Necrozoospermia, also known as necrospermia, is a condition where all the sperm are dead in the sample of a man's fresh semen. However, complete necrozoospermia is relatively uncommon. Only 0.2-0.5 per cent of infertile males are thought to have total necrozoospermia. It can be classified into:
Moderate: 50 to 80 per cent dead sperm
Severe: more than 80 per cent dead sperm
The best way to manage and treat necrozoospermia is an accurate diagnosis.
To diagnose necrozoospermia, you may have to undergo a few tests, which may include:
Hypo-osmotic flagellar coiling test
Specialized sperm function tests
Male hormone testing
Necrozoospermia is often confused with asthenozoospermia, a condition in which sperm are non-motile but not dead. Asthenozoospermia is easier to manage because ICSI can be done after the living sperm have been identified using sophisticated tests like the hypoosmotic swelling test. It is necessary to speak with your doctor in order to receive the proper diagnosis and treatment. Another issue which you could face is the possibility of a false-positive diagnosis. It usually happens when:
The sperm is collected in condoms which are coated with spermicidal cream
Sperm is collected in a container that is unsterile
The lubricant used to gather the sperm are spermicidal, thereby killing all the sperm
How To Overcome The Issue Of Wrong Diagnosis?
It will help if you use a special non-toxic Silastic condom to collect sperm samples for semen analysis.
You may like to read
If a semen analysis test results in necrozoospermia, you should repeat the test from a trusted lab.
The lab technician must be experienced to identify between immotile sperm and dead sperm.
The technician may use special supravital stains, such as eosin-nigrosin, to accomplish this.
These tests must be performed correctly, which is why a reference andrology lab is an ideal place to verify the diagnosis.
Providing a second semen sample 1 hour after the first is recommended. It is fresher and will often include a few live sperm even if the first sample did not have any.
The semen sample must be centrifuged in the lab to check for pellet in the sperm.
What Are The Treatment Options?
When the cause of necrozoospermia is established, the first step is to address the cause. Antibiotics, for example, may be administered if there is an infection. If necrozoospermia is due to drug misuse, the doctor may suggest drug addiction treatment.
Fertilization rates are low in people with necrozoospermia. However, ICSI improves the possibilities of conception. IVF with testicular sperm extraction (TESE-ICSI) is the best treatment option in cases of necrozoospermia. Your doctor will use a local anaesthetic to numb the testis during this procedure. After that, a needle is inserted to extract a small tissue.
In spite of not finding any live sperm cells in the ejaculate, sperm cells are often found in the testicles. These sperm may not be able to penetrate and fertilize an egg on their own. That's why IVF with ICSI is necessary. Here, your doctor will inject the egg directly with the sperm. With TESE-ICSI, the success rates are high. However, considering a sperm donor or other family alternatives may be the best next step when fertility treatments fail.
(The article is contributed by Dr Hrishikesh Pai, Consultant Gynaecologist & Infertility specialist, Lilavati Hospital, Mumbai, D Y Patil Hospital, Navi Mumbai and Fortis hospitals)