Necrozoospermia

Necrozoospermia is a condition in which all of the sperm in a man's ejaculate are dead. In point of fact, there are a number of reasons for a man to be afflicted with necrozoospermia. Indeed, necrozoospermia can be the result of everything from diet, disease, injury, medications, alcohol or illicit drug use and other factors. In many instances, if the underlying cause of necrozoospermia is resolved, the condition of necrozoospermia likewise will be rectified.

If you have been told by your doctor that you suffer from necrozoospermia, it is important that you do seek further medical attention. In some instances, necrozoospermia can be a symptom of a serious problem that can have very serious additional consequences beyond necrozoospermia. For example, in some instances, necrozoospermia is the sign of another condition or disease that could even end up resulting in erectile dysfunction. Although allopathy has no answers for this condition, some Indian Ayurvedic formulations seem to have shown improvement with this condition in isolated case reports.

For the doctor, he must distinguish between live –immotile sperms and dead-immotile sperms. Assisted Reproductive Techniques can help patients whose sperms are alive but immotile. We had a patient; the individual simply didn't follow proper collection technique and had been using a lubricant gel. As soon as he collected without the lubricant, his motility was in the normal range. One should also test the semen for autoantisperm antibodies that might have been caused by a different habit of sex, eg. Anal sex. Usually, with such severe motility problems, the patient has to undergo Intracytoplasmic Sperm Injection (ICSI). Let me start a thread here for the medical bloggers.

For a man with 100% immotile sperm in the ejaculate, of which 10% are live, are pregnancy rates better with ICSI (after selecting live sperm with a hypo-osmotic swelling test); or is it better to offer TESE-ICSI (ICSI with testicular sperm extraction)?

10% viable sperms should be good enough for ICSI. Why TESE-ICSI, if one can get 10% viable sperms in the ejaculate? Moreover, TESE is associated with complications - like fibrosis. TESE because you cannot pick out which of the 10% are viable sperm to inject with good reliability. HOS test may help but data on it's use for ICSI involves small numbers. You are much more likely to have higher viability from the testis (assuming no motile sperm are found in the vas or epididymis) than from the ejaculate. Surgical retrieval of sperm is an option that should not be ignored in such cases, as we all are driven to achieve the best possible outcomes for our patients. Do a testicular retrieval fresh at the time of IVF/ICSI. You will probably find motile (twitching) sperm. This is much more reliable than trying to identify viable sperm in a 0% immotile ejaculate.

The task of selecting a single sperm for injection, from the stated 10% viable population from the sample of zero motility, on the basis of the HOS test, is no way nearly as easy as some colleagues would like you to believe. It is technically difficult to pick up curled sperm which have been exposed to HOS solution. But you can pick the sperm up from culture media, transfer your needle into a drop of HOS solution, hold the sperm near the opening of the needle and allow the HOS solution to diffuse into the needle and you can watch the sperm start to curl inside the ICSI needle. As soon as you see the sperm tail curl, you can move to a PVP drop, break the tail and perform the ICSI.

Our experience with such situation is that (1) the outcome (in terms of fertilization and pregnancy rates) is the same between viable (non-motile) testicular sperm and viable (non-motile) ejaculated sperm; (2) motile spermatozoa can be found in some (about 40%) of the patients with 100% immotile sperm in ejaculated semen. This is the only reason that testicular biopsy is carried out in patients with 100% non-motile ejaculated sperm in our Center.

First, a viability test is essential. Alternatives to HOS are Eosin Y or Trypan blue staining, or use of a fluorescent DNA-binding probe such as Hoechst 33258. If all the sperm in semen are 'dead', we would not suggest ICSI using them. In our practice, we determine whether there is an immediate possible cause of cell death such as high reactive oxygen species generation by leukocytes, which might be addressed. If not, a vas or testicular aspiration is considered. We have seen normal (for the site)
motility from either vas or testis when semen sperm motility is poor. Second, if some of the sperm are apparently live, we would attempt to stimulate motility using pentoxifylline. Surprisingly, this has worked in some cases of 0% motility. The induced motility may or may not be of sufficient quality and quantity to consider IUI or IVF. But, even if there is only twitching motility, this may be sufficient to choose sperm for ICSI. The pentoxifylline is washed out of the sperm preparation before any of the insemination procedures. This also avoids having to use HOS to choose non-motile sperm. Third, if no sperm respond to pentoxifylline, medical, genetic, or electron microscopic evidence could be gathered to rule out an immotile cilia syndrome, followed by genetic counseling.