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Male infertility

Male infertility: Definition: Male infertility is defined as the inability of a male to make a fertile female pregnant, also for a minimum of atleast one year of unprotected intercourse. Etiology: Many biological and environmental factors can cause male infertility. These include: Sperm problems, including malformed sperm, low sperm count (oligospermia) and the absence of sperm in your semen (azoospermia). Sexual dysfunction: premature ejaculation, anejaculation, infrequent sexual intercourse, erectile dysfunction. Genetic disorders, including Klinefelter syndrome and myotonic dystrophy. Some medical conditions, including diabetes, certain autoimmune diseases that attack your sperm and cystic fibrosis. Infections, including epididymitis, orchitis and sexually transmitted infections (STIs), including gonorrhea or HIV. Swollen veins in your testicles (varicoceles). Cancer treatments, including chemotherapy, radiation therapy or surgical removal of your testicles (orchiectomy). Testitular trauma. Endocrinological cause - congenital GnRH Deficiency (Kallmann syndrome), Prader Willi syndrome, Laurence - Moon - Beidl syndrome, iron overload syndrome, familial cerebellar ataxia, head trauma, intracranial radiation, testosterone supplementation, or hyperthyroidism. Idiopathic - idiopathic male infertility (10% to 20%) where semen parameters are all normal Risk factors: Have a body mass index (BMI) greater than 25 (overweight/obesity). Age 40 or older. Have been exposed to radiation. Have been exposed to environmental toxins, including lead, calcium, pesticides mercury. Use tobacco, marijuana or alcohol. Take certain medications, including flutarnide, spironolactone and bicalutamide. Spend a lot of time around heat that raises the temperature of your testicles, including saunas or hot tubs. Using a wheelchair can also increase the temperature of your testicles. Have a history of undescended testicles. Have a history of varicoceles. Take testosterone to treat low testosterone Take anabolic-androgenic steroids (AAS) or supplements containing traces of hormones to increase muscle mass. Classification: Male infertility can also be classified based upon the medical interventions that can potentially assist conception. Untreatable male sterility is seen in 12% - primary seminiferous tubular failure, Sertoli cell- only syndrome, and bilateral orchiectomy. Treatable causes of male infertility are found in 18%- obstructive azoospermia, ejaculatory duct, and prostatic midline cysts, gonadotropin deficiency, sexual function disorders, sperm autoimmunity, varicoceles, and reversible toxin effects. Untreatable male infertility is found in 70%-oligozoospermia, asthenozoospermia, teratozoospermia, and normospermia with functional defects. Assisted reproductive techniques will be necessary for reproduction. Epidemiology: Infertility is the problem affecting 15% of married couples globally. The male factor contributes for about 20%-40%. As per the WHO, approximately 60-80 million couples suffer from infertility and the prevalence varies from region to region. There are no reliable figures for the global prevalence of infertility. It is estimated to be 8%-12%. of which only the male partner accounts for 20%, females 38%, mixed 27% and unknown 15% . In India, it varies from 3.9% to 16.8% with wide variations not only in different states but also different castes and tribes of the same region The primary cause of infertility could be defined only in 40%. They are grouped as nonobstructive, obstructive, and coital. Reasons in 75% of cases of oligospermia remained unknown. Diagnosis: A semen analysis is one of the primary tests healthcare providers use to help diagnose male infertility. It's a lab test of a semen sample that examines the volume and quality of your sperm. Other tests that a provider may order to help identify or rule out the cause of male infertility may include: Imaging tests. These may include noninvasive tests, such as an ultrasound or magnetic resonance imaging (MRI), or invasive tests such as a venogram. Blood tests. Blood tests can measure your hormone levels and look for abnormalities with your genes or chromosomes. Urinalysis (urine test). A urine (pee) test can help diagnose STIs and diabetes. Testicular biopsy. A provider will remove a small amount of testicular tissue to determine how well your testicles produce sperm. Management: Lifestyle changes: You may be able to increase the production