Necrospermia

Necrospermia is most often detected during semen analysis for the study of male reproductive capacity. Relatively simple morphological analysis of seminal fluid makes it possible to obtain information about the type of pathology and the violation of the functionality of the male sexual system already at the first stage of clinical diagnosis. The causes of necrospermia can be diseases affecting the testicles, prostate gland, violating the conductivity of the seminal ducts. Semen examination is considered one of the basic tests for the detection of hormonal disorders, diseases of reproductive organs and developmental anomalies.

Necrospermia is said if more than half of the spermatozoa in the sperm secretion of a man are non-viable, non-living. It is important to discover the cause of this disorder: this increases the likelihood of the effectiveness of the prescribed treatment, since the therapeutic methods differ significantly in different variants of male infertility. [1]

Epidemiology

Necrospermia is said to occur when less than half of the viable sperm cells are present in a man's semen, or there are no living sex cells at all. This pathology is the cause of male infertility in about 0.4% of cases.

In turn, there are many known factors for the development of necrospermia. However, in one in five patients, the cause of the malfunction is not possible to find out. But in almost every second or third patient necrospermia is a consequence of infectious processes of the urogenital tract, mainly of a chronic nature, or sexually transmitted diseases.

In general, male infertility is considered to be an extensive problem that affects at least 15% of families - that's almost 50 million couples on the planet. According to statistics, a man and a woman can have reproductive system problems to about the same extent, so both spouses should be diagnosed if they repeatedly try to conceive in vain.

Over the last decade, the number of men experiencing fertility problems has been steadily increasing - and significantly, by about 85-110%. Specialists attribute this to the growing trend of improper lifestyle, nutritional disorders, unfavorable environmental conditions, and lack of physical activity.

There is also an increase in the number of cases of necrospermia for which the cause cannot be determined.

If the patient is found to have abnormalities in the spermogram, the study is repeated twice - at an interval of about two weeks. If there are several diagnostic reports, the evaluation is based on the best of them.

Causes of the necrospermia

Necrospermia can develop due to these underlying causes:

• Deficiency of basic hormones responsible for seminal fluid production: idiopathic GnRH deficiency, Cullman and Prader-Willi syndromes, hypothalamic insufficiency, pituitary hypoplasia, mechanical damage to reproductive organs, Lawrence-Moon-Bardet-Biddle syndrome, tumor processes such as prostate adenoma or craniopharyngioma, vascular problems (carotid aneurysm).
• Infiltrative processes, particularly hemochromatosis, Benier-Beck-Schaumann disease, and histiocytosis.
• Autoimmune leukocytic hypophysitis (inflammation of the pituitary gland due to an autoimmune reaction).
• Internal gland disorders - endocrinopathies, excessive glucocorticoid levels, isolated non-acquired gonadotropin deficiency, hypopituitarism and panhypopituitarism, pituitary dysgenesis, hypothalamic syndrome.
• Tumor processes (cystic neoplasms, pituitary and hypothalamic tumors, craniopharyngioma).
• Ischemia (hypogonadism).
• Chromosomal disorders (androgenic defects, dysgenesis of the gonads).
• Epidparotitis, viral infections (including HIV), orchitis.
• Chronic intoxication (alcoholic, narcotic, chemical, etc.).
• Drug intoxication (prolonged intake of Ketoconazole, steroid hormones, Cimetidine, Spironolactone).
• Varicocele - dilated scrotal venous vessels entail increased temperature inside the testicle, decreased semen production and sperm death.
• Autoimmune processes accompanied by the release of anti-sperm antibodies (antibodies come into contact with sperm, immobilize them or provoke their death).
• Cryptorchidism, which is characterized by the failure of one or two testicles to descend from the abdomen into the lower segment of the scrotum. The disorder leads to a deficiency in the production of seminal secretion, and the testicle's presence in an elevated temperature causes negative changes in the quality and production of semen.
• Klinefelter's hereditary syndrome is a chromosomal disorder characterized by an extra X chromosome and manifested by abnormal testicular development and low sperm production. The production of testosterone can be both reduced and normal.
• Infectious processes - particularly tuberculosis or sarcoidosis with spread to the testicles and nearby structures.
• Systemic pathologies (insufficient renal and hepatic function, celiac disease, hereditary hemoglobinopathy).
• Neurological pathologies (hereditary dystrophy, Rossolimo-Kurshman-Steinert-Batten disease).
• Anomalies of structure and development (cartilage hypoplasia).
• Urogenital mycoplasmosis.
• Androgen deficiency.
• Prolonged or severe temperature exposure to the testicular area.
• Traumatic, mechanical damage to the external and internal genital organs.
• Metabolic disorders, overweight.
• Exposure to radiation, exposure to irradiation, chemo drugs.
• Urogenital infections.
• Too infrequent and too frequent sex.
• Unfavorable heredity (genetic diseases).

Risk factors

The processes of spermatogenesis are very sensitive to external and internal influences. Unfavorable influences can worsen any of the sperm parameters, resulting in fertilization problems - necrospermia.

