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Male Infertility

Male Infertility
  • Infertility impacts one of every 6 couples trying to conceiving out of which 30% male factors.
  • Semen analysis defines the fertility status of male include sperm concentration, motility, and morphology.
  • Semen consists of sperm secretions from the accessory organs mainly the prostate and seminal vesicles, small contributions from the bulbourethral ( cowper,s )gland and epididymides also there.
  • 2 testies produce sperm and testosterone hormones under the influence of FSH (follicle stimulating hormone) and LH (luteinizing hormone).
  • LH is needed for the leyding cells in the testes to make testosterone, it is necessary for sexual drive.
  • Sperm produced in the seminiferous tubules and Sertoli cell nourish &regulates the sperm maturation.
  • Then it converges and collects into part of testes which is known as rete testis.
  • After then empties into the epididymis.
  • The epididymis is a swimming school of sperm, they spend 5 to 12 days here and becomes mature in motility & fertilization capacity.
  • The total process of spermatogenesis takes 75 days and it occurs at 34 C, so testes are outside of the body.
  • At the time of the ejaculation, they threw out into vagina through the vas deferens along with seminal vesicle fluid and prostatic fluids.
  • Unejaculated spermatozoa are reabsorbed in vas differences.
  • In female genital tract cervical crypts act as a reservoir of sperm providing supply for up to 72 hours.
  • Process of capacitation in the cervix and is completed in the fallopian tube.

Investigation –male

  • Very first should rule out for-
  • Hypospadias – urethra is located at the base of the penis.
  • Cryptorchidism – undescended testes which might be in abdomen.

Sample collection of semen –

  • Necessary sexual abstinence for at least 3 days and a maximum of 7 days of abstinence from sex is advocated.
  • For additional samples, if needed, the abstinence period should remain constant every time.
  • Method of collection mostly by masturbation & ejaculated into a clean container, it should be kept between 20 & 37 C.
  • Sample collection at home should be brought to the laboratory within 30 minutes of collection.
  • Collection of semen by coitus interruptus :
  • Silicone condom should be used, ordinary latex condom should not be used as they are toxic to sperm.
  • Next lab investigation should do at 3-month intervals.
  • Sperm count remains higher in winter.

Microscopic examination of semen –

  • Lower reference limit for semen volume is 1.5 ml.
  • Normally semen liquefy within 30 to 40 minutes.
  • pH- 7.2 is normal and pH less than 7 with low volume and low sperm count may be associated with ejaculatory duct obstruction or congenital bilateral absence of the vas deferens.

Sperm vitality –

  • Sperm vitality is a useful tool for assessing the membrane integrity of the sperm cell.
  • ≥  70 % live ( A,B,C grade )
  • ≤ 30 % dead (D grade )
  • The presence vital but immotile cells are indicative of a structural defect in the flagellum.
  • A high percentage of immotile and non-viable sperm suggest epididymal pathology which can be corrected by homeopathic treatments.

Morphology of sperm (Kruger strict criteria) –

  • Sperm morphology is one of the better prognosticators for fertility.
  • Abnormal shaped sperm are considered as teratozoospermia.
  • Evaluation of sperm morphology using Kruger’ s strict criteria severely impaired male fertility potential was measured by a result of less than or equal to 4% ( denotes percentage sperm having normal morphology ) and scores of greater than 14% indicated normal fertilization potential.
  • Sperm count
  • Normal – 70-80 million
  • Below 15 million- difficult conception
  • Below 5 million- oligospermia
  • No sperm – Azospermia.
  • Motility of sperm –
  • Quality & motility of sperm is more significant then count.
  • The sperm which moves forward fast is able to swim up to the ovam & fertilise it.
  • Grade A – (fast progressive)  swim forward fast in a straight line.
  • Grade B – (slow progressive) swim forward very slowly.
  • Grade C – (Non-progressive) move their tails but don’t move forward.
  • Grade D – (Non-motile) don’t move at all.
  • Within 60 min of ejaculation, sperm should be ≥ 25% Grade A,  ≥ 50% Grade A & B.  The sperm of grade C & D are considered poor.
  • Semen with poor motility sperm considered is Asthenospermia.
  • 7 days abstinence is associated with a decrease in motility despite an increase in sperm count.

 

Sperm Agglutination

Adherence of sperm to each other in an ejaculate indicated the presence of anti-sperm antibody in the sample which can be determined using a mixed agglutination reaction (MAR) test and it can be treated successfully with the help of homeopathy.

Fructose Test

  • Fructose is produced by seminal vesicles and it provides energy for sperm motility.
  • Absence fructose in semen suggests a – Absence of semen vesicles or Block in vas difference, or before the ejaculatory duct due to cystic fibrosis or scar which can be corrected by fibrolytic homeopathic remedies.

 

Absence of sperm in semen

  • Absence of sperm in semen known as azoospermia. It’s 2 % of male infertility.
  • A man may have normal libido & can ejaculate normally & semen looks normal.
  • In case of zero sperm re-check should do again.
  • It should Rule out for cryptozoospermia
  • Few sperms in the ejaculated material that they are identified only after concentration & centrifugation of the sample.
  • Check the pellet for sperm precursor.
  • If occasional sperm found in pellet it can be treated successfully with homeopathy.

 

If the report is persistently Zero then investigate for-

  • Obstructive azoospermia or Non-obstructive Azoospermia. By  USG or Doppler study of  Scrotum.
  • Obstructive azoospermia usually a block at the level of the epididymis.
  • No precursor cells are seen on semen analysis.
  • Normal ejaculate volume and azoospermia may indicate ductal obstruction or abnormal spermetogenesis.
  • Transrectal ultrasound is helpful in the diagnosis of ductal obstruction.
  • Men with normal sized testes and low ejaculate volume may have ejaculatory duct obstruction or dysfunction.
  • Vasography helps in the identification of vas deferens or ejaculatory ducts.
  • A normal testicular biopsy also indicates an obstruction in the reproductive system.
  • In case of absent vas deferens, semen volume is low like 0.5ml or less, pH is acidic and fructose is negative, if vas deferens is present them the diagnosis is a seminal vesicle obstruction.
  • Men with Non-obstuctive azzospermia have abnormal testicular functions or small testes with volume  > 12cc.
  • The testicular failure may be partial so it produces very few sperms which are not enough for it to be ejaculated. The homeopathic treatment stimulates sperm production and leads to conceiving.
  • Some men may have complete testicular failure associated with Cryptorchidism, Sertoli cell only syndrome which can be corrected by homeopathic treatment in some cases.
  • USG / Doppler study- Reveal varicocele- mostly found left side but may be bilateral and Patient may be with oligospermia/ azoospermia which doesn’t require surgical intervention. It can be treated successfully with proper homeopathic treatment.

 

Sperm dysfunction-

  • Seminal plasma contains many antioxidants which keep sperms fit for fertilization.
  • Defective Antioxidant leads to weak fertilization. Power of sperm which can be stimulated by homeopathic treatment.
  • Sperm activation & acrosomal reaction are dependent upon the influx of calcium before the sperm fuses with the oocyte.
  • Calcium group of homeopathic remedies plays a good role here to improve acrosomal reaction.
  • Capacitation is functional maturation of spermatozoa & area of acrosomal cap is also altered to proceed the acrosomal reaction.
  • After fertilization first cell division cleavage initiated with the help of CS1 (cleavage signal 1) protein which is located on the head of the sperm.
  • Difficulty in any of above process leads to sperm dysfunction which leads to sperm dysfunction which can be improved by using appropriate homeopathic remedies and mother tinctures at various stages of treatments.