World J Mens Health.  2022 Apr;40(2):228-242. 10.5534/wjmh.210149.

Sperm Vitality and Necrozoospermia: Diagnosis, Management, and Results of a Global Survey of Clinical Practice

  • 1American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.
  • 2Reproductive Biology, Fertility Preservation, Andrology, CECOS, Poissy Hospital, Poissy, France.
  • 3Paris Saclay University, UVSQ, INRAE, BREED, Jouy-en-Josas, France.
  • 4Department of Urology, Cleveland Clinic, Cleveland, OH, USA.
  • 5Department of Physiology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia.
  • 6Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt.
  • 7Department of Urology, Hamad Medical Corporation, Doha, Qatar.
  • 8Department of Urology, Weill Cornell Medical-Qatar Doha, Qatar.
  • 9SH Ho Urology Center, Department of Surgery, Chinese University of Hong Kong, Hong Kong.
  • 10Department of Urology, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
  • 11Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
  • 12Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa.
  • 13LogixX Pharma, Theale, Berkshire, UK.
  • 14Andromed Health & Reproduction, Fertility Diagnostics Laboratory, Maroussi, Greece.
  • 15Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA.
  • 16Austin Fertility and Reproductive Medicine/Westlake IVF, Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
  • 17Department of Urology, Loma Linda University Health, Loma Linda, CA, USA.
  • 18Department of Physiology, School of Natural Medicine, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, South Africa.
  • 19Fakih IVF Fertility Center, Abu Dhabi, UAE.
  • 20Department of Biochemistry, College of Medicine, University of Garmian, Kalar, Iraq.
  • 21Department of Endocrinology and Metabolic Diseases, Polytechnic University of Marche, Ancona, Italy.
  • 22Department of Andrology, Sexology and STIs, Faculty of Medicina, Cairo University, Cairo, Egypt.
  • 23Department of Andrology, Fundacio Puigvert, Barcelona, Spain.
  • 24Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan.
  • 25Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA.
  • 26Department of Andrology and Urology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam.
  • 27Department of Andrology, Binh Dan Hospital, Ho Chi Minh City, Viet Nam.
  • 28Department of Urology, Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
  • 29Department of Urology, Samsun Vezirköprü State Hospital, Samsun, Turkey.
  • 30Centro ANDROGEN, La Coruña, Spain.
  • 31Servicio de Urología, Hospital Clínico de Barcelona Barcelona, Spain.
  • 32Department of Surgery, School of Medicine, Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya, Malaysia.
  • 33Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
  • 34Department of Urology, Samsun Training and Research Hospital, Samsun, Turkey.
  • 35Andrology and IVF Unit, Procrea Institute, Lugano, Switzerland.
  • 36Department of Surgery, McGill University, Montreal, QC, Canada.
  • 37IVF Clinic “Akeso-Embryo ART”, Athens, Greece.
  • 38Andrology and Reproductive Medicine Unit, Gynepro Medical, Bologna, Italy.
  • 39Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia.
  • 40AndroUrology Centre, Brisbane, QLD, Australia
  • 41Reproductive and IVF Unit, Andrology Outpatients Clinic, ASL Bari, Conversano (Ba), Italy.
  • 421st Urology Department, School of Medicine, Aristotle University, Thessaloniki, Greece.
  • 43Department of Urology, Innsbruck Medical University, Innsbruck, Austria.
  • 44Department of Urology and Renal Transplantation, University of Foggia, Ospedali Riuniti of Foggia, Foggia, Italy.
  • 45Department of Urology and Andrology, Kansai Medical University, Hirakata, Osaka, Japan.
  • 46Department of Urology, Pusan National University School of Medicine, Busan, Korea.
  • 47Medical Research Institute of Pusan National University Hospital, Busan, Korea.
  • 48Citmer Reproductive Medicine, IVF LAB, Mexico City, Mexico.
  • 49Department of Urology, Medipol Mega University Hospital, Istanbul, Turkey.
  • 50Department of Andrology, Hammersmith Hospital, London, UK.
  • 51Department of Urology, Michael Chilufya Sata Copperbelt University School of Medicine, Ndola, Zambia.
  • 52Department of Experimental Physiology, School of Health Sciences, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
  • 53Departamento Docencia e Investigación, Hospital Militar Campo de Mayo, Universidad Barcelo, Buenos Aires, Argentina.
  • 54Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.
  • 55Section of Urology, University of Santo Tomas Hospital, Manila, Philippines.
  • 56Department of Surgery, Urology Division, Sultan Qaboos University, Muscat, Oman.
  • 57Department of Urology and Andrology, AIG Hospitals, Gachibowli, Hyderabad, India.
  • 58Department of Andrology, Uromedica Polyclinic, Belgrade, Serbia.
  • 59Department of Urology, Graduate School of Medicine, Osaka University, Osaka, Japan.
  • 60Avant Concierge Urology & University of Central Florida, Winter Garden, FL, USA.
  • 61Department of Andrology and Reproductive Medicine, Jindal Hospital, Meerut, India.
  • 62Department of Urology, Faculty of Medicine, Minia University, Minia, Egypt.
  • 63Department of Urology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
  • 64HORAC Grand Front Osaka Clinic, Osaka, Japan.
  • 65Division of Andrology, Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India.


Sperm vitality testing is a basic semen examination that has been described in the World Health Organization (WHO) Laboratory Manual for the Examination and Processing of Human Semen from its primary edition, 40 years ago. Several methods can be used to test sperm vitality, such as the eosin-nigrosin (E-N) stain or the hypoosmotic swelling (HOS) test. In the 6th (2021) edition of the WHO Laboratory Manual, sperm vitality assessment is mainly recommended if the total motility is less than 40%. Hence, a motile spermatozoon is considered alive, however, in certain conditions an immotile spermatozoon can also be alive. Therefore, the differentiation between asthenozoospermia (pathological decrease in sperm motility) and necrozoospermia (pathological decrease in sperm vitality) is important in directing further investigation and management of infertile patients. The causes leading to necrozoospermia are diverse and can either be local or general, testicular or extra-testicular. The andrological management of necrozoospermia depends on its etiology. However, there is no standardized treatment available presently and practice varies among clinicians. In this study, we report the results of a global survey to understand current practices regarding the physician order of sperm vitality tests as well as the management practices for necrozoospermia. Laboratory and clinical scenarios are presented to guide the reader in the management of necrozoospermia with the overall objective of establishing a benchmark ranging from the diagnosis of necrozoospermia by sperm vitality testing to its clinical management.


Asthenozoospermia; Eosine Yellowish-(YS); Infertility; Nigrosin; Spermatozoa; Vitality
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