How Necrozoospermia affects fertility?

When couples face difficulty in conceiving, it can be due to both male and female factors. Therefore, checking the male partner’s health becomes equally important as checking the female partner’s health. One of the reliable tests that is mostly recommended for men is semen analysis. It helps analyse the male reproductive health conditions, including necrozoospermia, which we will be discussing in this article. Many of you might be reading about this condition for the first time, but do not worry, as this guide will help you get the clarity you want.

What is Necrozoospermia?

Necrozoospermia is a male infertility condition characterised by dead or non-viable sperm cells in the ejaculate. According to clinical guidelines, necrozoospermia is diagnosed when more than 42% of sperm in a semen sample are non-viable (based on vitality staining tests).
If all sperm are dead, the condition is called complete necrozoospermia.

Most people confuse viability with motility, but both are different conditions:

• Motility tells about the movement of sperm.
• Viability tells us whether they are alive.

Therefore, in necrozoospermia, sperm can appear immotile, not because they have a movement problem, but because they are not alive.

Who Can Get Necrozoospermia?

Necrozoospermia can affect men regardless of their age. It is not restricted to any particular demographic or lifestyle group. It can appear in:

• Men with underlying infections
• Men with hormonal imbalances
• Men who have had testicular injuries
• Men with long-standing and untreated varicocele
• Individuals with prolonged heat exposure
• Men with systemic medical issues like diabetes
• Long-term smokers or substance users

Causes of Necrozoospermia

Necrozoospermia is rare and seen in less than 1% of infertility cases. There are multiple factors that can lead to sperm death before ejaculation:

1. Genital tract infections

Conditions such as epididymitis or prostatitis can create a toxic environment for sperm, which leads to reduced viability.

2. Oxidative stress

High levels of oxidative stress caused by smoking, alcohol, poor diet, environmental toxins, or chronic illness can damage sperm membranes.

3. Varicocele

Varicocele is a condition that raises testicular temperature and impairs oxygen levels. This may eventually result in sperm death.

4. Autoimmune reactions

These refer to the body’s own reaction against healthy cells or tissues. If your body is producing antibodies that attack sperm cells, this may lead to necrozoospermia.

5. Ejaculatory duct obstruction

When sperm remain trapped in the reproductive ducts for too long, they may die before being released.

6. Fever or systemic illness

High fevers or chronic diseases like diabetes can temporarily reduce sperm vitality.

7. Toxin or medication exposure

Certain chemotherapy drugs, anabolic steroids, and radiation exposure can impair sperm survival.

8. Testicular trauma

Injury to the testicles may lead to poor sperm production and viability.

9. Genetic causes

This is a rare scenario where certain genetic abnormalities can impact sperm structure and survival.

Symptoms of Necrozoospermia

Most men do not notice any visible symptoms. Commonly reported symptoms when present are related to the underlying cause, not necrozoospermia itself. These include:

• Testicular pain or swelling (infection or varicocele)
• Discomfort while urinating
• Decreased semen volume
• Sexual dysfunction
• Fever (if an infection is present)

Many men may not have any noticeable symptoms until they undergo semen testing.

How is Necrozoospermia Diagnosed?

Your fertility specialist may recommend any of the following tests for a detailed analysis:

1. Sperm Vitality Test: It is done using the eosin-nigrosin stain or the hypo-osmotic swelling test to check how many sperm are alive.
2. Motility Assessment: This is required to differentiate between non-moving but “alive sperm” and dead sperm.
3. Semen Culture Test: It helps identify infections of the reproductive tract.
4. Hormone Check: It is important to track the levels of key reproductive hormones i.e. testosterone, FSH, LH, and prolactin.
5. Ultrasound: USG scan helps check for varicocele or duct obstruction.

A single semen test is often not enough. Doctors usually confirm the condition through repeated testing or combining multiple tests.

Types of Necrozoospermia

The following are two major types of necrozoospermia:

Partial Necrozoospermia	Complete Necrozoospermia
The semen sample contains more than 42% dead sperm. Some viable sperm are still present. This type of necrozoospermia is common and easier to manage.	100% of the sperm in the sample are dead. This type is rare and affects less than 0.2% of infertile men. It requires advanced treatment options.

Treatment Options For Necrozoospermia

The underlying cause is the prime factor that decides the course of treatment. The following are some options available:

1. Infection Treatment 

If the cause is infection, then antibiotics and anti-inflammatory medicines help restore normal sperm vitality in many cases.

2. Varicocele Repair (Varicocelectomy)

It helps improve temperature regulation and reduces oxidative stress, which may improve sperm viability.