of healthy sperm by making certain lifestyle changes including Maintaining a healthy weight for you Eating more fruits and vegetables Engaging in regular physical activity, including walking, jogging, bicycling, dancing Managing stress Stopping smoking, drinking and using recreational/nonprescription drugs. Avoiding the use of sexual lubricants (lube) during sexual intercourse Diet: Eat your veggies. Try organic veggies or at least make sure you wash your veggies thoroughly. Cut back on processed meat; try fish instead. Be careful with trans fats (eat less fried junk food). Minimize soy. Watch out for BPA in canned goods. Look for BPA-free cans. Try to avoid plastics where possible. Don't overindulge in high-fat dairy items (ice cream, whole milk, etc.). Don't smoke cigarettes. Eat walnuts (if you don't have a nut allergy of course). Lose weight if you are overweight Herbal therapy and male reproductive health: (Siddha view): According to the siddha concept, health depends upon balance between three fundamental bodily bio- elements or doshas referred to as Vata, Pitta and Kapha Vata (airy element), characterised by dry, cold, light, minute, and movement. Pitta (fiery element) or bile, flowing through the liver and permeating the overall heating of the body. Kapha (watery element) is characterised by heaviness, cold, tenderness, slowness, lubrication, nutrient carrier, nourishment. In siddha pharmacology, there exists a special group belonging to rasayana herbs, that aid nourishment and also stimulate the sexual tissues. Moreover, they also help to promote beauty and sex appeal and that increase spermatogenesis. With the knowledge of the possible causes and factors leading to male infertility, the appropriate herb can be selected to meet the need . These are the herbs which can be referred to in Western term as aphrodisiacs. These herbs can be used as stimulants or tonics to improve male reproductive vitality. Stimulants to reproductive functions are typically heating substances like fenugreek, garlic, damiana, and onion. They have an invigorating action on the male sexual organs. Tonics provide better nourishment to the reproductive tissues to rejuvenate the quality and quantity of the same. Some herbs have both stimulating as well as nourishing properties, such as garlic, fenugreek and ashwagandha (Withaniasomnifera). The herbal drugs can be classified in varied ways, and one such simplified classification according to their functions on male reproductive health is as follows :- Herbs increasing the quantity of semen or stimulating semen production, Polygonatumverticillatum, for example, Mucunapruriens, Microstyliswallichii, Roscoeaprocera, and Asparagus racemosus. Herbs purifying and improving semen quality, for example, Vetiveriazizanioides, Myricanagi, Saussurealappa, Sesamumindicum, Anthocephaluscadamba. and Herbs rejuvenating ejaculatory functions, for example, Strychnosnux vomica, Myristicafragrans, Cannabis sativa, and Cassia occidentalis. Herbs improving sustenance and ejaculatory performance, for example, Cinnamomumtamala, Anacyclus pyrethrum, Sidacordifolia, Asparagus racemosus, Mucunapruriens, and Cannabis sativum. Herbs increasing libido, namely, Asparagus racemosus, Withaniasomnifera, Datura stramonium, Anacyclus pyrethrum, Hibiscus abelmoschus, and Opium. Herbs to improve male fertility: Ashwagandha (Withaniasomnifera):- அமுக்கிரா In Sanskrit, ashwagandha refers to 'the smell of a horse', owing to its root's strong odor resembling that of horse urine. Another reason for its naming for mythological comparison of the sexual vitality it may impart to men with that of a horse. Innumerable beneficial qualities to alleviate male reproductive disorders including induction of spermatogenesis, improved blood flow to the reproductive tissues and regulated endocrine functions. It relieves conditions such as spermatorrhea, nocturnal emission, premature ejaculation, and enlarged prostate. Withania Somnifera Is able to combat stress-induced male infertility and protects against swimming-induced endocrine dysfunctions of male reproduction in rat . The aqueous extract of this herb has been shown to improve spermatogenesis, owing to elevated interstitial cell stimulating hormone and testosterone- mimicking effects together with induction of nitric oxide synthase . Yet another study showed that Ashwagandha root extract administration resulted in a significantly greater improvement in spermatogenic activity and increase in serum hormone levels in the oligospermic