Spermatozoa with necrospermia: What is it and how is it treated?

By (senior embryologist), (gynecologist), (embryologist), (gynecologist), (embryologist) and (biochemist).
Last Update: 07/15/2022

Necrospermia, also known as 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 there are few treatments. 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).

It should be noted that immotile sperm does not mean that they are dead. Therefore, is is of vital importance to study the vitality of spermatozoa in seminal samples with a high percentage of immotile spermatozoa.

What is necrozoospermia?

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

In 2010, the World Health Organization (WHO) publised reference values for semen parameters. With respecty to vitality, they consider that a normal man should present with at least 58% live spermatozoa.

It is important not to confuse necrospermia with astenospermia or astenozoospermia. These terms refer to sperm which lack mobility, but are alive.

To evaluate male fertility, we perform a seminogram or spermiogram. It consists of analyzing the ejaculated sample under a microscope, observing the spermatozoa, and checking their concentration, mobility, and morphology.

When a man suffers from necrospermia, the seminogram will show that more than 50% of the sperm are not mobile. This could be because the sperm are dead, or simply because they are incapable of movement. In the first instance we are talking about necrospermia, while the latter is a mobility problem, known as astenozoospermia.

How to know if the spermatozoa are alive

When a high proportion of the sperm are immotile, the specialist may order a hypoosmotic test. This test is based on the integrity of the membrane. When a spermatozoon is dead, its membrane has holes or broken areas, while if the spermatozoon is alive its membrane is intact and can therefore control 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 swells causing it to coil into a helix. In contrast, dead spermatozoa will not show any reaction.

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. Conversely, live sperm with an intact membrane do not take up the stain.

Causes of necrozoospermia

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 turn to assisted reproductive techniques to have children.

What is the best treatment for necrozoospermia?

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

If the seminogram results in a diagnosis of necrospermia, the test should be repeated within three months in order to confirm it. 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, your doctor may recommend some changes to reduce the sperm mortality rate: These include leading a healthy lifestyle, with a balanced diet and avoiding alcohol consumption.

Some specialists recommend taking dietary supplements such as vitamins and antioxidants. Sperm are cells very sensitive to oxidative stress, and free radicals can severely damage or even kill them. Howeever they cannot work miracles. Sperm vitality will not increase dramatically after taking supplements, but they can help if the problem is caused by cellular oxidation.

Finally, necrospermic men should avoid long periods of sexual abstinence. Having an elevated amount of sperm in the semen promotes their death. The longer the period of sexual abstinence, the greater the number of dead sperm in the ejaculate.

Pregnancy and necrozoospermia

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

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

Assisted reproduction and fertility treatments

The best option for a man with necrospermia is to visit a fertility specialist and consider undergoing in vitro fertilization (IVF). Artifical insemination (AI), or intrauterine insemination (IUI), is not recommended, since it does not give a reasonable chance of success.

By using the technique of ICSI, the laboratory can choose a sperm cell with good motility and an excellent morphological structure. Once chosen, it is injected into the egg cell. If the sperm cells are motionless, the specialist may use pentoxifylline (a sperm mobility activator) to find out if they are actually live or dead.


The cost of an IVF cycle may vary greatly from clinic to clinic, and from country to country. It also depends on the particularities of each individual case.

In Spain, the price is usually between €3,500 - €5,500. If you have treatment in the USA, you can expect to pay between $11,000 and $15,000 for an IVF cycle. In the UK, the cost of private treatment is between £1,500 - £5,000, if you are not eligible for treatment on the NHS.

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.

You also need to take into account any medication required for ovarian stimulation. This may not be included in the price. Additional tests may also be required that are not included in the estimated prices above.

If pregnancy cannot be achieved using the partner's sperm, the specialist may recommend using donor sperm. Providing that the woman has no fertility issues, turning to artificial insemination by donor (AID) may be a good option to have a baby.

The price of AI is less than that of IVF. You can read about using donated sperm to have a baby in this article: Having a baby using donated sperm, where you will find more information about the treatment and prices.

