“Doctor I am really fed up with this issue !! What I have done wrong with any one so that I am being punished this way by God ?? I really don’t feel like living any more….., Doc I am feeling guilty when I come in front of my wife. Why she should suffer! Being a lady she must be waiting to become a mother , but…….! All our relatives are taunting her, but she do not respond any one, although she knows that she is not at fault, in fact I am the one who has the problem! Doc I have low sperm count with low motility too!! We have tried almost everything, including IUI, IVF, Ayurvedic, Homeopathic, Naturopathic, Magnetotherapy, Acupuncture, everything doc, but nothing worked out! We heard from one of our friend that you have treated number of such cases with good success, so we have come here with a great hopes !! Doc will it be possible to increase the count?….”

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Ramesh was asking me a question with his wife. I told him that we shall work on his case but before starting of the treatment he need to understand his problem in holistic way. There is a need to understand what exactly do we mean by Oligospermia or rather what could be the consequences of being Oligospermic case? Ultimately it has got linkage with the male infertility. A male with low sperm count i.e. oligospermia can not father a pregnancy. But although it has been said repeatedly I have seen in my own practice that with proper Ayurvedic therapeutic management we can really overcome this problem to a great extent. I don’t want to have tall claims that for every case it will work, but yes in most of the cases it has showed an encouraging results.

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In one of the article by one of the leading Infertility specialist there was a statement that – “Many infertile men are obsessed about their low sperm count - and this seems to become the central concern in their lives. Remember that the real question the man with a fertility problem is asking is not: What is my sperm count or what is my motility? But - are my sperm capable of working or not? Can I have a baby with my sperm? Since the function of the sperm is to fertilize the egg, the only direct way of answering this question is by actually doing IVF for test fertilization. This is, of course, too expensive and impractical for most people.

The major problem with all these tests, however, is that they are all indirect --- there is no very good correlation between test results, pregnancy rates, and fertilization in vitro for the individual patient. This is why offering a prognosis for the individual patient based on an abnormality in the sperm test result is so difficult, and why we find that different doctors give such widely varying interpretations based on the same sperm report”

But let me tell you I have seen rather treated number of such cases those who have opted for modern methods alone, underwent treatment modalities like IVF, ICSI (intracytoplasmic sperm injection, pronounced "ICSI") or microinjection etc. but with no results !! I think in such conditions it will be wise to think in completely different perspective with the view of Ayurvedic philosophy & treat these cases. I do agree that in some of the cases the sperm count is too minimal, so in such condition if we can increase a count as well their motility with Ayurvedic Therapy & then shift these cases to Modern Medical Infertility consultants then it will be really of sense! Because that might save time, money & may increase chances of results as well! I have tried with this way & seen better results in certain cases who had No results alone with modern methods.

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Now let us see what exactly we need to know in connection with Oligospermia. We need to know the following terms –Infertility & its causes, Male Infertility, Azoospermia , Oligospermia, Asthenozoospermia , Impotency.

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If we observe that a in a married couple , if a female do not conceive even after one & half to two years after marriage, provided they are not adopting any special measures for contraception ( avoidance of pregnancy) then they can think of going to a doctor for such a condition initially to explore the cause for it .

According to some data in almost 30% of cases there is a problem with Male partner in the form of either Low sperm count ( Oligospermia), or No sperm count (Azoospermia ) or Normal count with low or no motility of sperms so that they can’t swim & reach to the ovum for getting fertilization process leading to the event of pregnancy (Asthenozoospermia) or with normal count & motility of sperms ,but inability to have sexual act , may be due to penile erection problem or low or no urge ( Impotency)

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In next 30% cases do have problem with the female partner. May be with ovulation problems or structural deformity of the uterus etc.

In next 30 % group there is a problem in both the partners.

In last 10 % group there is nothing wrong that can be observed in either of them & yet they don’t conceive.

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Coming back to our topic of discussion, if we see the data on Male Infertilty as seen in medical Journals & on web , we understand the socio psycho economic aspect of this problem. The references arte as follows –

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Society issues for Male infertility ?????????

Hospitalization statistics for Male infertility: The following are statistics from various sources about hospitalizations and Male infertility:

• 0.005% (597) of hospital consultant episodes were for male infertility in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
• 99% of hospital consultant episodes for male infertility required hospital admission in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
• 100% of hospital consultant episodes for male infertility were for men in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
• 1% of hospital consultant episodes for male infertility required emergency hospital admission in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
• 1.1 days was the mean length of stay in hospitals for male infertility in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
• 1 days was the median length of stay in hospitals for male infertility in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
• 38 was the mean age of patients hospitalised for male infertility in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
• 83% of hospital consultant episodes for male infertility occurred in 15-59 year olds in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
• 2% of hospital consultant episodes for male infertility occurred in people over 75 in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
• 69% of hospital consultant episodes for male infertility were single day episodes in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
• 0.0004% (192) of hospital bed days were for male infertility in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)

Incidence (annual) of Male infertility: at least 2 million annual cases (based on NWHIC)
Incidence Rate: approx 1 in 136 or 0.74% or 2 million people in USA

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Azoospermia & Oligospermia

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Now let us see what do we mean by Azoospermia & Oligospermia

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What is Azoospermia? ????
??Brief description: Total lack of sperm in ejaculate

Causes of Azoospermia

Underlying condition causes of Azoospermia: The list of possible underlying conditions mentioned in various sources as possible causes of Azoospermia includes:

• High fever - causing temporary lack of sperm
• Undescended testicle
• Testicle conditions (type of Male sexual conditions)
• Obstructions of seminal passages
• Testicle infection
• Certain hormonal disorders (type of Endocrine disorders)

Related information for causes of Azoospermia: Further relevant information on causes of Azoospermia may be found in the risk factors for Azoospermia and underlying causes of Azoospermia.