patients as compared to the placebo treated .This herb evidently combats against oxidative stress by reducing lipid peroxidation as well as protein carbonyl content, increasing sperm count and motility, rejuvenating the seminal plasma levels of antioxidant enzymes. This herb's action at the HPG axis level is also evident through various studies, one such showed significant increased serum testosterone and LH levels and decreased levels of FSH and prolactin (PRL) in infertile men . Owing to it stress relieving, relaxing effect on the body and mind, as well as fortifying of all the dhatus, it is considered as the best herb to target many of the contributing factors that are associated with reduced sexual energy. Mucunapruriens: (பூனைக் காலி ) This sweet yet sometimes bitter tasted herb is quite heavy and oily. Mucunapruriens is mainly used to balance vata and pitta, as both kapha and ama are increased in excess by this herb. Typical doses of the powdered Mucunapruriens range from 1.5 to 6 grams. Alkaloids derived from M. pruriens seeds were found to stimulate spermatogenesis and overall weight of the testicles and accessory glands in the male albino rat . M. pruriensis capable of stimulating sex ual activities in male rats as inferred by increased mounting frequency, ejaculation latency and also enhanced intromission frequency. In a study, M. pruriens has been shown to efficiently recover the spermatogenic loss which was induced in male rats by ethinyl estradiol administration and the herb's beneficial effects were mediated by mitigation of ROS, apoptosis regulation, and increase in the number of germ cells. The major constituent of M. pruriens, L-DOPA, largely contributes to its pro-spermatogenic properties . The seed extract of M. pruriens showed marked improvement in sexual potency and behavior, libido, sperm parameters, and endocrine levels . M. pruriens has been able to ameliorate the levels lipids, triglycerides, cholesterol, phospholipids, vitamin A, C, and E and corrected fructose nullifying oxidative stress induced lipid peroxidation in seminal vesicles and restored the levels of SOD, catalase, GSH, and ascorbic acid in seminal plasma . From the neuroendocrine perspective, M. pruriens elevates testosterone, LH, dopamine, adrenaline, as well as noradrenaline levels and decreased levels of FSH and PRL in infertile men. M. pruriens treatment to infertile men indeed improves steroidogenesis and semen quality. Asparagus racemosus:( தண்ணீர் விட்டான் கிழங்கு) Shatavari can serve as a powerful male tonic. With a bittersweet taste, this herb renders cooling and purifying effect to the liver and blood, and targets pitta at its main site in the small intestine. Its cooling properties balance the heating herbs which are used to improve sperm count, such as, garlic, onion, ashwagandha, etc. Thus, Shatavari prevents depletion of sperm caused by burning via excess pitta. Owing to its heavy and nourishing properties, it is useful for vata, especially when combined with ashwagandha or bala. Sexual desires are associated with emotional aspects and in such conditions, this herb in combination with cooling nervine herbs like brahmi (gotu kola) may enhance libido and help to overcome agonizing emotions like anger and irritability. Is the best herb to balance pitta and vata in mediating male reproductive functions. General fatigue, low sexual energy, anger, stress, irritability, inflammation, hyperacidity, urogenital infections, burning sensations etc. are the conditions when this herb can be used as drug in standardized dosage of 2 to 6 grams of the powdered herb, 2 to 3 times daily. This herb is avoided in cases of respiratory or sinus congestion . Sidacordifolia ( சிற்றாமுட்டி) Bala refers to 'strength' in Sanskrit, and being a rejuvenative tonic herb for vata and pitta, this herb finds application in nourishment and strengthening of all the bodily tissues, especially the muscle, plasma,bone marrow and reproductive tissue. It is sweet, heavy and oily and increase kapha when used in excess, and also is mildly cooling. Bala is one of the best anti-vata herbs in siddha which mitigatesdisorders related to both body and mind. It plays a leading role as an Ayurvedic herb in the treatment of chronic fatigue, to rejuvenate overall health in exhaustion of physical or mental strength. It serves as a tonic to restore sexual strength, promote spermatogenesis and enhance male fertility . This herb can be taken internally or externally . . A typical dose of Bala ranges from 2 to 6 