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

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