SEMINAL ABNORMALITIES

Description

  • The commonest cause of impaired male fertility is the defective or absent spermatogenesis
  • The impairment may be in any one of the parameters like density, motility, or morphology of the spermatozoa

Reference range for semen characteristics:

  • Semen volume 1.5- 5 ml
  • Colour white, Opalescent
  • Liquefaction in 30 minutes
  • Total sperm count >39 million per ejaculate
  • Sperm concentration >15 million per ml
  • Total motility >40 %
  • Progressive motility >32 %
  • Vitality >58 %
  • Morphology (normal forms) 4 %
  • pH 7.2 – 8.0
  • Leucocytes >1 million per ml
  • Seminal zinc >2.4 µmol per ejaculate
  • Seminal Fructose >13 µmol per ejaculate

Etiology

  • Includes pre testicular, testicular, and the post testicular causes
  • Important Causes are
  • Hormonal problems
  • Genetic causes
  • Varicocele
  • Idiopathic
  • Lifestyle factors
  • Genital infection
  • Chemotherapy
  • Radiotherapy
  • Cryptorchidism
  • Gonadotoxin exposure
  • Endocrine disturbances

Types

Nomenclature related to semen quality are:

  • Aspermia - Absence of semen (no or retrograde ejaculation)
  • Hypospermia - Low ejaculate volume
  • Azoospermia - No spermatozoa in the ejaculate
  • Oligozoospermia – <15 million spermatozoa / mL of ejaculate
  • Asthenozoospermia – <32% of spermatozoa show progressive motility
  • Teratozoospermia – Increased amorphous spermatozoa
  • Oligoasthenoteratozoospermia (OAT syndrome ) – Low concentration, Insufficient motility, and increased amorphous spermatozoa
  • Cryptozoospermia – spermatozoa absent from fresh preparations but observed in centrifuged pellet
  • Haemospermia - presence of erythrocytes in the ejaculate
  • Leukospermia (Pyospermia)– presence of leucocytes in the ejaculate above the threshold value
  • Necrozoospermia – low percentage of live, and high percentage of immotile, spermatozoa in the ejaculate
  • Normozoospermia – total number of spermatozoa, and percentages of progressively motile & morphologically normal spermatozoa, equal to or above the lower reference limits

Investigation

  • Semen analysis - with abstinence of 3 days to maximize the quantity of ejaculate and concentration of the sperm
  • Semen analysis should be repeated in 12-week intervals ( Minimum of 2 separate samples)
  • Hormonal analysis
  • Transrectal ultrasonography (TRUS), Vasography; if obstructive pathology (post testicular causes) is suspected
  • Scrotal ultrasonography with Colour Doppler – if varicocele is suspected
  • Antisperm antibody
  • Testicular biopsy
  • If ejaculatory volume is low, then further investigations to be done includes post ejaculatory urine examination (retrograde ejaculation), TRUS (absence of vas deferens), hormonal evaluation (hypogonadism)
  • If semen does not liquefy within 30 minutes- do a hormonal evaluation
  • In Oligozoospermia - TRUS (Partial ejaculatory duct obstruction), Anti sperm antibody evaluation, Hormonal evaluation, Physical examination and imaging studies for Varicocele
  • In Azoospermia - sperm centrifuged to verify azoospermia, post-ejaculatory urine (retrograde ejaculation), hormonal analysis, testicular biopsy (testicular failure), TRUS (ejaculatory duct obstruction)
  • If motility is decreased- Antisperm antibody evaluation & investigations for varicocele should be done

Treatments

Hypospermia

  • Ksheera
  • Gritha
  • Amalaki
  • Satavari
  • Vidari
  • Kapikachu
  • Maharasnadi kashaya
  • Narasimha rasayana 
  • Amrutaprasha gritha
  • Chandanasava
  • Swarna makshika bhasma

 Increased viscosity & increased liquefaction time

  • Triphala
  • Pippali
  • Vyoshadi vataka
  • Dhanwantara gutika
  • Kasturyadi gutika
  • Dashamoola katutraya kashaya
  • Varanadi kashaya
  • Sidhamakaradwaja

 Pyozoospermia, Heamospermia

  • Guduchyadi kashaya
  • Sukumara kashaya
  • Bruhatyadi kashaya
  • Chandraparabha vati 
  • Chandanasava
  • Saribadyasava
  • Virechana – kalyanaka guda

pH > 8.5

  • Sathavari
  • Vidari
  • Kokilaksha 
  • Mahatiktaka kashaya
  • Chandanasava

Teratozoospermia

  • Gandharvahastadi
  • Saribadyasava
  • Aswaghandharishta
  • Vaiswanara choorna
  • Chandraprabha vati

Oligozoospermia, treatment should be according to the cause 

  • Gandharva hastadi kashaya
  • Saptasara kashayaVaiswanara choorna
  • Bhringarajaasava
  • Kalyanaka gritha
  • Amrutaprasha gritha
  • Vidaryadi Gritha
  • Narasimha Rasayana
  • Chandraprabha vati
  • Virechana – sukumara eranda

 Asthenoazoospermia

  • Saptasara kashaya
  • Vaiswanara choorna
  • Narasimha Rasayana
  • Dhanwantara gutika
  • Kalyanaka Guda 

 Aspermia

  • Gandharvahastadi kashaya
  • Saptasara kashaya
  • Vaiswanara choorna
  • Bhrihati
  • Kapikacchu
  • Gokshura

 Procedures

  • UttaraVasti with Ksheerabala - in Oligozoospermia, OAT syndrome
  • Nasya with ksheerabala taila - in Hypothalamo pituitary causes
  • Vamana –in increased liquefaction time, increased viscosity, Asthenozoospermia 
  • Virechana - in Pyozoospemia, Haemospermia
  • Dashamoola uthara Vasti - Particulate debris, amorphous matter > 2+ 
  • Virechana, Dashamoola uthara Vasti -in Antisperm Antibody, Agglutination 
  • Uttara Vasti - in obstructive Azoospermia
  • Mustadi Rajayapana vasti 

Department

Male Infertility

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