Necrospermia accounts for about 1-2% of male infertility and has a complex etiology.
Semen examination showing a decrease in sperm viability and more than 40% dead sperm is called Necrospermia (dead sperm).
First of all, several concepts should be clarified: Lv Liguo, Department of Urology, Guangdong Provincial Hospital of Traditional Chinese Medicine
1. In semen routine, sperm motility is divided into ABCD levels, and D-level sperm are immobile sperm. Immobile grade D sperm includes inactive sperm and dead sperm, both of which have no fertilization ability, but it cannot be assumed that grade D sperm is dead sperm.
2.Eosin staining test and sperm hypotonic swelling test can clearly distinguish the proportion of dead sperm among D-grade sperm, which is one of the laboratory tests for clinical diagnosis of dead sperm.
3. Clarify the birth and development of spermatozoa.
Under normal circumstances, spermatozoa are produced by the spermatogenic epithelium of the testes and then enter the epididymis for further development and maturation. The caudal part of the epididymis and the jugular abdomen of the vas deferens are the sites of sperm storage. The epithelial secretions of the seminal vesicles are rich in fructose, which is the energy source for the activity of ejected sperm, and the prostatic fluid is alkaline, which is suitable for the survival and activity of sperm.
The above process shows that a problem in one part of the process of spermatogenesis, development and transport can lead to dead spermatozoa. It is generally believed that the dead spermatozoa are closely related to inflammation of the epididymis and inflammation of the epididymis, because sperm are stored in the epididymis, so special attention should be paid to the relationship between inflammation of the epididymis and pathological changes of the epididymis and dead spermatozoa.
II. Clarify the relationship between epididymis and spermatozoa
1. The tail of the epididymis has the best conditions for sperm storage. 50-80% of the sperm in the human reproductive tract are stored in the tail of the epididymis.
2. Generally, sperm stay in the epididymis for 5-21 days, with an average of 14 days, mostly in the caudal part of the epididymis. During the storage process, the sperm undergoes a series of changes and eventually acquires the ability to fertilize – the sperm’s ability to fertilize is acquired within the epididymis!
3. When sperm are stored inside the epididymis for too long, sperm will age. Aged sperm have low fertilization rate, high malformation rate and high miscarriage, so it is recommended that sperm are ovulated 4-5 days before ovulation, thus maintaining the vitality of sperm. Aged sperm is also processed through the epididymis.
4. The epididymal fluid has high concentrations of glycerol phosphorylcholine, carnitine, sialic acid, dihydrotestosterone, PH, androgen binding protein, low oxygen content, and the fluid is hypertonic, so that it constitutes a good sperm storage reservoir. In this environment, sperm appear to lose water, have reduced vitality and slow metabolic function, thus completing physiological maturation in a resting state.
5. After the spermatozoa are discharged from the epididymis, they enter the hypotonic and neutral (PH 7.2-7.8) seminal fluid environment (seminal fluid includes 60% of the seminal vesicle gland fluid and 30% of the prostatitis fluid) and receive the accessory gland fluid deployment, and the metabolic and physiological activities are then activated.
Third, the etiology of dead spermatozoa
The most common causes of dead spermatozoa are: abnormal testicular spermatogenesis, endocrine abnormalities, varicocele, various inflammatory diseases such as orchitis, epididymitis, inflammation of the vas deferens, seminal vesiculitis, prostatitis, vitamin A deficiency, low PH value, zinc deficiency, positive anti-sperm antibody, etc.
How to clarify the clinical causes and lesion sites of dead spermatozoa? The following are specific analyses of the common etiologies, and see how to deal with them.
1. In terms of lesion site, pay attention to the epididymal factor!
Sperm are produced by the testes, matured, stored and decayed in the epididymis, of which the tail of the epididymis has the best conditions for sperm storage, and 50-80% of the sperm in the human reproductive tract are stored in the tail of the epididymis. Therefore, the most likely site of dead spermatozoa is the problem of the epididymis and testicles.
The unfavorable microenvironment of the epididymis can damage sperm and cause sperm death. Pathological damage to the epididymis can cause an imbalance of oxidative and antioxidant activity, and the massive production of oxygen free radicals can cause severe sperm damage and death. Some toxic substances can also act directly on sperm and cause sperm death. The disintegration of dead sperm and the release of enzymes can affect and inhibit the surviving sperm, causing a vicious circle.
2. In terms of the nature of the lesion, the infection factor ranks first!
Semen infection confirmation and localization methods: seminal plasma elastase determination, prostate fluid routine, seminal plasma biochemical 4, prostate seminal vesicle ultrasound.
3. Lack of certain nutrients in semen that are essential for sperm survival
(1) Fructose deficiency: Fructose is an important energy-supplying substance to ensure the survival and activity of spermatozoa. When inflammation exists in the vas deferens, the fructose contained in normal seminal vesicle fluid will decrease and affect the survival of certain spermatozoa.
