Infertility can be defined as the failure to achieve pregnancy after regular unprotected sex (without the use of any contraception) for at least a year.
Primary infertility
Infertile Person has never had a child.
Secondary infertility
Infertile person has had one or more children in the past.
To understand infertility, it is important to know normal male reproductive system. Therefore we should first try to understand the male reproductive system in very simple way –
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Male reproductive system
Important players
– Testes
The main function of testicles is two-fold: they are responsible for producing sperm as well as the hormone testosterone. The testicles are made up of seminiferous tubules (hundreds of tiny tubes), Leydig cells (which is where testosterone is produced), and Sertoli cells (which are responsible for nurturing immature sperm cells).
– Scrotum
Scrotum helps to regulate the temperature of the testes, Because the testicles need to remain about 1°C cooler than normal body temperature. When exposed to cold air, the scrotum contracts to keep the testes warm but hangs lower when it is hot outside.
– Epididymus
Found at the top of the testes, the epididymus is a set of tightly coiled tubes. If stretched it out, the epididymus would reach 20 feet long. The epididymus acts as a temporary storing place for sperm as they continue to mature. It is within these tubes that sperm gain the ability to move.
– Vas deferens
This long tube extends from the epididymus in the testicle, up, over the bladder and finally ending at the seminal vesicles. The vas deferens acts as both a passageway for the sperm as they exit the body and as another storing place as the sperm wait to be ejaculated.
– Seminal vesicles
These two pouch-like sacs are found behind the bladder. The seminal vesicles add an alkaline fluid that makes up 30% of the total semen volume. This secretion helps give the sperm energy, thereby giving their motility a boost.
– Prostate gland
This gland sits just below the bladder and contributes about 60% of the total semen volume. This alkaline secretion is similar to the fluid produced in the seminal vesicles and is necessary to the sperms’ survival by helping neutralize the naturally occurring acids in the urethra and the vagina.
– Cowper’s glands
Positioned just below the prostate, these are two small glands that produce about 5% of the alkaline secretions that make up semen.
– Ejaculatory ducts
These are two short ducts that connect the prostate gland to the urethra. The joining of the two vas deferens makes up the ejaculatory ducts.
– Urethra
Used as the final passageway for both semen and urine, this tube starts at the bladder, goes through the prostate and extends to the tip of the penis. When a man climaxes, the prostate closes off the bladder to prevent any urine from joining the semen.
– Penis
The method of delivery for sperm, this organ is made up of veins, arteries and spongy tissue. When a man becomes sexually aroused, the arteries dilate allowing the tissue to become engorged with blood. This causes the penis to stiffen and become erect.
– Hormones
– Gonadotropin Releasing Hormone (GnRH)
Originating in the hypothalamus in the brain, GnRH is responsible for signaling the pituitary gland to start production of follicle stimulating hormone (FSH) and lutenizing hormone (LH).
– FSH
This hormone is responsible for stimulating and maintaining sperm production.
– LH
This hormone is responsible for getting the production of testosterone started.
– Testosterone
Produced in the Leydig cells in the testes, this hormone helps with sperm production but it is mainly responsible for male maturation (the deepening of the voice, sex drive, growth and development of the sex organs).
Sperm production
Women have the chance to get pregnant only once a month (when they ovulate), men seem to have the ability to fertilize an egg at any time. However, the production of sperm is not a simple one. In fact, it takes about 74 days for sperm to be produced and readied for ejaculation.
At birth, males have simple round cells contained within their seminiferous tubules. This is the most primitive form of sperm. During puberty, stimulation by testosterone and other hormones cause the cells to divide, thereby beginning the maturation process of sperm.
The sperm cells will divide and mature until they begin to resemble tadpoles, These mature sperm are highly specialised cells and are made up of three parts: a head, neck and tail.
– Head
Head is a structure called the nucleus, which Contains all the genetic information that a man contributes to his child. The head is designed to stick to and then enter (penetrate) the egg.
– Neck
The neck joins the head to the tail.
– Tail
The part of the tail nearest the neck contains the mitochondria, which provides the energy for the sperm to move. The tail moves in a whipping motion to push the sperm towards the egg.
Journey
Once the sperm has developed its head and tail, it is shuttled along to the epididymis. Here it will enjoy a three-week stay by the end of which it will have gained the ability to move. Next, the sperm move through the vas deferens to the seminal vesicles where they stay until they are ejaculated. All along this trip, the sperm will be provided with fructose, a type of sugar, to give it energy as it travels along.
During ejaculation, fluid from the prostate, seminal vesicles, and Cowper’s gland combine with the sperm to make semen. This will be expelled from the body during orgasm. For fertilization of the female egg to occur, it is necessary to ejaculate inside the vagina.