grams, to be taken 2 to 3 times daily. Ipomoea digitata : ( நிலப் பூசணி) It is a starchy tuber, effective in promoting spermatogenesis with faster action when taken as a milk decoction. It is lighter for kapha types than shatavari and bala. Its combination with kapikacchu is effective in the treatment of enlarged prostate. This sweet and cool herb promotes ojas, muscle tone, motor coordination and nullifies sexual debility . It falls right between too warming and too cooling herbs providing great value as both a vata and pitta balancing herb. A typical dose of Vidarikandha ranges from 2 to 6 grams, 2 to 3 times daily Shilajit (Asphaltum, mineral pitch); it is immensely important siddha herb which, with its heating energy, increases virility and sexual stamina via removing excess kapha, while maintaining the normal genital tone. In kapha related reproductive imbalances, it is used in combination with Ashwagandha. For enlarged prostate, its combination with saw palmetto, punarnava, gokshuradiguggulu, ashwagandha, or vidhari. This herb should be used in doses ranging from 250 to 500 mg twice daily Piper longum :- (திப்பிலி ) Pippali is a rejuvenating herb with a warming, stimulating and kapha reducing action. Its oily nature prevents it from drying making it suitable for vata and its pleasant post digestive effect makes it more calming to pitta than other hot spices and herbs. It aids blood flow to the reproductive tissues when taken in combination with Ashwagandha . According to the Siddha, it enhances life energy and expels impurities via respiration. It also improves digestion, absorption, assimilation, respiration and reduces arthritic agonies. The typical dosage of this herb is 1 to 3 parts in complex formulas, or ranges from 250 mg to 1.5 grams. Thippilii should be avoided in high pitta or inflammatory conditions . Butea superba: (கல்யாண முருங்கை) Buteasuperba (Leguminosae) has long been consumed as a stimulant of male sexual vigor. Its alcoholic extract for 6 months significantly elevated the sperm concentration and enhanced sperm motility with no disruptive signs to sperm or testis. Moreover, the ethanol extract of B. superba has been shown to increase penile erection acting through CAMP/cGMP pathways . Curculigoorchioides: (நிலப்பனை) Curculigoorchioides (Amaryllidaceae), or Kali Musli or Syah (black) Musli, is an aphrodisiac or rejuvenator ameliorating sexual arousal and performance by inducing penile erection, mating sustenance, orientation behavior, etc. This herb also promotes anabolic and spermatogenic effect by pronounced increased weight of reproductive organs. Rats that received Curculigoorchioides treatment displayed reduction in mount latency, incrementan penile erection index, and increase in mount frequency. In case of physically induced or heat induced sexual dysfunction, this herb is useful in ameliorating the decreased spermatogenesis and mitigated disruptions owing to the heat shock protein. Cynomoriumcoccineum:( Maltese fungus) Cynomoriumcoccineum Linn. (Cynomoraceae) is a black leafless parasitic plant without chlorophyll. Aqueous extract of this herb has been shown to induce significant elevation in the sperm count, the percentage of viable sperm and sperm motility, reduced the number of abnormal sperm, increased spermatogenesis . Chlorophytum borivilianum: (வெள்ளை மு சிலி ):- Safed Musli (Chlorophytumborivilianum) of family Liliaceae is claimed to be an effective aphrodisiac and sexual stimulant. Ethanolic roots extract of this herb or sapogenins extracted from the roots showed anabolic and spermatogenic effect in treated male rats evidenced by total body weight increase and also increment in weight of reproductive organs. The herb could also affect sexual behavior of animals by reducing mount ejaculation, post-ejaculatory latency, and intromission latency, increasing mount frequencyand affinity towards female . Moreover, the aqueous extract of dried roots of this herb enhanced sexual arousal, strength, and libido as well as sperm count in Wistar male rats . This herb also reportedly improves male reproductive functions in diabetic scenario Epimedium koreanum: Epimedium L. (Berberidaceae), is a popular Chinese herb and botanical supplement used as health tonic. Most important species of this herb used for medicinal purposes are E. pubescens Maxim., E. brevicornum Maxim, E. koreanum Nakai, E. sagittatum . Hydroalcholic extract of the herb shown to display aphrodisiac effects and are commonly used to enhance erectile function . The