Andrological profile of infertile men with necrozoospermia (phenotypical features and etiologies): retrospective analysis of a cohort of more than 300 patients.

Abstract

Background: Necrozoospermia is a rare cause of male infertility, with a reported incidence of 0.2 to 0.4% in the literature. There are three types of etiology for necrozoospermia: testicular, post-testicular and mixed causes. The main objective of this study is to identify the risk factors of severe necrozoospermia and establish an andrological profile.

Methods: The dataset of patients suffering from necrozoospermia was retrospectively collected in the reproductive biology and andrology departments of the university hospital of Lille between 2003 and 2021. The following data were collected: age, body mass index, profession, drug use, hormone assays, semen analyses, history of genital or male accessory gland infection, pelvic surgery, hyperthyroidism, polycystic kidney disease, varicocele, any seminal tract anomality. Patients were divided into three groups according to the degree of sperm vitality: mild (vitality between 40 and 54%), moderate (20-40%) and severe (< 20%) necrozoospermia. The various causes of necrozoospermia were categorized as follow : testicular, post-testicular, mixed, idiopathic.

Results: Semen analysis showed a significant decrease in ejaculate volume in the severe group compared to the moderate (-0.8mL; p = 0.0068) and mild (-1.3mL; p = 0.042) ones, but within WHO reference limits (> 1.4 mL). Comparison of total testicular volumes showed significantly higher values for the severe group compared to the moderate (+ 7.9 mL; p = 0.0005) and mild (+ 6.7mL; p = 0.0032) ones. Patients with seminal tract anomalies had significantly more severe necrozoospermia (-10.78% vitality ; p = 0.0001).

Conclusion: Having a post-testicular cause, especially a seminal tract anomality, is a risk factor of severe necrozoospermia. In this case, the andrological profile is normal testicular volume, averaging 16mL, a decrease in ejaculated volume meaning there is, no clear impairment of spermatogenesis.