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CASE REPORT
Year : 2019  |  Volume : 40  |  Issue : 1  |  Page : 44-47  

Ayurvedic management of necrozoospermia - A case report


Regional Ayurveda Research Institute for Metabolic Disorders, Central Council for Research in Ayurvedic Sciences, Ministry of AYUSH, Bengaluru, Karnataka, India

Date of Web Publication21-Nov-2019

Correspondence Address:
Shashidhar H Doddamani
Regional Ayurveda Research Institute for Metabolic Disorders, Central Council for Research in Ayurvedic Sciences, Ministry of AYUSH, #12, Manavarthekaval, Uttarahalli, Kanakapura Road, Bengaluru - 562 109, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ayu.AYU_120_15

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   Abstract 


Male factors are responsible for more than forty percent of the infertility cases. Necrozoospermia is one among the main cause for infertility in male. Necrospermia i.e. 100% immotile and 0% viable spermatozoa in ejaculate, is a rare and poorly documented cause of male infertility. A 56-year-old man was referred for reproductive counseling with secondary infertility and diagnosed as necrozoospermia (Shukra Dosha). He presented with complaints of having no issues since 7 years of married life with his second wife. The patient has a son from divorced first wife. After the thorough clinical examination and laboratory investigations, diagnosis was confirmed as necrozoospermia. The patient was administered Koshtha-Shuddhi (purgation) with Eranda Taila (castor oil) as per the guidelines of Ayurvedic treatment. After the proper purificatory procedures depending on dominance of deranged Dosha, the patient was given Arogyavardhini Vati, Chandraprabha Vati, Shilapravanga and Phala Ghrita (medicated ghee) as Sneha (internal oleation). At the end of 3½ month, semen analysis showed marked improvement in sperm count and increase in the sperm motility. The present finding and the effective management of necrozoospermia with Ayurvedic formulations with no adverse effect highlight the promising scope of traditional medicine in male infertility disorders.

Keywords: Necrozoospermia, Semen analysis, Shukra Dosha


How to cite this article:
Doddamani SH, Shubhashree M N, Giri S K, Naik R, Bharali B K. Ayurvedic management of necrozoospermia - A case report. AYU 2019;40:44-7

How to cite this URL:
Doddamani SH, Shubhashree M N, Giri S K, Naik R, Bharali B K. Ayurvedic management of necrozoospermia - A case report. AYU [serial online] 2019 [cited 2019 Dec 7];40:44-7. Available from: http://www.ayujournal.org/text.asp?2019/40/1/44/271422




   Introduction Top


Necrozoospermia is a rare condition and poorly documented cause of male infertility. Its incidence in an infertile male is reported to be from 0.2% to 0.5%.[1] It is defined as a condition in which spermatozoa in the ejaculated semen are dead or immotile. According to sperm norms of the World Health Organization, sperm viability is higher than or equal to 75% in human semen samples. Fertility of the semen is impaired below this percentage.[2]

In Ayurveda, Shukra Dosha (pathological disorders of sperm/semen) is mentioned as of eight types. They are Vataja, Pittaja, Kaphaja, Kunapa, Granthi, Puti, Puya and Ksheena.[3] Necrozoospermia is akin to Vataja Shukra Dosha in Ayurveda. Quality and quantity of Vataja Shukra Dosha are Phena (frothy), Tanu (less viscosity), Ruksha (lack of unctuousness), Kashta Alpa Matrayukta (painful ejaculation with less quantity of semen), and incapability of producing off spring.[4]

The line of treatment for Shukra Dosha as mentioned in Ayurvedic texts are Snehana (oleation), Vamana (emesis), Virechana (purgation), Niruha(medicated enema with decoction) Anuvasana (medicated enema with oil)[5] and Shamana Aushadhi (palliative therapy) depending on the condition. According to these principles, it is advocated to use Shamana therapy after performing Virechana Karma (purgation). In the present study, selected Shamana Aushadhi (palliative therapy) were easily available for prescription in OPD patients.


   Case Report Top


Presentation

A male patient aged 56 years attended the outpatient department, presenting with the complaints of no issues since 7 years of married life with the second wife who is 35 years old. However, he has a son from his divorced first wife who is healthy. The patient did not report any problems with erections, orgasm, or ejaculation and he was not taking any medication for any systemic disorders like hypertension, diabetes mellitus etc. On physical examination, testes were in normal position. Rest of the physical examination was normal. Initial history of the female partner suggested regular ovulatory cycles and revealed no problems with her endocrine profile or the patency of her  Fallopian tube More Detailss. There was no history in the patient suggestive of sexually transmitted diseases, mumps, tuberculosis, filariasis, epididymo-orchitis, herniorrhaphy/herniotomy and chronic persistent genital infection, paraparesis and exposure to gonadotoxins, for example, cigarette smoke, alcohol, alkylating agent, gossypol and pesticides. Semen analysis from the laboratory revealed no sperm motility and on viability testing, it was shown that there was 100% necrozoospermia. As the patient could not afford, other investigations such as antisperm antibodies could not be carried out.