primary active component of Epimedium extracts, Icariin, is a type of flavonoid and selectively inhibits phosphodiesterase-5 (PDE5) improving erectile function . Icariin also can mimic the effects of testosterone inducing spermatogenesis. Eurycomalongifolia ( Tongkat ali) Eurycomalongifolia Jack (Simaroubaceace) or Tongkat Ali, is one of the major aphrodisiac herb from Malaysia . E. longifolia extract treatment showed successful induction of sexual motivation in naive male rats . Ethanol extract of this herb increased the sexual libido and performance of the treated male rats by increasing the duration of coitus and copulation frequency . Tribulusterrestris:-( நெருஞ்சில்) Tribulusterrestris Linn. (Zygophyllaceae) or puncture vine, a perennial creeping herb, has worldwide distribution and is regarded as an aphrodisiac since ancient times besides being used for various ailments such as inflammations, leucorrhoea, urinary infections, edema, and ascites .Administration of T. terrestris to animals showed to improve plasma testosterone level and induced spermatogenesis.It also increases the levels of testosterone as well as luteinizing hormone and the activities of dehydroepiandrosterone, dihydrotestosterone, and dehydroepiandrosteronesulphate . It increases sexual behavior evident through increase in mount frequency and intromission frequency, reduction in mount latency, intromission latency, and penile erection index as well as increase in prostate weight and intracavernosal pressure . This herb also possesses androgen, testosterone, DHT, and DHEA increasing property having stimulating effects on reproductive functions and thus used in mild to moderate cases of endocrine disruptions . The ability of to induce nitric oxide release may also account for its claims as an aphrodisiac . Mechanism of action: Male reproductive functions are restored and controlled by induction or inhibition of neurochemicals, regulation of neuroendocrine axis and their cross talks as well as by local mediators acting within the reproductive tissues. The herbal therapies may ameliorate male reproductive functions possibly at three levels. Herbs may act on the central or peripheral nervous system improving the responsiveness of male reproductive tissues. The neuronal control over the male reproductive organs is mediated by an orchestra of neurochemicals/neurotransmitters, among which the serotonin and dopamine are the prime controllers of sexual behavior with serotonin mediating inhibitory functions and dopamine playing an excitatory role . The effects of herbal therapies to regulate the level of the nitric oxide support their contribution towards treating erectile dysfunctions. Nitric oxide (NO) is an established endogenous mediator of penile erection and its synthesis via NO synthase is mainly concentrated in structures of the brain that are involved in sexual behavior (olfactory bulb, amygdala, septal structures, supraoptic and paraventricular nuclei, etc.) . NO is a known vasodilator which can increase blood flow to the penis inducing penile erection and to other male reproductive organs facilitating better hormonal accessibility in the same to promote robust reproductive functioning . Herbs can favourably interfere in the HPG axis in the regulation of sex hormones importantly testosterone, LH, FSH and interstitial hormones such as, the development of secondary male sexual organs, accentuate pubertal changes and increase overall male fertility . Conclusion:- Aphrodisiac herbs can be used as stimulants or tonics to improve male reproductive vitality. Stimulants to reproductive functions are typically heating herbs having an invigorating action on the male sexual organs. Herbal tonics provide better nourishment to the reproductive tissues to rejuvenate the quality and quantity of the same. Some herbs have both stimulating as well as nourishing properties. Owing to the health complications, partial impact and high cost of modern therapies for male infertility, the herbal aphrodisiacs are regaining popularity and laying their long-term impact on male reproductive health by improving sexual behavior, vigor, neuroendocrine control as well as structural and functional aspects of reproductive tissues, qualitative and quantitative improvement in semen and also sperm morphology and motility. Biomedical research should pierce deeper to emerge with more hidden mechanisms by which innumerable herbs may act to eradicate male infertility which is becoming a major threat to upcoming progenies. Read More