[Diagnostic approach and therapeutic strategy in 133 infertile patients with astheno-necrozoospermia]

One-hundred thirty-three patients (aged 22 to 48, median 27 years) found affected by repetitive severe astheno-necrozoospermia (ASNE) (forward sperm motility < 10%; viable forms < 25%) in their ejaculates detected by both conventional viability tests (eosin Y exclusion and HOS tests) associated with oligo (51.1%), poly (3.7%), terato- (82.7%), -zoospermia, hyperdesfoliation of seminal spermatids (36.8%), hypospermia (11.3%), a comprehensive (history analysis; physical examination; lab: hormonal, microbiological, hemato-chemical blood screening, ultrasound scans at didymo-epididymal and prostato-vesicular glands, genital venous doppler) work-up allowed to recognize the following possible causes of ASNE: infectious (24.1%), spermiotoxyc (16.5%), hormonal (15.0%), iatrogenic (12.8%), chronic extratesticular diseases (CETD) (10.9%), varicocele (6.8%), idiopathic (14.3%). Overall population, except CETD patients gave their written informed consent about trial options for a three month period: a. rational, evidence-based treatment, group-standardised for doses and lenght (treated patients = subgroups T: total number = 71); b. short-term treatment/no treatment, (matched-control = subgroups Co: total number = 47). Follow-up semen data performed after completion of the assigned trial, together detected a conventionally normal percentage (> 25%) of viable sperm (necrozoospermic-responders (NR) in 37 (52.1%) out of subgroup-T patients. All subgroups-T patient, excepted subgroup-T patient affected by idiophathic ASNE (NR = 0%), exhibited NR rate (range 50-69.2%) values always significantly higher than subgroups-Co (NR = 0%, in all subgroups). Moreover, in each subgroup-T patients the percentages of viable and forward motile sperms values were significantly higher than matched-controls. The results of this study indicate that in patients affected by ASNE an andrological comprehensive work-up is mandatory because ASNE has a heterogeneous pathogenesis and a favourable prognosis, in terms of viable forms sperm improvement is possible after evidence-based therapeutic strategy.