On examination

Clinical examination revealed no abnormality (physical and systemic). During scrotal examination, temperature was found normal and no scar or swelling was noticed. Position and size of the testes was normal in nature. Epididymis was palpable with swelling, spermatic cord was thickened and prostrate was normal during the examination. [Table 1] shows the details of physical examination of the patient.
Table 1: Physical/local examination of the patient

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Assessment criteria

The patient was assessed based on sexual functional parameters and semen analysis before and three and half months after the treatment. Details of the investigations carried out before and after the treatment are given in [Table 2].
Table 2: Effect of Ayurvedic management on semen analysis

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Treatment

According to Ayurveda, the patient was diagnosed as having Vatika Shukra Dosha, with investigations showing evidence of necrozoospermia. He was treated for a period of 3 ½ months.

Plan of treatment

Shodhana (purification)

Purva Karma like Langhana, Deepana, Pachana and Snehapana were not followed as the patient was not having Ama Lakshana assessed during the examination. So, 50 ml of Eranda Taila (castor oil) was administered at 7.30 AM for the purpose of Koshtha-Shuddhi (purgation) along with warm water, and the patient reported six Vegas (passed stools six times) during that day. He was advised to take light semi-solid diet and avoid exertion for 3 days.

Shamana therapy

  1. Phala Ghrita 15 ml with milk in the empty stomach once daily
  2. Chandraprabha Vati – 500 mg, Vati one tablet twice daily after food with water
  3. Shilapravang Vati – (250 mg), one Vati twice daily after food with milk
  4. Arogyavardhini Vati – (500 mg), one Vati twice daily after food with water.


Chandraprabha Vati and Arogyavardhini Vati were procured from IMPCL and dispensed through OPD. Phala Ghrita (Arya Vaidya shala, Kottakal) and Shilapravanga (Sri Dhootapeswar Ltd) were prescribed from outside.

All the above medicines were given for 3 months. Arogyavardhini Vati was replaced by Sarivadi Vati after a month and continued for 2 months. No adverse drug reaction was reported during the treatment which was confirmed during follow up visits.


   Results Top


After the treatment, total sperm count was increased to 9 million from 2 million and there was also increase in sperm motility. Though 100% sperms were non- motile before treatment, only 45% remained non motile after the treatment. It is observed that, 30% were actively progressive, 15% were slowly progressive and 10% were non progressive. USG reports suggest that, there was necrozoospermia with infection initially and which is changed to oligozoospermia with infection. [Table 2] shows before and after results of semen analysis. [Table 3] shows sexual functional parameters.
Table 3: Effect of Ayurvedic management on sexual functional parameters

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   Discussion Top


Necrozoospermia is the medical term for sperm that does not move at all. The sperm may be alive and just not moving or the sperm may be dead. Necrozoospermia is a potential cause of male infertility. Although there is no promising remedy for this ailment, Ayurvedic formulations have shown remarkable improvement in sperm count in isolated case reports[6].

In Ayurveda, a separate branch has been devoted for aphrodisiac medicines (Vajikarana). The concept of Vajikarana, as described in the texts of Ayurveda, is a special category of treatment modalities which improve the reproductive system and enhance sexual functions. It offers a solution to minimize Shukra defects and to ensure a healthy progeny. Vataja Shukra Dosha can be compared with necrozoospermia where quality and quantity of semen is a vitiated by Vata Dosha.

Vataja Dushti (impairment of Vata) leads to defects in quantity due to Rukshata (lack of unctuousness) and Kapha Kshaya (depletion of Kapha) also causing defects in motility causing non-progressive and immobile sperms.[7] After the treatment, it is observed that, 3% agglutination is seen in the semen analysis. Agglutination of spermatozoa suggests the existence of antisperm antibodies. But, other investigations such as antisperm antibodies could not be done, due to nonaffordability of the patient.

Aphrodisiac therapies are of three types:[8]

  1. Shukra Karaka– Sperm generating or enhancing sperm count
  2. Shukra Rechaka– Those which help in ejaculation of seminal fluid
  3. Shukra Karaka and Rechaka– Medicines which serve both the above purposes.