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 more than 58% percent of sperm present in the ejaculate are dead.

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

  • Habitual use of alcohol or street drugs
  • Poor, unhealthy diet
  • Radiotherapy or chemotherapy
  • Genitourinary infections
  • Hormonal disorders

In these cases, reversing necrospermia and increasing sperm vitality is complicated. As such, it is likely that the affected man will have to turn to assisted reproductive techniques to have children.

Is there a relationship between necrozoospermia and ectopic pregnancy?

By Laura García de Miguel M.D., M.Sc. (gynecologist).

Necrozoospermia is not related to inccorect implantation of the gestational sac outside the uterus, but is associated with IVF failure, poor seminal quality, poor prognosis for fertilization and creating embryos.
Read more

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.

Is there a cure for necrospermia?

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

The best advice for a man with necrospermia to reduce the number of dead sperm in his semen, is to lead a healthy lifestyle. Complex vitamins and antioxidant supplements also exist to help the condition. If the necrospermia is caused by infection, antibiotics are needed to treat it. In any case, is is advisable to avoid long periods of sexual abstinence to avoid the build up of sperm in the semen.

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.

Aside from necrospermia, there are other sperm disorders that can compromise a man's fertility. Want to learn more about them? 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?

We make a great effort to provide you with the highest quality information.

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A Dumont, A-L Barbotin, V Lefebvre-Khalil, V Mitchell, J-M Rigot, F Boitrelle, G Robin. Necrozoospermia: From etiologic diagnosis to therapeutic management (view)

L Björndahl, I Söderlund, U Kvist. Evaluation of the one-step eosin-nigrosin staining technique for human sperm vitality assessment. Hum Reprod. 2003 Apr;18(4):813-6. doi: 10.1093/humrep/deg199 (view)

Moskovtsev SI, Librach CL. Methods of sperm vitality assessment. Methods Mol Biol. 2013;927:13-9.

Sapozhkova ZY, Eremin KI. Updates in protocol for human semen examination. Klin Lab Diagn. 2020;65(2):106-110. doi: 10.18821/0869-2084-2020-65-2-106-110.

FAQs from users: 'Can I have a natural pregnancy with necrospermia?', 'What causes necrospermia?', 'Is there a relationship between necrozoospermia and ectopic pregnancy?', 'What does dead sperm look like?', 'What's the normal range of dead sperm in a semen sample?', 'To what extent can smoking affect necrospermia?', 'Can dead sperm be revived?', 'Does necrospermia increase with age?', 'Is there a cure for necrospermia?', 'Can dead sperm still fertilize?', 'Does cancer cause necrospermia?', 'Does dead sperm smell like fish?', 'Is dead sperm dangerous?', 'Where do dead sperm go?' and 'Does dead sperm leave the woman's body?'.

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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
 Laura García de Miguel
Laura García de Miguel
M.D., M.Sc.
Bachelor of Medicine and Surgery from the Autonomous University of Barcelona, with specialization in Obstetrics & Gynecology at Sant Joan de Déu University Hospital. Master's Degree in Human Reproduction from the Complutense University of Madrid. Currently, she is the Medical Director of Clínica Tambre in Madrid, Spain. More information about Laura García de Miguel
License: 280843059
 Marta Barranquero Gómez
Marta Barranquero Gómez
B.Sc., M.Sc.
Graduated in Biochemistry and Biomedical Sciences by the University of Valencia (UV) and specialized in Assisted Reproduction by the University of Alcalá de Henares (UAH) in collaboration with Ginefiv and in Clinical Genetics by the University of Alcalá de Henares (UAH). More information about Marta Barranquero Gómez
License: 3316-CV
 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:
 Michelle Lorraine Embleton
Michelle Lorraine Embleton
B.Sc. Ph.D.
PhD in Biochemistry, University of Bristol, UK, specialising in DNA : protein intereactions. BSc honours degree in Molecular Biology, Univerisity of Bristol. Translation and editing of scientific and medical literature.
More information about Michelle Lorraine Embleton

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