Symptoms of Azoospermia

List of symptoms of Azoospermia: The list of symptoms mentioned in various sources for Azoospermia includes:

• Male infertility

More symptoms of Azoospermia: In addition to the above information, to get a full picture of the possible symptoms of this condition and its related conditions, it may be necessary to examine symptoms that may be caused by complications of Azoospermia, underlying causes of Azoospermia, associated conditions for Azoospermia, risk factors for Azoospermia, or other related conditions.

Medication causes list: The list of possible medications or substances mentioned in sources as possibly causing Azoospermia includes:

• Radiation treatments
• Chemotherapy
• Certain toxins

Basic Summary for Oligospermia

Main name of condition: Oligospermia

What is Oligospermia? ????
??Brief description: Having too few sperm
??Parent types of: Male infertility, testicle disorders
??Organs Affected: testes, sperms

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What are the symptoms of Oligospermia? ?????
??Duration: Recovery within 2-3 months for temporary reductions.

Symptoms of Oligospermia

List of symptoms of Oligospermia: The list of symptoms mentioned in various sources for Oligospermia includes:

• Male subfertility

More symptoms of Oligospermia: In addition to the above information, to get a full picture of the possible symptoms of this condition and its related conditions, it may be necessary to examine symptoms that may be caused by complications of Oligospermia, underlying causes of Oligospermia, associated conditions for Oligospermia, risk factors for Oligospermia, or other related conditions.

Misdiagnosis of Underlying Causes of Oligospermia

Underlying conditions list: The list of possible underlying conditions mentioned in various sources for Oligospermia includes:

• Causes of temporarily reduced sperm counts:
• High fever? (Mumps)
• High temperatures
• Certain drugs
• Certain poisons
• Certain hormonal conditions (type of Non-Contagious Diseases)
• Certain severe illnesses
• Smoking
• Excessive alcohol
• Recreational drug use
• Varicocele
• Varicose veins around the testes
• Inflammation of the testes
• Radiation exposure
• Radiotherapy

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Normal values for Sperm count

Sperm Volume

A very low volume i.e. less than 0.5 ml may indicate a problem in producing the specimen (including missing the container), a dysfunction with the accessory glands or retrograde ejaculation.

Abnormal pH

An abnormally low pH i.e. less than 7.0 may indicate retrograde ejaculation when combined with a very low ejaculate volume. A pH of below 7.0, normal volume and azoospermia may indicate an obstruction of the ejaculatory ducts or congenital bilateral absence of the vas in this case result is poor.

An abnormally high pH i.e. greater than 8.5 may indicate an infection or dysfunction of one of the accessory glands result is good.

Abnormal Sperm Density

A sperm count below 20 x 10^6 / ml should be considered clinically relevant, a count nearby 5 x 10^6 / ml count will increase with treatment.

Reduced sperm count is generally idiopathic. However it may be due to defective spermatogenesis or an incomplete obstruction.

Abnormal Sperm Motility

If less than 50% of the sperm are moving progressively (asthenozoospermia) a problem with motility or an increased level of sperm degradation may be indicated.

Decreased motility may be secondary to sperm dysfunction, prolonged periods of sexual abstinence, partial blockage or infection.

If greater than 50% of sperm are immotile then the analysis will determine whether the sperm are immotile or dead. This will determine whether the sperm immotility is due to cell death or a motility defect.

Increased cell death may be treatable if the cause is identifiable e.g. partial blockage, increased abstinence periods, infection. Immotile sperm can be used for assisted conception purposes as long as they are alive.

Abnormal Sperm Morphology

A human sperm show large variation in morphology, study on sperm obtained from post-coital cervical mucus have helped to define the morphology of an ideal spermatozoon.

Morphological study comprise of many factors like spermatogenesis, sperm transport, sperm maturation and ageing, time in seminal plasma, smearing technique, fixation, staining, mounting and the quality of microscope used.

Sperm Surface Antisperm Antibodies

The presence of both IgG and IgA antisperm antibodies are measured on the sperm surface. The results are given in terms of the number of motile sperm affected by antisperm antibodies surface antibodies may affect both movement of the sperm and the ability of the sperm to bind to the oocyte results are clinically significant and positive if more than 50% of sperm are affected by either class of antibody. IgA antibodies are considered of greater clinical significance than IgG. Antisperm antibodies often are, but not always, associated with testicular surgery or trauma

Ayurvedic Concept about Oligospermia

Ayurveda has discussed in length about Infertility ,its causes, about sperm, about reduction in sperm .No doubt that none of the standard texts of Ayurveda mentions about the count of Sperm or Motility of sperm but clearly mentions about qualitative measures about Sperm ( Shuddha Shukra Lakshanam). Ayurveda also advocates about do’s & don’t about diet in special connection with Shukra. It has been rightly stated that food articles like milk, ghee, udad (black gram) are good for Shukra whereas the food articles which are having properties opposite to that of Shukra i.e. with more heat, spicy, pungent food items have to be restricted in our diet. It will be of specific need to treat those with the problems of Oligospermia.