Based on the above principles, multiple treatment modalities were applied in this case.

Acharya Kashyapa has emphasized on the role of Virechana Karma (purgation) for the purification of the Beeja (sperm), as it make Beeja (sperm) effective in achieving fertilization. It also improves sexual vigor and helps in achieving healthy progeny.[9]

Koshtha-Shuddhi ( purgation) with Eranda Taila(castor oil) was given for detoxification and to pacify Vata which is the main cause for vitiation of Shukra (sperm).[10]

The medicated ghee (Phala Ghrita) was given early in the morning in empty stomach as Shamana Snehana (palliative mode of oleation),is indicated in Shukra Dosha.[11] It acts as an aphrodisiac medicine. Chandraprabha Vati is a herbomineral compound preparation, has action on major systems such as urinary system and reproductive system. It has been reported to have immense free radical scavenging activity.[12]

Inflammatory conditions in the entire genitourinary tract are amenable with administration of Chandraprabha Vati. It relieves the infection and acts as a spermatopoietic agent. In a nutshell, this is employed in male as well as female infertility. It is a choice of drug in urogenital diseases for treating the infection.[13]

Liver plays an important role in regulating the amount of free testosterone in the body. About 40%–50% of total testosterone is bound to a protein called sex hormone-binding globulin which is produced in the liver. The rest of the testosterone is bound to a protein called albumin which is also produced in the liver. With decreasing liver function, plasma testosterone concentrations decrease significantly.[14] With a view of improving the liver function, commonly prescribed classical Ayurvedic polyherbomineral formulation, Arogyavardhini Vati, was given. It contains drugs like Abhraka Bhasma (ash of mica), Shilajatu (Asphaltum), Eranda (Ricinus communis Linn.) and Katuki (Picrrorhiza kurrooa Royle ex Benth). It has been tested and found to be safe in an experimental study. No appreciable toxicological effects were observed on the brain, liver, and kidney of the rats when administered up to 28 days.[15] Hence, it was prescribed to the patient for 1 month initially. It also has hepatoprotective action.[16]

Sarivadi Vati is a drug of choice in Klaibya (male infertility) and urogenital infections.[17] It mainly comprises Sariva (Hemidesmus indicus R. Br), Madhuka (Glycyrrhiza glabra Linn.), Kushtha (Saussurea lappa C. B. Clarke), Abhraka Bhasma (ash of Mica) and Loha Bhasma (ash of purified and processed iron).

Shilapravanga is well-known proprietary herbomineral aphrodisiac medicine which fights treats, exhaustion and debility and restores natural zest and is medicated in for male infertility.[18] It contains Shuddha Shilajit, Pravala Pishti (calx of coral), Vanga Bhasma (ash of Tin), Mouktik Pishti, Suvarna Makshika Bhasma, and other drugs; Shilajatu is a prominent Vrishya (aphrodisiac) drug as explained in Bhavaprakasha[19] and Charaka Samhita.[20]


   Conclusion Top


It is therefore evident that the treatment approach based on Ayurvedic principles can produce encouraging results in the management of Shukra Dosha (necrozoospermia) not only in improvement in sexual functional parameters[21] but also in increasing the quality and quantity of semen. Such encouraging results offer hope to many who are suffering from necrozoospermia and also instills confidence among new Ayurvedic physicians in handling male infertility without surgical interventions and managing with simple medication.

Acknowledgment

The authors are grateful to Director General, CCRAS, New Delhi, and Incharge, NADRI, Bengaluru, for providing facilities and encouragement.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Tournaye H, Liu J, Nagy Z, Verheyen G, Van Steirteghem A, Devroey P. The use of testicular sperm for intracytoplasmic sperm injection in patients with necrozoospermia. Fertil Steril 1996;66:331-4.  Back to cited text no. 1
    
2.
Lecomte PJ, Barthelemy C, Nduwayo L, Hamamah S. Necrospermia: Etiology and management. In: Hamamah S, Olivennes F, Mieusset R, Frydman R, editors. Male Sterility and Motility Disorders. Serono Symposia USA. New York: Springer; 1999.  Back to cited text no. 2
    
3.
Pandit Prashurama Shstry Vidyasagar, editor. Sharangadhara Samhita of Acharya Sharangdhara, Purvakhanda. Ch. 7, Ver. 172-173. 2nd edition. Bombay: Panduranga Jwalaji Nirnayasagar Press; 1931. p. 51.  Back to cited text no. 3
    
