La necrozoospermie : du diagnostic étiologique à la prise en charge thérapeutique
2017
This review describes
necrospermia, its diagnosis, causes and management. Sperm vitality is commonly assessed in the laboratory of
reproductive biology, with the
eosintest or with the hypo-osmotic swelling test.
Necrospermiais 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.
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