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Ayurveda has mentioned that Shukra is the last vital tissue produced in our body. There is interesting reference saying that there exist Shukra in female as well apart from Raja (Menstrual flow) which can be equated with the ovum according to some of the few contemporary ayurvedic scholars.Ayurveda has advocated a separate branch wich deals with not only the treatment modalities concerning Shukrakshaya (Oligospermia) but also dealing with various other aspects regarding wholistic approach towards better sexual health of an individual under chapters of Vajikarana tantra.Unfortunately this part is wrongly uitilised by many Ayurvedic pharmaceuticals for their commercial purpose, just to make more sales via advertisements of these sex tonics & aphrodisiacs.

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One of the well known commentator of ‘Charak Samhita’, Chakrapani has discussed these Vajikarana drugs into three categories, although they are not discussed in any of the major three manuscripts of Ayurveda (Brihattrayi – Charak Samhita, Sushruta Samhita, Ashtanga Hridayam); they are as follows –

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1. Shukrasrutikara Dravya – the one which helps in maintaining the proper flow of the shukra with stambhana means it also takes care to prevent premature ejaculation of the seminal fluid.
2. Shukravruddhikara Dravya – The one which actually increases the shukra, qualitatively & quantitatively as well. Here the emphasis has been given not to just improve the quantity & quality of Shukra alone but of the all Dhatus ( Vital tissues of the body ) with the help of appropriate use of rasayanas ( Rasayanas are those drugs which keeps diseases & aging process away ).These class of drugs are more special importance to our topic of discussion for Oligospermia.
3. Srutivruddhikara Dravya – They contains properties of above two.

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Shukra ideally should not be equated alone with that of the sperm in modern concept. It is much beyond that. It has be understood on larger broader perspective. There is a concept of Shukravruddhi (condition in which there exists a higher levels of Shukra) which shows symptoms like more urge for sexual act ( which we know it can be seen with low sperm count as well ! ) & presence of Shukrashmari . Where as in the reference of Shukrakshaya? (Condition in which there exists a lower levels of Shukra ) having references with pain in testicular region, inability to see good qualities of seminal fluid, no more viscous, less pearly white in colour etc. has been mentioned.

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There is a clear cut reference stating that when there is a contact of Shukra (Sperm) & Shonita (stree beeja) (Ovum) {Beeja}, then only there is a possibility of Garbhadan (fertilization of ovum), along with three other factors (i.e. normal menstrual physiological status of the female {Ritu}, normal anatomical status of the uterus {Kshetra}, normal/favorable nutritional supply to that area of uterus {Amboo}). If all these four conditions are fulfilled then only there may be a possibility of Garbhasdharana (conceiving a pregnancy) .

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Certain Do’s & Don’t

1. One need to remember that there is not a single pill, which can really make a difference in this condition. There has to be a holistic approach .There needs to be ideally life style changes.
2. Stress, frustration becomes the main stay in these cases. We need to teach them how to overcome the stress. One need to realize that unlike all other diseases oligospermia is also one of the diseased condition which can be correctable.
3. With comparatively low sperm count say approximately about 10 to 20 millions/ml. one may still in a position of fathering a pregnancy.
4. Very low count people can initially increase to certain level & then may go for the integrated approach of the therapy , like Ayurveda & Allopathic new techniques, this also gives a better & faster results .as I have seen in my own clinical practice.
5. One need to avoid very pungent, spicy, oily food. Similarly have less intake of sour & salty food.
6. Be away from smoking , alcohols, other addictive habits, since all these have properties opposite to that of Shukra.
7. Shower the testicles with tap water , so that the temperature in & around them can remain cold & can be useful in the process of generation of sperms (spermatogenesis)
8. Avoid wearing tight undergarments since it can increase temperature in & around testes & also exerts undue pressure on testes which might hamper the process of spermatogenesis.
9. Avoid use of Bikes for long run since it can gives jerks to the region of genitalia.
10. Make use of (Black Gram) Udad dal, Draksha (Grapes), Cows Ghee, Milk in your diet. Always consume fresh food. Try to avoid tin food, processed food, steal food.
11. One may think of use of Chicken soup ,or items of chicken in diet if preferring non vegetarian diet. Only keep in mind that the dish should not be too much spicy!?

Certain common Ayurvedic hers & drugs used in the management of Oligospermia –

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1.Shatavari

2.Ashwagandha

3.Vidarikanda

4.Shweta Musali

5Kishna Musali

6.Kapikatcchu

7.Bala & many such single drugs in a specific combinations along with other formulations are utilized to get better effects in cases of Oligospermia.