Sperm vitality and necrozoospermia: diagnosis, management, and results of a global survey of clinical practice

Ashok Agarwal*, Rakesh K. Sharma, Sajal Gupta, Florence Boitrelle, Renata Finelli, Neel Parekh, Damayanthi Durairajanayagam, Ramadan Saleh, Mohamed Arafa, Chak Lam Cho, Alaa Farkouh, Amarnath Rambhatla, Ralf Henkel, Paraskevi Vogiatzi, Nicholas Tadros, Parviz Kavoussi, Edmund Ko, Kristian Leisegang, Hussein Kandil, Ayad PalaniGianmaria Salvio, Taymour Mostafa, Osvaldo Rajmil, Saleem Ali Banihani, Samantha Schon, Tan V. Le, Ponco Birowo, Gökhan Çeker, Juan Alvarez, Juan Manuel Corral Molina, Christopher C.K. Ho, Aldo E. Calogero, Kareim Khalafalla, Mesut Berkan Duran, Shinnosuke Kuroda, Giovanni M. Colpi, Armand Zini, Christina Anagnostopoulou, Edoardo Pescatori, Eric Chung, Ettore Caroppo, Fotios Dimitriadis, Germar Michael Pinggera, Gian Maria Busetto, Giancarlo Balercia, Haitham Elbardisi, Hisanori Taniguchi, Hyun Jun Park, Israel Maldonado Rosas, Jean de la Rosette, Jonathan Ramsay, Kasonde Bowa, Mara Simopoulou, Marcelo Gabriel Rodriguez, Marjan Sabbaghian, Marlon Martinez, Mohamed Ali Sadighi Gilani, Mohamed S. Al-Marhoon, Raghavender Kosgi, Rossella Cannarella, Sava Micic, Shinichiro Fukuhara, Sijo Parekattil, Sunil Jindal, Taha Abo Almagd Abdel-Meguid, Yoshiharu Morimoto, Rupin Shah

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

18 Citations (Scopus)


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.

Original languageEnglish
Article number210149
Pages (from-to)228-242
Number of pages15
JournalWorld Journal of Men?s Health
Issue number2
Publication statusPublished - 2022


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

ASJC Scopus subject areas

  • Reproductive Medicine
  • Ageing
  • Health Policy
  • Public Health, Environmental and Occupational Health
  • Psychiatry and Mental health
  • Urology
  • Pharmacology (medical)


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