Anywhere from 250 million to 1 billion sperm are produced and ejaculated at one time in a healthy male. However, only about 200 of these will actually make it up through the vagina, cervix and uterus and into the correct fallopian tube. From this drastically reduced group, only one sperm will actually be able to fuse together with the egg to create a child. In total, it takes a few days for sperm to make the trip through the female reproductive system to the egg.
Causes of infertility
Age
Healthy men in their 70s and beyond can still father children however the time taken to cause a pregnancy is longer from middle-age onward. The potential reasons for this include a decrease in sexual activity, semen volume, sperm motility (movement), the total number of motile sperm and possibly sperm
function and DNA quality.
Obstructive problems
Blockage in a sperm-carrying tubes due to –
– Groin surgery (including hernia repair and fixation of undescended testicles).
– Trauma to the scrotum sack covering the testicles (even fairly minor sporting injuries).
– Infection (particularly chlamydia, gonorrhoea and tuberculosis).
– Previous vasectomy (a form of contraception that involves tying the sperm-carrying tubes).
Congenital problems
– Absence of the vas deferens on one or both sides. (The vas deferens is the tube that conducts the testicular component of semen to the urethra, which then carries semen through the penis to the outside world.)
– Absence of seminal vesicles (where other semen components are made)
Other obstructive cause
– Berry-Perkins-Young syndrome, in which sufferers have a chronic chest disease (bronchiectasis), chronic sinusitis and obstructive infertility.
Testicular injury and disease
– A blow to the testicles, which may occur in sport or during a fight, can cause swelling of the testicles, or bleeding in or around them. This probably causes the blood supply to the testicles to fail, resulting in permanent damage to the sperm production mechanism.
– Torsion of the testicles (twisting of a testicle on its cord) can have a similar effect if it is not treated very quickly with surgery.
– Viral infections can cause inflammation of the testicles (orchitis, which usually appears as painful swelling of the testicles) and failure of sperm production.
– Mumps affect fertility if it causes orchitis.
– Undescended testicles (cryptorchidism) may lead to failure of sperm production.
Varicocele
Varicocele is dilation of the testicular veins in the spermatic cord that leads from the testicles to the abdomen. Varicocele may be either one sided or occurs both sides, but more common on the left.
Varicocele either heats up the testicles or impairs their blood supply thus affecting fertility. The co-existence of other risk factors, such as smoking, with varicocele seems to have a greater effect on the risk of infertility.
Sperm disorders
– Azoospermia
Absence of sperms, In case of azoospermia homoeopathic treatment is highly hopeful.
– Oligospermia
Meager number of sperms.
– Astheno sperm
Sperms with feeble mobility. This may be sometimes due to the dilated and tortuous condition of the veins of the testis- varicocele. This can be managed very well with homoeopathic medicines by evading surgery.
– Teratospermia
Structural malformations of the sperms.
Genetic disorders
– Chromosome disorders
Can affect their fertility in various ways:
– affect the development of the testicles.
– Klinefelter’s syndrome
In this disorder, instead of having 46 chromosomes, including one X and one Y chromosome (46XY), the man has an additional X chromosome (47XXY).
– can disrupt cell division and sperm production.
Problems with erection and ejaculation
– Erectile dysfunction (inability to attain or maintain an erection adequate for intercourse)
– Premature ejaculation
– Failure to ejaculate
– Inability to achieve vaginal penetration
Hormonal problems
– Testosterone deficiency
It can reduce fertility and may be caused by problems with testicular testosterone production, or problems with the pituitary gland or hypothalamus in the brain, which control testosterone production.
– Overproduction of prolactin (hyperprolactinaemia),
A hormone produced by the pituitary gland, may also reduce fertility.
General medical disorders that reduce fertility
There are several conditions that may reduce fertility:
– Fever
Influenza (flu), pneumonia, or even a severe cold can cause a high fever, which will adversely affect sperm production and quality. These changes usually recover over a few weeks.
– Diabetes
It can cause problems with erection and ejaculation through causing damage to the function of the ‘automatic nervous system’.
– High blood pressure
Hypertension (high blood pressure) can cause problems with erection, either directly or as a side effect of medication.
– Coronary artery disease
Coronary artery disease can cause problems with erection. This could be due to generalized hardening of the arteries, in the penis as well as the heart, or to drugs used in the treatment of heart problems.
– Neurological disorders
Multiple sclerosis, stroke, and spinal cord injury and disease can all cause problems with erection and ejaculation.
– Kidney disease
Chronic renal failure, which results in a build up of waste products in the body, can adversely affect sperm quality and fertility. It can also cause erection problems.