Doctors voice such possible factors for the development of necrospermia:

• Internal factors:
  • Decreased levels of follicle-stimulating and/or luteinizing hormone as a result of pituitary or hypothalamic dysfunction;
  • infectious and inflammatory reactions;
  • hereditary (congenital) defects affecting the reproductive system;
  • disorders of the endocrine system, particularly of the thyroid gland and adrenal glands;
  • varicocele;
  • testicular disorders (torsion, hydrocele, etc.);
  • metabolic disorders (diabetes, obesity);
  • inguinal hernia.
• External factors:
  • Sexually transmitted infections, venereal diseases;
  • mechanical injuries, groin injuries, vascular injuries;
  • intoxication with chemical substances, pesticides, etc.;
  • abuse of alcoholic beverages, smoking, taking narcotic drugs;
  • radiation exposure;
  • hypovitaminosis, lack of minerals, poor monotonous diet.

These factors can directly or indirectly reduce the number of spermatozoa, inhibit their motility, and worsen their morphological characteristics. Specialists note that the concentration content, motility and morphological structure are the main indicators of the quality of seminal fluid and the ability of the male organism to fertilization. [2]

Pathogenesis

The processes of spermatogenesis in the male organism start with the onset of puberty. Hormones are responsible for their regulation, and normally these processes continue until old age. The complete cycle of spermatogenesis lasts about 74 days: many millions of male sex cells are formed each time.

Spermatozoa are produced under the influence of FSH and LH - follicle-stimulating and luteinizing hormones. Luteinizing hormone, in turn, activates the production of testosterone, which in combination with FSH influences the process of spermatogenesis.

Sperm production takes place in the tortuous ducts of the testicles. They enter the sperm duct directly into the spermatic duct through the direct tubules of the testicles and the outflow ducts of the appendages. The exit ducts of the seminal vesicles, in which the liquid seminal secretion flows, connect with the seminal ducts to form a single ejaculatory tract that merges with the urethra.

If there is an infectious process, the pathogen penetrates the seminal vesicles, prostate gland, appendages and testicles through the ascending route. Depending on the affected area develop inflammatory reactions in the form of prostatitis, orchitis, epididymitis and so on. Toxic substances and products of microbes have an unfavorable effect on male sex cells, lower the acidity of the environment, reducing their activity and viability. In addition, pathogens "take away" nutrition from the sperm, thereby worsening the conditions of existence of sperm, which die due to lack of nutrients.

The sooner the inflammation is detected from its onset, the less likely it will be to develop infertility provoked by necrospermia.

The development of chronic inflammatory process entails even more pronounced disorders in the urogenital system. In severe cases, purulent complications with further obstruction and tissue scarring occur.

• Obstructive changes cause a decrease in the motility of sperm, which lose the ability to move quickly through the urogenital tract, so the unfavorable effect on them of the products of bacterial activity is aggravated.
• The structure of the prostate smooth muscle changes, contractile activity suffers. This is accompanied by signs of ejaculation disorder and signs of dysuria.
• The production of the liquid part of the seminal secretion, which is responsible for stimulating sperm, is impaired. As a result, the cells die or their activity is significantly reduced.
• Dysfunction of the pelvic floor and perineal muscles occurs. This is accompanied by lumbar pain, discomfort in the sacrum and groin, a feeling of tension and pain in the testicles.

The younger a man is and the less time has elapsed since the onset of puberty, the more negatively infectious processes affect his fertility. Prolonged overheating of the body also causes testicular dysfunction - this applies not only to patients who have to work almost daily in hot workshops, but also to avid fans of baths, saunas and hot baths.

Chronic intoxication leads to overgrowth of connective tissue in the seminal ducts, which creates obstacles to the flow of seminal fluid.

The blood supply to the genitals is also of great importance. If there is insufficient blood supply to the testicles, their activity is impaired, and disorders of both testicles are already an impossibility to carry out fertility.

The most common causes of necrospermia are considered to be chronic inflammatory reactions in the seminal vesicles and prostate.

Symptoms of the necrospermia

Necrospermia is not accompanied by any clinical symptomatology (of course, if there are no other, background diseases). The only sign is the inability to fertilize a healthy woman for more than one year of regular sexual intercourse ending in ejaculation. When examining a woman, doctors do not find any abnormalities on the part of reproductive capabilities. But in a man, necrospermia is detected already at the first most indicative study - spermogram.

There's an increased chance of necrospermia:

• in existing or transferred chronic pathologies of the genitourinary tract (STDs, prostatitis, cystitis, prostate adenoma);
• previous surgeries on the genitourinary organs;
• for genital trauma.

If the patient has a varicocele, the pathology is manifested by the swelling of venous vessels in the scrotum. Sagging testicles, changes in their configuration, color, temperature are also alarming signs.

Additional symptoms of other disorders that accompany necrospermia may include:

• abnormal urethral discharge;
• lower abdominal and groin pain;
• general weakness, fever.

