Boursier Angèle, Dumont Agathe, Boitrelle Florence, Prasivoravong Julie, Lefebvre-Khalil Valérie, Robin Geoffroy, Barbotin Anne-Laure
Institut de Biologie de La Reproduction-Spermiologie-CECOS, Hôpital Jeanne de Flandre, CHU Lille, Lille, France.
Service de Gynécologie Endocrinienne et Médecine de La Reproduction, Assistance Médicale à La Procréation et Préservation de La Fertilité, Hôpital Jeanne de Flandre, Avenue Eugène Avinée, CHU Lille, Lille, France.
Andrology. 2022 May;10(4):642-659. doi: 10.1111/andr.13172. Epub 2022 Mar 16.
Necrozoospermia is a condition found in 0.2%-0.4% of male infertility cases. The causes of necrozoospermia are multiple: they can be related to testicular and/or post-testicular damage. Additionally, these causes most often involve the production of reactive oxygen species (ROS) and/or sperm DNA fragmentation (SDF) which can reduce the chances of spontaneous pregnancy or affect the outcome of assisted reproductive technologies.
To focus on potential etiologies of necrozoospermia, its diagnosis and its therapeutic management especially before the employment of ICSI.
Authors searched PubMed/Medline, Web of Science, Cochrane Library, Google and Institutional websites for medical subheading terms and free text words referred to "necrozoospermia", "sperm vitality", "sperm viability", SDF and "ICSI".
We identified 12 main etiologies of necrozoospermia responsible for either a decrease of sperm vitality, a mild, a moderate or a severe necrozoospermia. In case of a confirmed decreased vitality, a thorough check-up should be conducted and if available, etiological treatment should be proposed. Therapeutic management could also include repeated ejaculations, drug treatments, the use of ICSI with ejaculated or surgically extracted spermatozoa in case of a non-treatable necrozoospermia.
The potential causes of necrozoospermia should be investigated because many of them could be corrected, thus avoiding the use of ICSI. Moreover, if ICSI procedure remains necessary, the therapeutic management of necrozoospermia could also improve the chances of success by reducing oxidative stress and/or SDF.
死精症在0.2%-0.4%的男性不育病例中出现。死精症的病因多种多样：可能与睾丸和/或睾丸后损伤有关。此外，这些病因大多涉及活性氧（ROS）的产生和/或精子DNA碎片（SDF），这会降低自然受孕的几率或影响辅助生殖技术的结果。
关注死精症的潜在病因、诊断及其治疗管理，尤其是在采用卵胞浆内单精子注射（ICSI）之前。
作者在PubMed/Medline、科学网、考科蓝图书馆、谷歌和各机构网站上搜索了与“死精症”“精子活力”“精子生存力”“SDF”和“ICSI”相关的医学副标题术语和自由文本词汇。
我们确定了导致精子活力下降、轻度、中度或重度死精症的12种主要死精症病因。如果确诊活力下降，应进行全面检查，如有可能，应提出病因治疗。治疗管理还可包括多次射精、药物治疗，对于无法治疗的死精症，可使用射出的或手术提取的精子进行ICSI。
应调查死精症的潜在病因，因为其中许多病因可以纠正，从而避免使用ICSI。此外，如果ICSI程序仍然必要，死精症的治疗管理也可以通过减少氧化应激和/或SDF来提高成功率。