Confirmation method: Fructose characterization in semen routine; or seminal plasma biochemical analysis; or ultrasound examination of the seminal vesicle gland.
(2) Zinc deficiency: The normal level of zinc in semen should be 80-25ug/ml. In prostatitis, the zinc level in semen may drop, and if it drops below 50ug/ml, the sperm will easily die.
Confirmation method: seminal plasma zinc measurement.
4. Change in semen pH
The pH of normal semen is 7.2-8.9, which is alkaline. pH below 6.5 can cause a large number of sperm deaths. A decrease in semen pH is mostly related to inflammation of the reproductive system, and bacterial metabolites can cause a decrease in semen pH.
Confirmation method: Routine semen analysis includes pH measurement.
5. Physical factors such as high temperature and radiation
High local temperature or local exposure to high doses of radiation or long-term exposure to radiation can reduce the survival rate of spermatozoa and lead to castration.
6, drug factors
The use of sperm-damaging drugs, such as rhodopsin and cyclophosphamide, can cause cadaverous spermatozoa.
7, endocrine factors
8, immune factors
Increased serum anti-sperm antibodies can lead to cadaverous spermatozoa.
Fourth, the treatment of dead spermatozoa
The treatment of dead spermatozoa is very difficult, and it is important to remove the causes, such as anti-inflammatory treatment and removal of toxic substances on sperm. Anti-oxidant and anti-free radical treatment, after the initial application has achieved better results. In vitro treatment of sperm activation can also be carried out to activate the surviving but inactive sperm so that they can swim, and on this basis the active sperm can be separated, and artificial insemination can be performed when conditions permit. In this regard, experience has been gained and better results have been achieved.
1.Treatment of infection
The main cause of dead sperm is inflammation of the sex glands and vas deferens. As the infection consumes a large amount of essential nutrients or trace elements zinc on which sperm survive, or the pH of semen changes, and factors such as the appearance of anti-sperm antibodies, which destroy the environment in which sperm live and cause sperm death. Therefore, aggressive treatment of paraphimosis has the potential to resolve the infertility problem in patients with cadaveric spermatozoa. The key to treating dead spermatozoa is to treat prostatitis and seminal vesiculitis.
(1) Antibacterial drugs.
Used for dead sperm due to prostatitis and seminal vesiculitis caused by bacterial infection.
Generally doxycycline, methotrexate, TMP + SMZ combined application is more.
(2) Non-hormonal antibacterial drugs
Anti-inflammatory pain and POTUS are commonly used. Pantethine is 50mg once, 3 times a day, and Pantethone is 100mg once, once a day.
2.Supplemental “nutrition”
(1) Oral carnitine drugs, amino acid drugs.
(2) Intravenous drip compound amino acid injection is more effective.
(3) intravenous application of low molecular dextrose intravenous drip can be effective.
(4) Supplementation of trace elements zinc and selenium.
(5) Supplementation of vitamin A and C.
(6) Supplementation of fructose.
3.Treatment of varicocele
(1) High level ligation of spermatic vein is recommended for moderate to severe patients.
(2) Mild patients can choose Chinese medicine and western medicine for treatment.
4.Hormonal drugs to regulate the endocrine function in the body
(1) Bromocriptine for hyperprolactinemia.
5.Drugs to promote sperm production and increase sperm vitality
(1) Clomiphene for the treatment of oligospermia.
(2) Chinese herbal medicine and proprietary Chinese medicine are used with evidence to improve semen quality in general and increase the conception rate of women.
6.Chinese medicine
The main types of symptoms are kidney qi deficiency, yin deficiency and fire, dampness and heat, liver depression and qi stagnation, etc. However, in general, it is a mixed evidence of deficiency and reality, and while supplementing deficiency, it is necessary to take into account such aspects as clearing heat and detoxification.
7.Food therapy.
(1) combined with inflammation of the reproductive system, can be appropriate to apply heat-clearing and detoxification of Chinese herbal soup dietary therapy.
(2) carnitine can provide energy for sperm, carnitine content in meat soup is high, you can drink more meat soup, goat meat carnitine content is the highest.
(3) Eat food rich in zinc and selenium, among fruits, apple has the highest zinc content, and seafood has more selenium content.
8.Assisted reproductive technology
(1) Sperm washing: treatment of immune infertility in men with high anti-sperm antibodies.
(2) Sperm optimization: select sperm with good motility for intrauterine insemination (IUI) or for other assisted conception techniques, and use ultrasound to monitor ovulation during the female partner’s ovulation period.
(2) In vitro artificial insemination (IVF): IVF can be considered for infertile men with a sperm viability rate of 30% or more.
(3) Intracytoplasmic sperm injection (ICSI): For infertile men with very poor sperm motility, this method can be used when fertility is still not resolved by conventional IVF treatment. This is a better treatment for patients with weak spermatozoa who have very poor semen quality.