What Causes Necrospermia? – Symptoms & Treatment

By (senior embryologist), (gynecologist), (embryologist) and (psychologist).
Last Update: 12/22/2021

Necrospermia or necrozoospermia is a sperm disorder characterized by the presence of dead sperm in the semen.

The reasons behind this male infertility cause are varied and the treatments sparse. For this reason, it is common for men diagnosed with necrospermia to become parents via Assisted Reproductive Technology (ART), most commonly through In Vitro Fertilization (IVF).

Definition and diagnosis

Necrospermia or necrozoospermia are the medical terms used when the presence of dead sperm in a man's ejaculate is above 42%. This sperm disorder is a major cause of male infertility.

The test that evaluates male fertility is the seminogram or spermiogram. It consists of analyzing the ejaculated sample under the microscope, observing the spermatozoa, and checking their concentration, mobility, and morphology.

Cuando un hombre sufre necrospermia, en el seminograma se ve que más del 50% de los espermatozoides no se mueven, puede que estén muertos o simplemente no sean capaces de moverse. In the first case we would speak of necrospermia, while if the problem is one of motility it would be asthenozoospermia.

The World Health Organization (WHO) published in 2010 some reference values for semen parameters. Regarding vitality, it is considered that a normal man should have 58% of live spermatozoa.

How to know if the spermatozoa are alive

The test consists of a hypoosmotic test based on the integrity of the membrane. When a spermatozoon is dead, its membrane presents holes or broken areas, while if the spermatozoon is alive its membrane is intact and controls the entry and exit of substances.

To check this, spermatozoa are placed in a hypoosmotic medium. Living sperm will react in this solution, absorb water and the tail will swell causing it to coil into a helix. In contrast, dead spermatozoa will not show any reaction.

A hypoosmotic medium is one with a high proportion of water and a low concentration of dissolved substances. When a living spermatozoon, with a higher content of dissolved substances, is placed in the medium, it will tend to absorb water from the outside to balance the pressures.

In addition to the hypoosmotic test, there are other tests that check sperm vitality: the eosin-nigrosin staining test or the acridine orange test. In these cases, the spermatozoa that are stained are the dead ones, since the membrane is broken and the dye enters indiscriminately.


Necrospermia can occur occasionally due to factors such as stress or taking a specific medication. However, there may be other causes that cause permanent necrospermia:

  • Habitual alcohol and drug use
  • Poor nutrition
  • Radiotherapy and chemotherapy
  • Genitourinary infections
  • Hormonal disorders
  • Long periods of sexual abstinence

In these cases it is more difficult to reverse necrospermia and increase sperm vitality, so it may be necessary to resort to assisted reproductive techniques to have children.


Unfortunately, there is no cure or specific treatment for necrospermia.

If the results of the seminogram support the diagnosis of necrospermia, the test has to be repeated within three months in order to confirm such diagnosis. The presence of unviable sperm might be consequence of an isolated event, caused by temporary stressful periods, fever or even drug-induced.

If the second seminogram confirms the diagnosis, some recommendations may be given to reduce the sperm mortality rate, including leading a healthy lifestyle, with a balanced diet.

Taking dietary supplements such as vitamins and antioxidants may be helpful as well. Sperm are cells very sensitive to oxidative stress, so free radicals can severely damage or even kill them.

A diet rich in antioxidants may hinder cell death. Despite the fact that antioxidants delay cell oxidation, it should be noted that taking these supplements will not dramatically improve sperm vitality.

Finally, necrospermic men should avoid long periods of sexual abstinence, as having an elevated amount of sperms in the semen promotes their death.

Getting pregnant

In order to know a man's ability to procreate, it is important to know exactly the degree of male infertility he presents, in this case, what percentage of sperm with necrospermia is in his ejaculate.

Natural pregnancy is possible as long as there are live sperm in the ejaculate, but it is very difficult to achieve if the degree of necrospermia is greater than 42%. It also depends on other parameters such as sperm concentration and motility.

Fertility treatments

The best option for a man with necrospermia is to visit a fertility specialist and consider undergoing in vitro fertilization (IVF). In these cases, intrauterine insemination (IUI) is not recommended, since it does not assure the process to be as successful as IVF.

ICSI encompasses the selection a sperm cell with good motility and an excellent morphological structure. Once picked, it is inserted inside the egg cell. If the sperms were found to be motionless, the specialist may use pentoxifylline to find out if they are actually live or dead.

Pentoxifylline is a sperm motility activator used in ICSI procedures when the semen sample has asthenozoospermia.


The cost of an IVF cycle may vary greatly from clinic to clinic, and depending on the particularities of each case. Nonetheless, the overall cost usually ranges between $7,000 and $8,500

Typically, the cost of a single IVF cycle does not include out-of-pocket expenses such as medications, which can add up to $4,500 or over.

In case pregnancy couldn't be achieved using the husband's sperm, the specialist may recommend using donor sperm. In this case, and provided that the woman has no fertility issues, turning to artificial insemination by donor (AID) may be an option to have a baby. The cost is $300-$4,000 approximately.