However, all of the above symptoms are manifestations of other diseases, or signs of direct causes of necrospermia (prostatitis, varicocele, etc.).

Only a doctor can accurately find out the origin of the symptoms and make a diagnosis after all the necessary diagnostic steps have been carried out.

Many patients wonder if there are any signs that can be used to determine the presence or absence of necrospermia. For example, can the disorder be detected by the appearance of semen? No, it is not possible to do this: seminal fluid does not change outwardly, and to determine necrospermia it is necessary to examine it under a microscope, count the number of sperm, assess the configuration, size and motility.

However, every man can pay attention to the condition of his sperm, because in some cases it is really recommended to visit a doctor, for example:

• when the color of ejaculate is abnormal (normally it is matte white, or slightly grayish or yellowish, but not greenish, bluish, red or brown);
• in case of excessive transparency of semen (normally it is cloudy);
• with excessively liquid semen (normally it is viscous, thick, after a few minutes in the air begins to dry up);
• when the volume of seminal fluid secreted is insufficient (less than 1.5-2 ml), or when there is no ejaculation at all.

These signs require medical consultation, because many diseases that are accompanied by such changes in the sperm may be factors in the development of necrospermia in men.

Stages

The processes of spermatogenesis - the formation of male sex cells - involve four stages: they are reproduction, growth, maturation and formation.

1. The reproductive stage consists of the division of spermatogonial cells by mitosis.
2. The growth stage involves the development of first-order spermatocyte cells.
3. The maturation stage is characterized by the course of meiosis with the formation of second-order spermatocytes and then spermatids.
4. The formation stage is the transformation of spermatids into spermatozoa.

Since any diagnosis to determine the causes of male infertility begins with a spermogram, it is necessary to take this analysis at least twice (better - more) with an interval of about 2 weeks. This makes it possible to evaluate spermatogenesis at all stages of the process.

Important: some types of intoxication and medications (in particular, chemopreparations) can provoke disorders of spermatogenesis, but such phenomena are usually transient and temporary. The most pronounced adverse effects were noted during treatment with Cisplatin: experts found the development of necrospermia, azoospermia, as well as testicular atrophy. In addition, chemotherapy can cause congenital diseases in the future child. To avoid this, patients who have undergone chemotherapy are advised not to try to conceive, at least for several years after the end of treatment.

Forms

Necrospermia is categorized into these developmental variants:

• Incomplete necrospermia - this diagnosis is made if the ejaculate analysis reveals less than 45% but more than 5% of live (viable) spermatozoa. This type of pathology can be called relatively favorable, because the patient has a fairly high chance of becoming a father.
• Complete necrospermia - this pathology is said to occur when no more than 0-5% of viable sperm are found in the sperm fluid. This disorder is characterized by the most unfavorable prognosis, but, fortunately, it occurs in very rare cases.

According to the form of course, the pathology is divided into such types:

• Reversible necrospermia, which is temporary, transient in nature. Most often the problem is provoked by severe stress, metabolic disorders, unhealthy habits, systemic pathologies, poisoning, etc. Specialists believe that after the elimination of the cause and correction of the general state of the body, the restoration of fertility is quite possible. The recovery period most often lasts about six months and includes diet, lifestyle changes, physical procedures, etc.
• Irreversible necrospermia is a pathology that is not amenable to drug correction, does not disappear on its own. It is impossible to cure such a disorder.

In addition, necrospermia is divided into true and false. False form is most often caused by incorrect semen analysis, or incorrect interpretation of the results. If the ejaculate was collected in inappropriate conditions, the patient used a condom or intimate lubricant to collect biomaterial, and the semen itself was delivered to the laboratory after a long period of time, then the result of the study can be incorrect, false. To avoid errors, seminal fluid should be collected in a special room directly in the laboratory, using a perfectly clean glass container. The obtained material is handed over to the laboratory technicians as soon as possible.

The patient should not donate semen to avoid incorrect decipherment of the test:

• if he has had sexual intercourse with ejaculation 2-5 days before the study;
• if he's been to a bathhouse or sauna in the last week;
• if he or she had consumed alcohol the day before or had antibiotic or chemotherapy treatment.

True necrospermia is uncontroversial as confirmed by multiple episodes of semen analysis.

Complications and consequences

In some cases, necrospermia is temporary, which may be due to such causes:

• psycho-emotional overload;
• recovery period after a serious illness, surgery;
• poisoning, alcohol intoxication;
• a long period of abstinence.

In such cases, necrospermia is eliminated independently after neutralization of the provoking factors.

For other patients, the persistent state of necrospermia in the absence of treatment turns into male infertility, which, in turn, entails the emergence of psychological anxiety, social anxiety and fears. Often the inability to fertilize a woman becomes the cause of depression, constant stress, family conflicts and even divorce.

In addition to the difficulties of psychological and social plan, infertility can cause problems with health and well-being, trigger the development of neuroses and sexual impotence.

