Necrospermia accounts for about 1-2% of male infertility and has a complex etiology. The semen examination shows a decrease in sperm viability, and those with more than 40% dead sperm are called Necrospermia (Necrospermia). First of all, several concepts should be clarified: 1. In semen routine, sperm motility is divided into ABCD levels, and D-level sperm are immobile sperm. Immobile D-level sperm includes inactive sperm and dead sperm, both of which have no fertilization ability, but it cannot be assumed that D-level sperm is dead sperm. Lei Zhenhua, Department of Urology, Guangdong Province Hospital of Traditional Chinese Medicine 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 an active energy source for ejaculated sperm, and the prostatic fluid is alkaline, which is suitable for the survival and activity of spermatozoa. 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. The relationship between the epididymis and sperm is clear. 1. 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. 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, therefore, it is recommended to ovulate 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, spermatozoa experience water loss, 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 allocation of the accessory gland fluid, and their metabolic and physiological activities are then activated. 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 vesicles, 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 is a specific analysis of the common causes, see the trick: 1, 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. 50-80% of the sperm in the human reproductive tract are stored in the tail of the epididymis. Therefore, the most likely site of the lesion of dead spermatozoa is the problem of the epididymis and testes. The unfavorable microenvironment of the epididymis can damage spermatozoa 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 necessary for sperm survival (1) Fructose deficiency: Fructose is an important energy supplying substance to ensure sperm survival and activity, and when inflammation exists in the vas deferens, the fructose contained in normal seminal fluid will be reduced and affect certain sperm survival. 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 Normal semen pH is 7.2 to 8.9, 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, high temperature, radiation and other physical factors Due to high local temperature or local exposure to high doses of radiation exposure, or long-term exposure to radiation, etc., can reduce the survival rate of sperm and the occurrence of dead sperm. 6, drug factors The use of sperm-damaging drugs, such as tretinoin, cyclophosphamide, etc., can cause dead sperm. 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, it is important to remove the cause, 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 the inflammation of the sex glands and vas deferens. As the infection consumes a lot 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 antimicrobial drugs: Anti-inflammatory pain and Protasone are commonly used. Pantethol 50mg once, 3 times a day, and Pantethol 100mg once, once a day. 2.Supplement “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) supplement vitamin A, C. (6) supplement fructose. 3.Treatment of varicocele (1) High 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 for sperm production and sperm vitality (1) Clomiphene for oligospermia. (2) Chinese medicine and Chinese patent medicines are used to identify the evidence to improve the quality of semen and increase the conception rate of women in general. 6. In Chinese medicine, the treatment is based on the differentiation of symptoms and types, mainly kidney qi deficiency, yin deficiency and fire, dampness and heat, liver depression and qi stagnation, etc., but overall it is a mixed evidence of deficiency and reality, and while replenishing deficiency, it is necessary to take into account the clearing of heat and detoxification. 7, dietary therapy: (1) combined with inflammation of the reproductive system, can be appropriate to apply heat 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, apples have 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): For infertile men with sperm viability above 30%, IVF can be considered. (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.