– Cancer
Cancers that affect the genital tract or endocrine (hormone-producing) systems may directly reduce fertility. Otherwise, drugs and radiation used to treat cancer may severely reduce sperm production or even stop it altogether. Stress (see below) may also have an effect.
– Alcoholism
Alcohol is toxic to sperm and overuse of alcohol can reduce sperm quality and fertility.
– Stress
Stress causes several hormonal changes in the body that can affect fertility. Stress can have many causes, including anxiety over fertility problems.
– Bad habits
Alcohol – Reduces sperm count and quality
Tobacco – May reduce sperm motility
Marijuana – affects hormone production
Opiates (heroin, morphine) – Affects hormone production
– Medicine
Anabolic steroids – Affect hormone production
Amiodarone – Inflammation of the testicles and epididymis (epididymo-orchitis) leading to problems with sperm production
Cancer chemotherapies – May severely reduce sperm count, quality and motility. Effects may be permanent
Colchicines – May severely reduce sperm count
Digoxin – Affects hormone production Heart failure
Erythromycin – May reduce sperm count
Gentamicin – Reduces sperm count
Hormonal therapies – May disrupt other hormone production
Ketoconazole – Reduces sperm count
Methotrexate – Reduces sperm count
Nitrofurantoin – Reduces sperm count
Phenytoin – Reduces sperm quality and motility
Spironolactone – Affects hormone production
Sulphasalazine – Reduces sperm count and quality
– Environmental toxins and radiation
Environmental toxins that may affect fertility
Alkylphenols, Dioxins, Organochlorine pesticides (Lindane, DDT) etc.
Signs or symptoms of male infertility
In most cases, there are no obvious signs of an infertility problem.
Intercourse, erections and ejaculation will usually happen without difficulty. The quantity and appearance of the ejaculated semen generally appears normal to the naked eye.
Diagnosis
Diagnosis can involve a medical history from the man to find out whether there are any obvious health issues that could affect fertility. A physical examination is performed, along with a semen analysis to check the number, movement and shape of the sperm in the ejaculate. Blood tests may also be done to check the hormone levels that control sperm production. Genetic investigations and
testicular biopsies are sometimes done.
Prevention
There are a number of things that men can do to help preserve and promote their fertility.
– Eat a healthy, balanced diet.
– Take regular exercise.
– Try to maintain their weight in the ideal range.
– Don’t smoke.
– Keep alcohol consumption within recommended limits.
– Don’t use recreational drugs.
– Try to reduce stress.
– Avoid tight underwear or wear boxer shorts – the evidence for benefit from this is very poor. One study from the Netherlands showed that tight leather trousers and tight plastic underpants affected sperm quality when worn together, but not alone! Y-fronts probably do not make much difference.
– Cold showers or scrotal soaks – while these might take the mind off fertility concerns for a few moments, there is no evidence of their effectiveness.
Homeopathic symptoms and cure
Homeopathic remedies are prescribed on the basis of symptoms rather than conditions, as each case of a particular illness can manifest differently in different people. There are many symptoms which can be effectively treated by homeopathy few symptoms are given below. If your symptoms are matching to any of the symptoms given below, it can be cured mail the disease and symptom number at drraishyam@gmail.com to know your medicine.
1. Infertility develops after a man has led a life of intense and frequent sexual activity for many years. A cold sensation felt in the genitals he is often very anxious about their health and loss of abilities, and may have problems with memory and concentration.
2. Erection fails when sexual intercourse is attempted, especially if thinking about the problem makes it worse. He is nervous and imaginative and usually warm-blooded, with cravings for both sweets and salt.
3. Genitals are completely limp, despite having sexual interest. Nocturnal emissions can occur without an erection, even if dreams are not sex-related. Craves tobacco.
4. Physical pleasure during sex has diminished and sexual urges are reduced. The person feels tired and weak, and may experience memory loss, with a compulsive need to check things (to see that doors are locked, etc.) Prostate problems may be associated with impotence, and urine may be lost when the person coughs or sneezes.
5. Problems with erections because of worry, and can also be troubled by memory loss. They often lack self-confidence, have digestive problems with gas and bloating, and an energy slump in the late afternoon and evening. Often useful for old people.
6. Men who have diminished sexual ability, especially if the problem starts after a fever or exhausting illness. The person feels weak and exhausted, but interest is usually still present. Unusual hair loss (Body hair or eyebrows)
7. Gentle-natured, quiet men with deep emotions. Problems with impotence often occur from embarrassment or shyness. History of emotional suppression and very sensitive feelings.
8. Infertility due to low immune system which is responsible for various diseases.
9. Infertility due to low sex drive.
10. Infertility due to low sperm count.