Diagnostics of the necrospermia

Today, most laboratories and clinics have the maximum diagnostic capacity to determine necrospermia and its causes. Diagnosis is performed using serologic and molecular biological techniques, as well as biochemical, bacteriologic, hemostasiologic, immunologic, cytologic, and general clinical tests.

Spermogram is the main procedure that is performed on all men, without exception, who apply for infertility. This is an analysis of sperm fluid that demonstrates the number of male sex cells in a certain volume of seminal secretion, and also allows to assess the structure, motility and viability of spermatozoa.

If the results of the first spermogram, the doctor suspects necrospermia, he recommends about two weeks later to retake the seminal fluid, and with the resulting conclusion to consult with an andrologist to determine the causes of the disorder. If sexual infections are detected, treatment is prescribed without waiting for the results of the reanalysis.

Infectious inflammatory processes, in particular prostatitis, have a significant impact on the characteristics of the ejaculate. The inflammatory reaction slows down the movement of sperm, causes them to stick together and form defective forms.

Seminal fluid examination is one of the most subjective laboratory techniques. Its results are always considered and evaluated only after several repeated spermograms (usually two or three). Some laboratories use special devices called sperm analyzers to perform the analysis. However, most specialists believe that the study performed by these devices should be duplicated by the evaluation of a spermologist, as there are a number of possible errors on the part of the device. For example, sometimes the sperm analyzer "confuses" individual morphological structures. However, the spermogram should always be repeated, regardless of the method used.

Other tests

In addition to a spermogram, a patient with suspected necrospermia may have other laboratory tests.

• The IDA test is an ancillary examination of seminal fluid that helps to determine the number of sperm coated with anti-sperm antibodies, which is what can make fertilization completely impossible. If half of the sperm is associated with antisperm antibodies, the patient is diagnosed with immunologic infertility.
• Evaluation of DNA fragmentation in male germ cells helps to identify the number of sperm that have an abnormal genetic status. Special treatment is necessary if the level of fragmentation exceeds 15%.
• If infectious-inflammatory pathologies are suspected, additional screening is performed, which includes:
  • urethral swab;
  • PCR examination for STDs;
  • seminal fluid culture (if the ejaculate revealed bacteria or increased leukocyte content);
  • prostate secretion analysis.
• Biochemical examination of seminal secretion (glucose, alkaline phosphatase, citric acid, zinc, etc.).
• Hormonal diagnosis with assessment of free radicals, FSH and LH hormones, as well as prolactin, testosterone and estradiol. The quality of the acrosomal reaction is determined, which is typical only for sperm with normal morphological structure.
• Cytogenetic analysis and electron microscopy of spermatozoa helps to evaluate the internal structure of the cells, the plasma content of the seminal secretion, the number and quality of chromosomes. If chromosomal defects are detected, the patient is sent for consultation with a geneticist.
• Analysis of the presence of antisperm antibodies (class M, A and G), Kurzrock-Miller and Shuvarsky tests (determination of immune conflict by the level of the cervical canal).

Ejaculate microdissection

The main laboratory test for suspected necrospermia is semen analysis (spermogram). For the analysis, the so-called ejaculate microdrug is used - a small amount of seminal fluid of the patient (literally a few drops) to establish the ability of a man of reproductive age to fertilization. The results of the analysis determine the qualitative and quantitative indicators of seminal secretion: the doctor receives both visual, microscopic and physicochemical information about the biomaterial.

Semen is collected for spermograms by masturbation in a designated room at the clinic or laboratory. The ejaculate is collected in a sterile container, after which it is handed over to the laboratory technicians. In most cases, the results of the spermogram can be picked up in just a few hours.

To avoid errors in the analysis, it is recommended to retake it after 2-3 weeks: this is especially true if there are significant pathological abnormalities in the indicators - for example, necrospermia.

The most objective results will be obtained with three or four repetitions with an interval of 2-3 weeks. Depending on the cumulative results, a comprehensive examination will be prescribed and the tactics of further therapy will be determined.

Instrumental diagnostics

Instrumental methods of investigation for necrospermia may include these procedures:

• Thyroid ultrasound;
• X-ray of the skull and Turkish saddle (to rule out pituitary tumors);
• transrectal and transabdominal ultrasound to assess the size and structure of the testicles and appendages, prostate, to detect disorders of the seminal vesicles;
• scrotal Doppler, ultrasound transperitoneal examination of the scrotum to detect varicocele, testicular hydrocele, to diagnose dilated pelvic venous vessels;
• Thermography of the scrotum (especially necessary for the diagnosis of varicocele);
• vasography (assessment of the radiologic picture of the seminal ducts, seminal vesicles);
• Testicular biopsy (relevant in idiopathic necrospermia if the testicles are of normal size and follicle stimulating hormone levels are within normal limits).

A distinction is made between percutaneous aspiration and microsurgical biopsy of the appendage, as well as percutaneous aspiration and open testicular biopsy using a special "gun". Nowadays, more and more specialists prefer to perform biopsies only by open biopsy, if strictly indicated and with the mandatory further cryopreservation of the selected sperm.

