Dumont A, Barbotin A-L, Lefebvre-Khalil V, Mitchell V, Rigot J-M, Boitrelle F, Robin G
Service de gynécologie endocrinienne et médecine de la reproduction, hôpital Jeanne-de-Flandre, centre hospitalier régional universitaire, 2, avenue Oscar-Lambret, 59000 Lille, France.
Service de biologie de la reproduction-spermiologie-CECOS, hôpital Jeanne-de-Flandre, centre hospitalier régional universitaire, 59000 Lille, France; EA 4308 gamétogenèse et qualité du gamète, institut de biologie de la reproduction-spermiologie-CECOS, hôpital Albert-Calmette, centre hospitalier régional universitaire, 59000 Lille, France.
Gynecol Obstet Fertil Senol. 2017 Apr;45(4):238-248. doi: 10.1016/j.gofs.2017.01.010. Epub 2017 Feb 16.
This review describes necrospermia, its diagnosis, causes and management. Sperm vitality is commonly assessed in the laboratory of reproductive biology, with the eosin test or with the hypo-osmotic swelling test. Necrospermia is defined by a percentage of living spermatozoa inferior to 58%, and can be related to male infertility. Several pathological mechanisms may be involved and can be classified either in testicular causes (hyperthyroidism, local hyperthermia, varicocele), or post-testicular causes (epididymal necrospermia, dysregulation of seminal plasma, adult polycystic kidney disease, vasectomy reversal, anti-sperm antibodies) or both (infection, toxic, age, spinal cord injury). The first treatment is to correct the underlying cause, if possible. Repetitive ejaculation has demonstrated to be effective as well. Many drugs would also improve the sperm vitality (antioxidants, non-and-steroidal anti-inflammatory drugs) but there is currently no guideline to recommend their use. With necrospermia, fertilization rates are lower but in vitro fertilization (IVF) with Intracytoplasmic sperm injection (ICSI) improves the chances of conception.
本综述描述了死精症、其诊断、病因及治疗。在生殖生物学实验室中，通常通过伊红试验或低渗肿胀试验来评估精子活力。死精症的定义是活精子百分比低于58%，且可能与男性不育有关。可能涉及多种病理机制，可分为睾丸性病因（甲状腺功能亢进、局部高温、精索静脉曲张）、睾丸后性病因（附睾死精症、精浆调节异常、成人多囊肾病、输精管复通术、抗精子抗体）或两者皆有（感染、中毒、年龄、脊髓损伤）。首要治疗方法是尽可能纠正潜在病因。重复射精也已证明有效。许多药物也可提高精子活力（抗氧化剂、非甾体抗炎药），但目前尚无推荐使用这些药物的指南。对于死精症，受精率较低，但卵胞浆内单精子注射（ICSI）体外受精（IVF）可提高受孕几率。