3. Hormonal Therapy

If hormonal imbalance is the cause, medications like hCG, clomiphene, or aromatase inhibitors may help.

4. Lifestyle Modifications

It is a crucial part of treatment that includes:

• Quitting smoking
• Limiting alcohol consumption
• Maintaining a healthy weight
• Regular exercise
• Avoiding hot baths, saunas, and laptop heat exposure
• Improving diet rich in antioxidants (vitamin C, E, zinc, selenium, lycopene)

5. Antioxidant Therapy

Supplements such as L-carnitine, CoQ10, and omega-3 fatty acids can improve sperm membrane health.

6. Assisted Reproductive Techniques (ART)

In advanced cases like complete necrozoospermia, the following options help couples achieve pregnancy:

• ICSI (Intracytoplasmic Sperm Injection):
  Even a single viable sperm can be injected into an egg.
• Testicular Sperm Extraction (TESE/Micro-TESE):
  Sperm retrieved directly from the testicle is often healthier than ejaculate sperm in necrozoospermia cases.
• IVF/ICSI combinations for couples with multiple infertility factors.

How Common Is Necrozoospermia?

Necrozoospermia is a rare condition and contributes around 0.2–0.8% of male infertility cases, making it far less common than conditions like low sperm count or low motility. Due to its rarity, it requires evaluation by a fertility specialist who is adept at handling complex infertility cases.

How Does Necrozoospermia Affect Male Fertility?

For pregnancy to occur naturally, sperm must meet three important conditions, i.e. they should be alive, motile, and able to fertilise the egg. In necrozoospermia, the lack of viable sperm makes natural conception difficult or impossible, depending on severity. This is how it affects fertility:

• Sperm cannot swim through cervical mucus
• They cannot reach or penetrate the egg
• Even if one reaches, dead sperm cannot fertilise

However, with ART treatments like ICSI or testicular sperm retrieval, many couples can still have a successful pregnancy.

Can Lifestyle Changes Help Reverse Necrozoospermia?

Yes, if the underlying cause is reversible, necrozoospermia can be reversed. Lifestyle changes can significantly improve sperm vitality in cases caused by:

• Heat exposure
• Oxidative stress
• Smoking
• Alcohol use
• Poor diet
• Mild varicocele
• Chronic stress

However, lifestyle changes alone cannot reverse necrozoospermia caused by:

• Genetic abnormalities
• Severe testicular damage
• Unresolved obstruction

Can a Woman Conceive Naturally If the Male Partner Has Necrozoospermia?

For conception, the presence of viable sperm is crucial.

Natural pregnancy is possible if:	Natural pregnancy is not possible if:
The male partner has partial necrozoospermia Enough viable sperm remain to fertilise an egg	The man has complete necrozoospermia No viable sperm are present in the ejaculate

In cases of complete necrozoospermia, fertility specialists usually attempt ICSI using testicular sperm, which offers good success rates.

The Closing Note

Necrozoospermia can sound alarming, but the solution lies in understanding the real reason behind it. Once the cause is identified, it becomes much easier to treat it. Many men see improvement with the right treatment and lifestyle changes. Even if the sperm viability remains low, there are advanced fertility procedures such as ICSI and testicular sperm retrieval that can make your dream of fatherhood possible. All you need is the right guidance from a fertility expert and a personalised treatment approach that suits your condition.

If you are struggling with any infertility or reproductive health issues, feel free to consult our leading fertility specialists at Birla Fertility & IVF, who bring years of experience in handling even complex cases of infertility.

FAQs

1. What is the normal range for necrozoospermia?

A normal semen sample has less than 42% dead sperm. If more than 42% are dead, it is considered necrozoospermia. If 100% are dead, it is called complete necrozoospermia.

2. Can necrozoospermia be treated permanently?

• Yes, if it is caused by a treatable problem such as infection, varicocele, hormonal imbalance, or lifestyle factors.
• No, if the cause is genetic, due to severe testicular injury, or caused by irreversible medical treatments like chemotherapy.

Even in non-reversible cases, ICSI with testicular sperm retrieval offers strong chances of conception.

3. What is the difference between necrozoospermia and azoospermia?

Parameter	Necrozoospermia	Azoospermia
Presence of sperm	Present, but dead	No sperm at all
Main issue	Sperm viability	Sperm production or blockage
Diagnosis	Vitality tests	Microscopic exam + hormonal tests
Natural conception	Depends on viability	Not possible
Treatment	Lifestyle, medications, ART	Depends on the cause, often requires surgical sperm retrieval