It is worth noting that the diagnosis of necrospermia remains quite complicated. Such a violation should be dealt with not just one doctor - urologist or andrologist, but a whole group of specialists, including a geneticist, endocrinologist, reproductologist, family physician-therapist. Only with a comprehensive approach it is possible to investigate and successfully treat the pathology.

Differential diagnosis

First of all, it is necessary to distinguish necrospermia from a pathological decrease in sperm motility - the so-called asthenospermia. Necrospermia is characterized by the presence in the seminal fluid of less than 30% of motile male germ cells, less than 5% of active sperm, and the number of viable sperm is less than 50%. Necrospermia can vary in severity of course, which depends on the frequency of sexual intercourse. If the frequency of ejaculation increases, it causes a decrease in pelvic congestion, an increase in the mobility of sperm and the period of their stay in the urogenital tract. As a result, the duration of adverse effects on male sex cells is minimized, and the number of viable individuals is increased. The result of seminal fluid examination indicates the presence of morphologically altered or dead spermatozoa, whereas unaltered normal types of spermatids - spermatozoa precursors - can be observed during testicular tissue biopsy.

To differentiate necrospermia, a diagnostic method of Blum staining is performed. On the surface of the slide put a little seminal secretion, near it drop a few drops of 5% aqueous solution of eosin. Sperm fluid is well mixed with the solution using a special glass rod, wait a while, then add an equal volume of 10% aqueous solution of nigrosin and again wait a few seconds. After that, using a ground glass, thin smears are made, dried and sent for immersion study. One hundred male sex cells are counted and the percentage of viable and non-viable sperm is evaluated. In live cells, the heads in the preparation have no color, while in dead cells they are stained with eosin.

A normal index assumes that the ejaculate contains more than 80% viable (uncolored) sperm.

Treatment of the necrospermia

Necrospermia can be treated in several ways:

• conservative;
• surgical;
• alternative (folk methods, herbal medicine, physiotherapy, homeopathy, etc.).

The most appropriate treatment option is chosen by the doctor, taking into account the results of the diagnosis. It is important that the prescribed therapeutic regimen to affect the original cause of the disorder. That is why the doctor must first determine this very causative factor, whether it is inflammatory or other process in the body.

The assistance of a surgeon may be required:

• when the ejaculatory ducts are narrowed or compressed;
• for congenital defects of the reproductive organs;
• for varicocele.

For some patients, the prescription of conservative therapy may be sufficient:

• hormonal agents (androgens, gonadotropic hormones, anti-estrogens, releasing hormones, prolactin-secretion inhibitors);
• non-hormonal means (enzyme preparations, immunomodulating and biogenic means, medicines correcting sexual function, vasoprotective means).

Hormonal treatment for necrospermia may be as follows:

• Hormone replacement therapy involves the replacement of missing hormones in the body to make up for its deficiency. This treatment helps if the problem with spermatogenesis was provoked by a lack of sex hormones, which is relevant for patients with sperm maturation disorders, hypogonadism, sexual dysfunction and so on.
• Stimulatory hormone therapy consists of administering small doses of hormonal agents to activate immunity and metabolism. As a result, there are shifts in the endocrine regulation of the functionality of the sex glands.
• Suppressive hormone therapy is accompanied by the administration of fairly large doses of hormonal drugs. This is done in order to temporarily inhibit the natural process of synthesis of own hormones, to suppress spermatogenesis. After the necessary amount of time, the hormone administration is stopped, which leads to the restoration of the blocked processes: at the same time, the number and quality of newly produced spermatozoa increases significantly.

Hormonal agents are administered to the male body by intravenous injections, internal use of medications, and also in the form of applications. The duration of the treatment course is most often 12 weeks.

If necrospermia in a man occurs against the background of tumor processes (for example, prostate adenoma), then hormonal therapy is contraindicated for him.

Along with medical and surgical treatment, alternative therapeutic methods are often used, such as folk medicine, homeopathy, physiotherapy, IVF and intrauterine insemination.

The use of any type of therapy should begin with general measures - in particular, with the elimination of household and occupational harmful effects, normalization of rest and work, correction of the patient's diet.

Medications

Drug therapy for necrospermia is prescribed mainly in case of impaired spermatogenesis as a consequence of infectious processes, endocrine diseases, sex-ejaculatory failures. The most commonly used categories of drugs are:

• androgenic drugs (Andriol - testosterone andecanoate, Testoviron - testosterone propionate, Sustanon 250 - testenate);
• anti-estrogenic drugs (Tamoxifen, Clostilbegid);
• gonadotropic hormones (Pergonal, Humegon - menotropin, Pregnyl, Profasi - choriogonadotropin);
• rylizing hormones (Luliberin, Cryptocurus);
• agents that inhibit prolactin synthesis (Bromcriptine);
• chemotherapy agents;
• Immunostimulant drugs (normal human immunoglobulin, Pyrogenal, Tactivin, Thymalin);
• angioprotective agents (Trental);
• biogenic stimulants (Solcoseryl, Trianol);
• sexual function correctors (Himcolin, Yohimbine, Andriol).

