Necrospermia - Causes, Symptoms, Diagnosis, and TreatmentWhat is necrospermia?
Necrospermia is a condition in which the spermatozoa in seminal fluid are dead or motionless.
When semen has less of mature normal sperms & more of dead sperms this condition is abnormal. When ever there is less of normal sperm then chances of spontaneous pregnancy decreases (i.e. difficulty in conceiving i.e. wife does not becomes pregnant). This is one of the common causes of male factor infertility. This is also one of the most common semen abnormalities in men.
What are necrospermia causes?
1. Deficiency of central sperm producing hormones
Hypothalamic: pituitary deficiency: Idiopathic GnRH deficiency, Kallman syndrome, Prader-Willi syndrome, Laurence-Moon-Biedl syndrome, Hypothalamic deficiency, pituitary hypoplasia, Trauma, post surgical, postiradiation, Tumour (Adenoma, craniopharyngioma, other), Vascular (pituitary infraction, carotid aneurysm), Infiltrative (Sarcoidosis, histiocytosis, hemochromatosis) Autoimmune hypophysitis, Drugs (drug-induced hyperprolactinemia, steroids use)
Untreated endocrinopathies, Glucocorticoid excess, Hypopituitarism, Isolated gonadotropin deficiency (non acquired): Pituitary, Hypothalamic, Associated with multiple pituitary hormone deficiencies: Idiopathic pan hypo pituitarism (hypothalamic defects), Pituitary dysgenesis, Space-occupying lesions(craniopharyngioma, Rathke pouch cysts, hypothalamic tumors, pituitary adenomas), , Laurence-Moon-Beidl syndrome Prader-Willi syndrome , Frohlich syndrome, Hypergonadotropic hypogonadism : Klinefelter syndrome, Noonan syndrome, Viral orchitis, Cytotxic drugs, Testicular irradiation.
2. Testicular disorders (primary leydig cell dysfunction i.e. Hypoganadism), Chromosomal (Klinefelter syndrome and variants, XX male gonadal dysgenesis), Defects in androgen biosynthesis, Orchitis (mumps, HIV, other viral, ),Myotonia dystrophica, Toxins (alcohol, opiates, fungicides, insecticides, heavy metals, cotton seed oil), Drugs (cytotoxic drugs, ketoconazole, cimetidine, spironolactone)
3. Varicocele: varicocele is dilatation of scrotal vein in the scrotum that leads to rise in temperature of testis and raise testicular temperature, resulting in less sperm production & death of whatever sperms are produced.
4. Drugs (e.g. spironolactone, ketoconazole, cyclophosphamide, estrogen administration, sulfasalazine)
5. Autoimmunity i.e. presence of Antisperm antibody. These Antisperm antibodies bind with sperms & either make them less motile, totally immotile or even dead which is called necrospermia.
6. Undescended Testicle (cryptorchidism). Undescended testis is a condition when one or both testicles fail to descend from the abdomen into the lower part of scrotum during fetal development. Undescended testicles can lead to less sperm production. Because the testicles temperature increase due to the higher internal body temperature compared to the temperature in the scrotum, sperm production may be affected.
7. Mosaic Klinefelter's syndrome In this disorder of the chromosomes, of the man is abnormal. This causes abnormal development of the testicles, resulting in low sperm production. Testosterone production may be low or normal.
8. Viral Orchits as mumps or other viral infections.
9. Infections as tuberculosis, sarcoidosis involving testis or surrounding structures as epididymis.
10. Chronic systemic diseases as Liver diseases, Renal failure, Sickle cell disease, Celiac disease
11. Neurological disease as myotonic dystrophy
12. Development and structural defects as mild degree of Germinal cell hypo-plasia
13. Partial Androgen resistance
14. Mycoplasmal infection
15. Partial Immotile cilia syndrome
16. Partial Spermatogenic arrest due to interruption of the complex process of germ cell differentiation from spermatid level to the formation of mature spermatozoa results in decreased sperm count i.e. oligospermia. Its diagnosis is made by testicular biopsy. This is found in upto 30% of all cases of dead sperm patients.
17. Heat Exposure to testis: as febrile illness or exposure to hot ambience induces a abnormality in spermatogenesis.
19. Infection – as bacterial epididimo-orchitis, even in prostatis spermatogenic defect have been noted
20. Hyper-thermia due to cryptorchidism
21. Chromosomal abnormality: has been found in many cases of low sperm count
22. Alcohol use, Cocaine or heavy marijuana use or Tobacco smoking may lower sperm count
23. Anti-sperm antibodies. In some people there occurs development of some abnormal blood proteins called anti-sperm antibodies, which binds with sperm and make them either immotile or dead or decrease their count.
24. Infections. Infection of uro-genital tract may affect sperm production. Repeated bouts of infections are one of the common causes associated with male infertility.
25. Klinefelter's syndrome. In this disorder of the chromosomes, a man has two X chromosomes and one Y chromosome instead of one X and one Y. This causes abnormal development of the testicles, resulting in low or absent sperm production. Testosterone production also may be lower.
26. Trauma to testis
27. Environmental toxins: as Pesticides and other chemicals in food or as ayurvedic medicines.
28. Genetic Factors: as idiopathic partial hypo-gonadotropic hypogonadism
How is the cause of necrospermia diagnosed?
For correct diagnosis of cause of necrospermia, we need detail history & physical examinations then certain relevant investigations are required.
History & Physical Examinations: First step in proper treatment is accurate diagnosis of cause of dead sperms. So we first try to find out cause. We take detailed history, thorough drug history and general physical examination, examination of testis, epididymis, testicular veins & sperm carrying duct examinations. These examinations give idea about whether testis is normally developed or not & how is its function. After that depending on likelihood of particular, cause relevant tests are done. All testing facilities are available at our centre. Thus you may consult us at our centre & at same time you may get all tests done. The time taken in getting all the reports ready is 36 hours.
Investigation & Diagnosis: For completes diagnosis of causes of dead sperms one or more of the following tests may be required as
1) Complete male hormone profile: This profile includes all the male hormone tests which control testicular development, functions including normal sperm Productions. The tests include L.H., F.S.H., Testosterones, prolactins, thyroids test, & other relevant hormone tests depending on history & examinations.
2) Antisperm antibody
3) USG or Doppler study of scrotum & testis
4) Semen culture sensitivity
5) Semen fructose
6) Immunobead test
7) Sperm Function Tests
8) Human Sperm-Zona Pellucida Binding Ratio
9) Human Sperm-Zona Pellucida Pentration test
10) Genetic Studies
11) FNAC Testis
12) Egg penetration test
13) Molecular genetic studies done in some special cases
14) Chromosome analysis i.e. Karyotype
15) Assessment of androgen receptor
16) Combined Pituitary hormone tests is performed when needed
17) MRI head if pituitary hormone defect suspected
18) Hemogram test for systemic diseases.
19) Sperm Function Tests
The hamster egg penetration assay (HEPA) and the hemizona assay (HZA) are sperm function tests which can help assess the ability of sperm to penetrate the egg. These tests will not definitively tell whether a pregnancy will occur, but an abnormal test result helps predict reduced fertilizing capability. These tests are performed only rarely today.
20) Semen Fructose
21) Sperm Coiling Test to find out whether the particular sperm is live or dead
How is necrospermia treated?
Secondary necrospermia can be treated once the cause of this condition is found. The treatment should be aiming at treating the cause before correcting the abnormity of testicles. Herbal meidicine "diuretic and anti-inflmmatory pill" could also eliminate all symptoms of necrosermia without reoccur.