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Novel insights into necrozoospermia from a single-center study: reference ranges, possible etiology, and impact on male fertility

Zhang, Er-Chen1,*; Yin, Xin-Yu1,*; Peng, Zi-Yan2; Lai, Zhi-Zhou3; Hu, Liang1,4,5; Peng, Yang-Qin4,5; Zhang, Huan1; Ming, Rui1; Lin, Ge1; Li, Wei-Na4,6

1NHC Key Laboratory of Human Stem Cell and Reproductive Engineering, School of Basic Medical Sciences, Central South University, Changsha 410008, China

2Laboratory of Zebrafish Genetics, College of Life Sciences, Hunan Normal University, Changsha 410006, China

3Hunan Guangxiu Hospital, School of Medicine, Hunan Normal University, Changsha 410001, China

4Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha 410008, China

5Hunan International Scientific and Technological Cooperation Base of Development and Carcinogenesis, Changsha 410008, China

6Hunan Guangxiu Hi-tech Life Technology Co., Ltd., Changsha 410013, China

Correspondence: Dr. WN Li (liweinaking@126.com)

Originally published: June 04, 2024 Received: May 22, 2023 Accepted: March 8, 2024


Necrozoospermia is a poorly documented condition with a low incidence, and its definition and clinical significance are unclear. Herein, we provide a reference range for necrozoospermia and discuss its possible etiology and impact on male fertility and assisted reproductive outcomes. We extracted relevant information from 650 Chinese male partners of infertile couples and statistically analyzed sperm vitality. Necrozoospermia was present in 3.4% (22/650) of our study population, and the lower cut-off value for sperm vitality was 75.3%. We compared two methods for assessing sperm vitality (eosin-nigrosin head staining and hypo-osmotic swelling test [HOST]), for which the percentage in the eosin-nigrosin group (mean ± standard deviation [s.d.]: 77.5% ± 10.5%) was significantly higher than that in the HOST group (mean ± s.d.: 58.1% ± 6.7% [5–10 min after incubation] and 55.6% ± 8.2% [25–30 min after incubation]; both P < 0.001). The incidence of necrozoospermia increased with age (odds ratio [OR] = 1.116, 95% confidence interval [CI]: 1.048–1.189, P = 0.001), while the percentage of normal sperm morphology and DNA fragmentation index (DFI) were significantly associated with necrozoospermia, with ORs of 0.691 (95% CI: 0.511–0.935, P = 0.017) and 1.281 (95% CI: 1.180–1.390, P < 0.001), respectively. In the following 6 months, we recruited 166 patients in the nonnecrozoospermia group and 87 patients in the necrozoospermia group to compare intracytoplasmic sperm injection (ICSI) and pregnancy outcomes between the two groups. The necrozoospermia group had a significantly lower normal fertilization rate (74.7% vs 78.2%, P = 0.041; OR = 0.822; 95% CI: 0.682–0.992) than that in the nonnecrozoospermia group. This study presents substantial information on necrozoospermia to establish comprehensive and applicable reference values for sperm vitality for spontaneous conception and artificially assisted reproductive management.

Keywords: male fertility; necrozoospermia; reference ranges; sperm vitality

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Asian Journal of Andrology CN 31-1795/R ISSN 1008-682X  Copyright © 2023  Shanghai Materia Medica, Chinese Academy of Sciences.  All rights reserved.