The complex of therapeutic measures consists of several types of therapy at once:

• etiologic;
• pathogenetic;
• immunologic;
• restorative.

Etiologic therapy is aimed at eradicating the infectious agent identified during diagnosis. The treatment course is prescribed for 3-4 weeks, based on the use of several (two or three) drugs at once. Most often used tetracyclines (Doxycycline), fluoroquinolones (Abactal), cephalosporins (Claforan), macrolides (Rulid), if indicated - Acyclovir, Fluconazole, Trichopol. At the same time to prevent the development of intestinal dysbacteriosis is prescribed Bactisubtil (for about 2 weeks). Sulfonamides and nitrofuran drugs have a gonadotoxic effect, so they are not included in the treatment scheme.

Pathogenetic therapy involves elimination of the primary source of infection, correction of neurotrophic disorders.

Hormonal agents are prescribed as part of a complex scheme for hormonal insufficiency or to activate the processes of metabolism and regeneration.

Immunologic reactivity is increased with Thymalin, Tactivin, biogenic stimulants.

The result of the treatment course is consolidated by sanatorium-resort treatment, correction of lifestyle (including sexual).

Examples of possible doctor's appointments are described in the following table:

Andriol	A hormonal drug with androgenic activity, prescribed for disorders of spermatogenesis. Dosage and dosage regimen is individual, which depends on the indications, age and the dosage form used. Possible side effects: excessive sexual stimulation, increased erections. With caution, it is used with impaired kidney and liver function.
Thymalin	Immunostimulant, accelerating regeneration processes, improving cellular metabolism. Thymalin in the form of lyophilizate dissolved in isotonic sodium chloride solution, administered intramuscularly daily 5-20 mg. For one course of treatment requires the introduction of 30-100 mg of the drug. Possible side effects: allergic reactions.
Raveron	A biogenic stimulant, which is especially often used in prostate adenoma and chronic prostatitis. Raveron is administered deeply intramuscularly: on the first day 0.3 ml, on the second day 0.5 ml, then 1 ml a day (or 2 ml every other day) for 1-1.5 months. If after a while the treatment course is repeated, then again start with the minimum dosage of 0.3 ml. Possible side effects: allergic rash.
Pregnyl	A drug containing human chorionic gonadotropin with LH activity (required for the development and maturation of male gametes and steroid hormone production). It is prescribed in hypogonadotropic hypogonadism and idiopathic dyspermia. Dosage is determined individually (usually 1000-2000 IU 3 times a week, subcutaneously, for at least three months). During treatment, it is necessary to suspend testosterone intake. Adverse reactions are rare, mainly in the form of allergies.
Pergonal	A preparation of follicle-stimulating and luteinizing hormones, stimulates spermatogenesis. Pergonal is administered intramuscularly, using an individually selected scheme. Pain in the injection area, weight gain, abdominal pain may occur.

Among homeopathic remedies for necrospermia, the drug Spemane, which is of plant origin and has a complex effect: it regulates the quality of potency and stabilizes the state of reproductive function, is particularly popular. The duration of the drug is coordinated by a doctor, but it can not be less than four months. As a rule, for the treatment of necrospermia Spemann take three times a day, two tablets. Repeat the course can be repeated after six months. With a severe course of pathology, Speman is taken simultaneously with another drug - Tentex forte, as well as with vitamin E. Most often these medicines do not cause side effects, well tolerated by the body. In rare cases, nausea, minor skin reactions are noted.

For the period of therapy of necrospermia should be completely excluded alcohol consumption.

Physiotherapy treatment

Special physiotherapy techniques can be used to treat necrospermia. Physiotherapy is a kind of treatment based not on the use of chemicals, but on physical effects. To eliminate the problem with health and reproductive function, specialists use heat, light, ultrasound, electric current, magnetic field and other physical factors. Such therapy becomes an excellent complement, and in some cases - and in some cases - the main method of treatment of patients.

Physiotherapy can dramatically increase immune defense, which entails an increase in the effect of any other therapeutic agent. For example, in every second or third case the cause of necrospermia is an inflammatory process. Traditional drug treatment for chronic inflammation is not always able to normalize the quality of seminal fluid. It is necessary to further strengthen the body, stimulate spermatogenesis, stabilize metabolic processes, get rid of testicular insufficiency, optimize the trophicity of spermatozoon in the appendages, activate tissue repair after inflammatory changes. Physiotherapy helps in this, namely the following treatment methods:

• Electrophoresis - has not only the therapeutic effect of the drug injected into the tissues. This procedure stimulates blood circulation in the capillary network, activates metabolism, has a pronounced analgesic effect, stops the development of inflammation and post-inflammatory edema, improves tissue trophicity and regeneration abilities (and even in deep tissue layers). Drug electrophoresis is able to create accumulations of the drug in the tissue layers, provide a high concentration of the drug in the problem area, use a smaller dose of the drug compared to other methods of administration, minimize the risk of allergic reactions, increase the sensitivity of tissues to the injected drug.