4.
Vaidya Yadavji Trikamji Acharya, Charaka Samhitha of Agnivesha, Chikitsa Sthana. Ch. 30, Ver. 140. 4th edition. Varanasi: Chaukhambha Sanskrit Sansthan; 2012. p. 820.  Back to cited text no. 4
    
5.
Srikantha Murthy KR, editor. Sushruta Samhita of Sushruta, Sharira Sthana. Ch. 2, Ver. 12. Reprint edition. Varanasi: Chaukhambha Orientalia; 2014. p. 21.  Back to cited text no. 5
    
6.
Jawanjal P. Evidence for increase sperm counts by ayurvedic formulations – A case study. World J Pharm Med Res 2018;4:152-5.  Back to cited text no. 6
    
7.
Nandigoudar SN, Harish Babu H, Raghavendra Y. Efficacy of Vajikaranain Shukra Dushti W.S.R. to oligo-astheno- teratazoospermia syndrome: Retrospective case series. J Ayurveda Holistic Med 2014;2:51-8.  Back to cited text no. 7
    
8.
Acharya YT, editor. Sushruta Samhita of Sushruta, Chikitsa Sthana. Ch. 26, Ver. 6-8. 6th edition. Varanasi: Chaukhambha Orientalia; 1997. p. 497.  Back to cited text no. 8
    
9.
Premavati T, editor. Kashyapa Samhita of Kashyapa, Siddhi Sthana. Ch. 2, Ver. 7. 2nd Reprint edition, Varanasi: Chaukhambha Visvabharati Academy; 2008. p. 278.  Back to cited text no. 9
    
10.
Jharkande O, Umapati M, editors. Dhanvantari Nighantu, Guduchyadi Varga. Ver. 297-298. 1st edition. Varanasi: Chaukambha Surabharati Prakashan; 2012. p. 92.  Back to cited text no. 10
    
11.
Varsakiya J, Goyal M. Effect of Phala Ghrita in the Management of Ksheena Shukra (Oligozoospermia): A Case Report. Int J Ayurvedic Herbal Med 2017;7:2815-21.  Back to cited text no. 11
    
12.
Bagul MS, Kanaki NS, Rajani M. Evaluation of free radical scavenging properties of two classical polyherbal formulations. Indian J Exp Biol 2005;43:732-6.  Back to cited text no. 12
    
13.
Sushama B, Nishteswar K. Pharmaco-therapeutic profiles of chandraprabha vati- an ayurvedic herbo-mineral formulation. Int J Pharm Biol Arch 2012;3:1368-75.  Back to cited text no. 13
    
14.
Gluud C. Testosterone and alcoholic cirrhosis. Epidemiologic, pathophysiologic and therapeutic studies in men. Dan Med Bull 1988;35:564-75.  Back to cited text no. 14
    
15.
Kumar G, Srivastava A, Sharma SK, Gupta YK. Safety evaluation of an ayurvedic medicine, arogyavardhini vati on brain, liver and kidney in rats. J Ethnopharmacol 2012;140:151-60.  Back to cited text no. 15
    
16.
Dange SV, Patki PS, Bapat VM, Shrotri DS. Effect of 'arogyavardhini' against carbon tetrachloride induced hepatic damage in albino rats. Indian J Physiol Pharmacol 1987;31:25-9.  Back to cited text no. 16
    
17.
Ambikadutta S, editor. Bhaishajya Ratnavali of Govindadas Sen. Ch. 62, Ver. 72-77. 15th edition. Varanasi: Chaukhamba Sanskrita Sansthana; 2002. p. 706.  Back to cited text no. 17
    
18.
Available from: http://www.madanapalas.com/shilapravang; http://www.google.com. [Last accessed on 2018 Dec 12].  Back to cited text no. 18
    
19.
Pandey GS, editor. Bhavaprakasha Nighantu of Bhavamishra, Uttarakhanda. Ch. 73, Ver. 20-21. 1st reprint edition. Varanasi: Chaukambha Bharati Academy; 1999. p. 615.  Back to cited text no. 19
    
20.
Acharya YT, editor. Charaka Samhita of Charaka, Chikitsa Sthana. (Prathama Pada), Ch. 2, Ver. 3. 2nd edition. Varanasi: Chowkhambha Orientalia Series; 2011. p. 390.  Back to cited text no. 20
    
21.
Rajiv G Amal, Nayan P Joshi, The role of Gokshuradi Yoga in the Management of Klaibya w.s.r. to erectile dysfunction, M D Thesis, Department of Kayachikitsa, Gujarat Ayurvedic Uni. Jamnagar. 2011.  Back to cited text no. 21
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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