If you need to undergo IVF to become a mother, we recommend that you generate your Fertility Report now. In 3 simple steps, it will show you a list of clinics that fit your preferences and meet our strict quality criteria. Moreover, you will receive a report via email with useful tips to visit a fertility clinic for the first time.

FAQs from users

Can I have a natural pregnancy with necrospermia?

By Paloma de la Fuente Vaquero M.D., Ph.D., M.Sc. (gynecologist).

Necrospermia is the presence of dead sperm in the semen, so there is very little chance of getting pregnant naturally. However, since semen production is cyclical (every two or three months), if the cause of necrospermia is reversible, we can obtain a normal semen after that time.

What causes necrospermia?

By Emilio Gómez Sánchez B.Sc., Ph.D. (senior embryologist).

The term necrospermia refers to a sperm disorder where 85 percent of sperm present in the ejaculate are dead.

The factors leading to necrospermia are unclear yet, but the most common include:

  • Alcohol or street drug consumption
  • Unbalanced diet
  • Radiotherapy or chemotherapy
  • Genitourinary infections
  • Hormonal disorders

In these cases, curing necrospermia is complicated, as well as increasing sperm vitality. In short, it is likely that the affected man has to turn to assisted procreating to have children.

To what extent can smoking affect necrospermia?

By Zaira Salvador B.Sc., M.Sc. (embryologist).

Tobacco consumption is very negative for the vitality of spermatozoa, since nicotine is a very toxic substance for them. There is a study that shows that the consumption of about 20 cigarettes a day causes necrospermia in men.

Does necrospermia increase with age?

By Zaira Salvador B.Sc., M.Sc. (embryologist).

This is not always the case, but age is a factor that can affect sperm vitality through cellular aging and increased oxidative stress.

Can dead sperm be treated?

By Zaira Salvador B.Sc., M.Sc. (embryologist).

Yes, a man can reduce the number of dead sperm in his semen by leading a healthy lifestyle, taking vitamin supplements, avoiding long periods of sexual abstinence, etc. Unfortunately, in the most severe cases, turning to Assisted Reproductive Techniques may be required to conceive a child.

Does cancer cause necrospermia?

By Zaira Salvador B.Sc., M.Sc. (embryologist).

In this case, necrospermia is not caused by cancer, but by treatments such as chemotherapy or radiotherapy. Therefore, it is important for patients who are going to undergo these treatments to visit a clinic beforehand to cryopreserve a semen sample so that they can have children in the future.

Suggested readings

Aside from necrospermia, there are other sperm disorders that can compromise a man's fertility. Want to find them out? Just follow this link: Guide to Sperm Disorders.

You can learn more about the different methods to detect the presence of dead sperms in the ejaculate with this post: Methods of Sperm Vitality Assessment.

We have made several references to the seminogram or semen analysis, a basic test that is performed to evaluate the quality of a man's semen sample in terms of sperm count, sperm morphology, sperm motility... Click here to learn more about it: What is a Semen Analysis Report?

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Authors and contributors

 Emilio Gómez Sánchez
Emilio Gómez Sánchez
B.Sc., Ph.D.
Senior Embryologist
Bachelor's Degree in Biology from the University of Seville. PhD in Biology from the University of Valencia. Large experience as an Embryologist Specialized in Assisted Reproduction. Currently, he is the IVF Lab Director of Tahe Fertilidad. More information about Emilio Gómez Sánchez
License: 14075-MU
 Paloma de la Fuente Vaquero
Paloma de la Fuente Vaquero
M.D., Ph.D., M.Sc.
Bachelor's Degree in Medicine from the Complutense University of Madrid, with a Master's Degree in Human Reproduction and a Doctorate in Medicine and Surgery from the University of Seville. Member of the Spanish Fertility Society (SEF) and the Spanish Society of Gynecology and Obstetrics (SEGO), she performs as a gynecologist specializing in assisted reproduction in the clinic IVI Sevilla. More information about Paloma de la Fuente Vaquero
License: 4117294
 Zaira Salvador
Zaira Salvador
B.Sc., M.Sc.
Bachelor's Degree in Biotechnology from the Technical University of Valencia (UPV). Biotechnology Degree from the National University of Ireland en Galway (NUIG) and embryologist specializing in Assisted Reproduction, with a Master's Degree in Biotechnology of Human Reproduction from the University of Valencia (UV) and the Valencian Infertility Institute (IVI) More information about Zaira Salvador
License: 3185-CV
Adapted into english by:
 Cristina  Algarra Goosman
Cristina Algarra Goosman
B.Sc., M.Sc.
Graduated in Psychology by the University of Valencia (UV) and specialized in Clinical Psychology by the European University Center and specific training in Infertility: Legal, Medical and Psychosocial Aspects by University of Valencia (UV) and ADEIT.
More information about Cristina Algarra Goosman
Member number: CV16874

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