In necrospermia with the help of electrophoresis can be administered all kinds of vitamin and trace element preparations, enzymes.

• Magnetotherapy allows you to treat inflammatory pathologies of the urogenital system. It is used running magnetic field in combination with local drug action. Magnetotherapy has a pronounced anti-inflammatory, anti-edematous, analgesic effect. If the patient suffers from prostatitis or urethritis, special heating catheters (urethral or rectal application) are involved. Thermomagnetotherapy involves the introduction of such a catheter into the rectum, with the possibility of heating up to 39-45°C. The course consists of ten sessions.
• Ultrasound therapy consists in the effect of ultrasound in the form of a kind of tissue micro-massage. The procedure is accompanied by increased blood flow and warming of tissues. This provides analgesic action, softening (in the presence of adhesions), improving blood circulation, increasing hormonal activity.
• Laser therapy, thanks to intense laser radiation, contributes to the strengthening of redox reactions in tissues, increasing tissue oxygen consumption, stimulation of trophic and regeneration processes. At the same time strengthens cellular immunity. Laser rays have a bacteriostatic effect, accelerate the resorption of adhesions. With continuous red or pulsed infrared radiation shows a stimulating effect on sperm, optimize energy processes. After a course of laser therapy, there is an increase in the content of sex and gonadotropic hormones in the bloodstream of patients. In addition, laser therapy is successfully used to increase the motility and number of sperm, which is especially relevant in necrospermia.

Herbal treatment

Medicinal herbs have always been regarded as affordable and effective means of maintaining male strength. They are also successfully used for the treatment of necrospermia. Especially popular among men are such folk recipes:

• Black cumin oil is a useful therapeutic product that is used in many areas to improve the health of the body. Scientists have found that this oil has a positive effect on the function of the thymus gland and, accordingly, on immunity. In the composition of black cumin there are phytosterols that stimulate hormonal production. In this case, the product can be successfully used to treat both men and women. The oil helps to stimulate the activity of sperm, increases their number. It is used in the morning and evening 1 tsp, with the same amount of honey. Drink the remedy is better not with water, but with herbal tea based on chamomile and oregano. The duration of therapy is 4 months. Then the treatment course can be repeated, with a break of at least two months.
• Plantain seeds in the form of decoction help to restore the activity of sperm. To prepare such a decoction, take 200 ml of boiling water and 1 tbsp. Seeds, combine, put on low heat and boil for 4 minutes. Then remove from the fire, cover with a lid and insist until it cools down. The medicine is filtered and drunk 4 times a day for 2 tbsp. L. The prepared decoction is allowed to store in the refrigerator, but not more than 3 days. The total duration of reception - 3 months.

Additionally, you can take sitting baths with plantain. Take 50 g leaves or rhizome of plantain, pour 1 liter of boiling water, insist 40-50 minutes, strain. Add to a warm bath. The procedure is carried out daily for two weeks. Repeat the treatment course - after 2 months.

• Sporash - a well-known folk remedy for infertility, both female and male. At necrospermia use this recipe: in a thermos pour 3 tbsp. Dry plant and pour 0.5 liters of boiling water, cover with a lid and kept for three hours. Take 4 times a day 100 ml half an hour before meals.
• Medicinal sage helps to clean the vascular network, improve the viability of the seed. It is optimal to carry out treatment simultaneously with sage and linden, since these plants effectively complement each other. To prepare the medicine, 1 tsp. Sage and the same amount of linden flowers pour 200 ml of boiling water, insist about 15 minutes, filter and drink as a tea. Every day you should drink at least a glass of such a remedy. The duration of treatment is not limited.
• Zaletayka, or panceria woolly - this is a rare, but quite famous plant, which is used to restore the reproductive system of the male. To prepare a decoction, 1 tsp. Dry herb is poured a glass of boiling water, placed on low heat for five minutes. Then remove from the fire, kept under a lid until cooling, filtered. Drink 2 tbsp. Three times a day before each main meal.

In addition, you can prepare a tincture of this plant. Take quality vodka and dry herb zaletayka, based on the proportion of 10:1. Infuse in a glass jar or bottle. After 10 days, the tincture is filtered and begin to take half a teaspoon three times a day, for 4 weeks.

• Rhizome of lewesia is used to prepare a tincture. In 500 ml of vodka poured 100 g of crushed rhizome, corked and kept in a dark place for about 6 weeks. Then the tincture is filtered and taken 20 drops three times a day before meals. The course of treatment should last 2 months. In summer, it is not recommended to take the remedy.

Surgical treatment

Surgery for necrospermia can be represented by a number of surgical manipulations, the basic focus of which is to improve the quality of seminal fluid, or selection of active viable sex cells for further IVF or ICSI procedures.

Many factors can contribute to a male's reproductive system dysfunction, and some of them do require surgical treatment.

One common cause of impaired spermatogenesis is varicocele, or dilated testicular veins. The only effective way to improve spermatogenesis in varicocele is to perform vein ligation surgery.

