Was this page helpful?
Article 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.
  1. 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

  2. Brahem S, Jellad S, Ibala S, Saad A, Mehdi M. DNA fragmentation status in patients with necrozoospermia. Syst Biol Reprod Med. 2012;58(6):319-23. doi:10.3109/19396368.2012.710869

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

  4. Chavez-badiola A, Drakeley AJ, Finney V, Sajjad Y, Lewis-jones DI. Necrospermia, antisperm antibodies, and vasectomy. Fertil Steril. 2008;89(3):723.e5-7. doi:10.1016/j.fertnstert.2007.04.007

  5. 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

  6. Wilton LJ, Temple-smith PD, Baker HW, De kretser DM. Human male infertility caused by degeneration and death of sperm in the epididymis. Fertil Steril. 1988;49(6):1052-8. doi:10.1016/s0015-0282(16)59960-9

Related Articles