Surgery is also prescribed for obturation processes associated with inflammatory diseases, congenital anomalies, trauma, interventions on the pelvic organs.

There are pathologies that cannot be cured by medication. It is in such cases and resort to the help of a surgeon. The technique of surgery is selected depending on the type of disease, on an individual basis.

In advance, as a preparatory step for surgery, the patient is given a number of tests, in particular:

• urological exam;
• spermogram, IDA test, and/or DNA fragmentation percentage assessment;
• scrotal ultrasound, transrectal ultrasound of the prostate gland;
• General clinical blood and urine tests, blood tests to determine infectious, genetic and hormonal causes of the disorder;
• chest x-ray;
• electrocardiogram;
• consultation with an anesthesiologist (and other specialists if necessary).

Surgical techniques such as:

• Varicocelectomy (Marmaru operation) is a minimally invasive intervention that is performed using microscopy through a small incision, using special microsurgical instruments. The surgeon performs tissue dissection, isolation and ligation of the dilated testicular vein, without damaging nearby lymphatic and arterial vessels. The operation is performed using spinal (epidural) anesthesia.
• Laparoscopic testicular vein ligation is an operation performed through three small incisions into which an endoscope and special instruments are inserted. With the help of an endoscope, the doctor is able to see on the monitor a multiply enlarged picture of the operating field. Tissue trauma is minimal, and the surgeon can clearly identify the venous vessel with its branches and make ligation. The intervention lasts about 60 minutes and the hospital stay is about 24 hours.
• Sperm biopsy from the appendage or testicle is a minimally invasive procedure to extract viable active sex cells. It can be performed using a variety of techniques:
  • Micro-TESE, sperm secretion extraction from the testis, is performed using a microscopic device and spinal or intravenous general anesthesia. Access is made through a small incision in the scrotal area. The surgeon examines the testicular tissue with a powerful microscope, finds channels with adequate spermatogenesis and selects biomaterial from them.
  • PESA is a method of aspirating semen from the testicular appendage through a thin needle, without making tissue incisions. The selected biomaterial is examined through a microscope, identifying active spermatozoa.

Modern surgery involves the use of microsurgical techniques. It is thanks to this that the patient receives minimal tissue damage, which shortens the period of hospitalization and further recovery. The term of rehabilitation after surgical sperm aspiration or varicocelectomy lasts no more than a week. It is important to comply with the postoperative recommendations of the doctor: wearing special compression underwear, limiting physical exertion.

Prevention

When a man contemplates family planning, he should be aware of all existing risk factors for reproductive disorders. By following simple preventive measures, it is possible to reduce the risk of developing fertility disorders.

The basic preventive rules are as follows:

• give up smoking, drugs, alcohol;
• consult a doctor and, if possible, stop taking medications that negatively affect reproductive function;
• wear loose underwear made of natural fabrics rather than tight underwear;
• in time to consult doctors about any inflammatory diseases, and especially - in the case of lesions of the genitourinary organs;
• beware of trauma to the groin, pelvis;
• avoid sedentary lifestyles and heavy physical exertion (moderate physical activity is optimal);
• adjust the diet in favor of plant foods, seafood;
• avoid overly salty, fatty, spicy foods;
• have one regular sexual partner and be regularly checked for sexually transmitted infections;
• avoid strong psycho-emotional stress, avoid stress;
• Monitor body weight and avoid obesity.

Some pathologies that negatively affect the reproductive capacity of a man are characterized by a progressive course. Therefore, it is very important to regularly visit the doctor for urogenital examination. For example, such a disease, such as varicocele, develops over more than five years. The patient himself will not be able to diagnose it in the early stages, but the doctor will notice the violation and help prevent extremely unpleasant consequences.

Forecast

Normally, a man's semen contains no more than 20-25% non-viable immobile sperm. If this number increases, the man becomes incapable of fertilizing a woman and conceiving a child.

The non-viability of absolutely all sperm in the seminal fluid is called true necrospermia: this condition is observed only in extremely rare cases. Therefore, if the semen analysis showed such a result, the first thing to do is to make sure that there are no errors in taking the analysis and conducting the diagnosis. To ensure that semen is not overcooled, and the interval between the collection of biomaterial and its study was extremely short, seminal fluid is better to take directly in the laboratory, using a sterile glass container. It is not possible to analyze semen from a condom, because the product contains some chemical substances that can reduce the motility of male germ cells.

By the way, if the sperm in the ejaculate are immobile, it does not mean that they are irretrievably dead. To identify living and dead cells use special dyes that are able to color dead sperm, but viable - not. If the semen contains immobile, but alive sperm, then they talk about akinospermia. This condition, like necrospermia, can result from inflammatory changes in the prostate, seminal vesicles, appendages. Under the influence of changes that occurred with sperm secretion, the motor activity of spermatozoa decreases or disappears. A special role in the development of necrospermia is currently attributed to a decrease in the level of fructose in the sperm plasma.

For many patients, necrospermia is an ongoing condition and has an unfavorable prognosis for treatment.