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ORIGINAL/RESEARCH ARTICLES
SEMEN ANALYSIS PARAMETERS AND EFFECT OF TREATMENT WITH ASPARAGUS RACEMOSUS AND MUCUNA PRURIENS
HS PALEP
Obstetrician and Gynaecologist, Prabhadevi, Mumbai 25. Male factor in infertility contributes to almost 30-50%. Unfortunately three quarter of men attending the infertility clinics have no recognizable cause. Normal parameters depending on volume, sperm density, motility and morphology as defined by WHO when taken into consideration, most men with abnormal semen parameters are not sterile but are only sub fertile. Latest techniques based on functional analysis of sperms in vitro and vivo are being explored. Still the line of treatment remains in most cases empirical. This paper aims at finding out the abnormal semen parameters with their significance and secondly the result of treatment with Asparagus Racemosus and Mucuna Pruriens.
MATERIAL AND METHODS
This is series in author’s private clinic since 1982, of two hundred thirty cases of more than 3 years of infertility. These patients were given dose of each of Asparagus R and Mucuna P 5 grams in milk daily.
ANALYSIS PARAMETERS
Age groups
Upto 25 years of age - 16.2%
25-40 years - 79.18%
Above 40 years - 4.56%
Bhajekar et al series showed upto 40 years of age - 16.2%
Rajan et al series showed up to 40 years of age - 80.17%
Above the 40 years - Bhajekar et al series - 17%
Rajan et al series - 7.14%
the 40 years - Bhajekar et al series -Recognisable aetiological factors
series
seriesHistory of trauma to testis Epididymo-orchitis Varicocoele Crypto-orchidism Hydrocoele Hernia Filarial scrotum Mumps History of small pox Exposure to venereal diseases VDRL Position Occupation in heated environment Tight undergarments Addiction to alcohol Family history of diabetes Hard labour History of Kochs Obesity Impotency Klinefelters syndrome Epididymo-orchitis, heated environmental factors in work place, varicocoele, hydrocoele, exposure to venereal disease, history of small pox formed important causes associated with infertility.
Testicular Volume
It is very important to recognize the testicular volume. Orchidometer, series of plastic ellipsoids graded for volume, provide simple standard for comparison. Normal adult testis should exceed 15 ml volume.
Volume Present
seriesRajan et al
series15-30 ml 10-15 ml Less than 10 ml 52% of the cases had reduced testicular volume. If the testicular volume is severely reduced, it signifies serious pathology.
Following are the probable aetiological factors for severe reduction in testicular volume.
1. Previous bilateral crypto-orchidism
2. Klinefelter’s syndrome
3. Other chromosomal disorders
4. Pubertal gonadotrophin deficiency
5. Miscellaneous post-traumatic or post-orchitisatrophy of testis
Semen volume
WHO minimum standard for normal semen volume is more than 1.0 ml. Of 158 patients, semen volume notings show as below:
Volume 0.5 ml 0.5-2 ml More than 2 ml 52% patients showed semen volume - less than 2 ml
48% patients showed semen volume - more than 2 ml
Singh et al ’79 showed mean semen volume in infertility group as 2.1 ml, whereas infertile controls is 3.5 ml.
Of these, two patient’s semen did not liquefy at all.Self Liquefication
Rate Patients Percentage Liquefied on collection 16 14.49% Liquefied by 30 minutes 35 50.73% Liquefied after more than
30 minutes
24 34.78%
Deficiency of liquification lead to arrest of sperm in clots decreasing motility and capacity to fertilize.
Singh et al ’79 showed mean liquification time
for infertile men as 24.4 minutes in comparison to
control fertile men as 24 minutes.
Sperm Density
Density Azoospermia Less than 5 millions Less than 20 millions Less than 40 millions More than 40 millions
Majority of patients were azoospermic, next in order were less than 5 millions/ml. 80% of the patients constituted either azoospermic or less than 20 millions/ml.Motility
Normal motility as per WHO standard should be more than 60% with grades of III and IV.Zero motility was in 8 cases in which 6 of them were with very poor count i.e. 1-2 dead sperms per whole coverslip specimen. But two cases were necrospermia with a good sperm count. Majority i.e. 87% of patients showed motility less than 60% of grade I or II.Morphology
Normal semen should have less than 30% abnormal forms. In this series, there were 12 cases which showed more than 30% abnormal forms in the way of pinheads, giant heads. The significance of morphological abnormalities are being revealed in
recent researches. The pinhead sperms lack acrosin membrane and acrisin, hence cause irreversible fertility.
Fructose
Spermatozoa have an appetite for fructose not shared by any other tissue. It is particularly favourable for their anaerobic glycolysis and suitable to them as fuel for their long intrauterine journey after ejaculation.
97% of cases were fructose positive, whereas 3% were fructose negative.
There were 4 fructose negative cases out of which 1 case is of congenital absence of seminal vesicles and others following exposure to venereal diseases.Quantitative fructose content of the semen studied by different groups showed it varies inversely with germ cell activity.
Presence of infection
Pus cells 5-10/HPF Pus cells more than 10/HPF
Whereas pus cells absent or 1-2/HPF were 51.13%.
RBC’s were present in 22 cases forming 16.54%.
Karyotyping
Karyotyping of one patient showed Klinefelter syndrome.
Testicular Biopsy
Testicular biopsy were done in 36 patients.
Majority of the cased formed maturation arrest at some stage of spermatogenesis and inadequate spermatogenesis.
Hormonal Assay
In 19 patients, FSH, LH, testosterone and prolactin levels were done which showed normal despite the fact that other semen parameters were
Report Present
series
Gupta et al ’78
seriesWong et al ’73
seriesNormal sper-matogenesis (2) 5.71% (16) 11.42% — Inadequate spermatogenesis (4) 11.42% (48) 34.28% (32) 22.9% Maturation arrest (15) 42.86% (22) 22.85% (45) 32.1% -Complete arrest (8) 22.85% — — - Arrest at spermocyte level (2) 5.71% — — - Arrest at spermatid level (5) 14.30% — — Testicular atrophy (8) 22.86% (26) 18.50% (8) 5.7% Germinal aplasia (2) 5.71% (11) 7.85% (11) 7.9% Sertoli cell
only syndromeChronic inflammatory changes (1) 2.8% — — No testicular tissue seen (3) 8.58% — — very poor.
DISCUSSION
The spermatogenesis is a highly complex process involving subtle interactions between endocrine, paracrine and autocrine regulators acting on different cell population within the testes. Till such time all the facets of this process are understood our
ability to treat these patients of subfertility remains unsatisfactory. Collin et al 1983 New England Journal have shown that therapy related pregnancy rates with the latest therapies available are in the region of 20-30%.
In view of this I tried to find the results with Asparagus R and Mucuna P compare with some of the published results in our country with Clomifene or HCG as therapeutic agents.
Of the two hundred thirty cases only 71 cases who continued treatment for 3 months minimum and maximum for 9 months or more were considered for series et al ’78 et al ’73 series series
Result
3 months
6 months
9 monthsCount improved Motility improved Conception Potency improved the efficacy of the therapy.
Eleven cases showed improved potency and general well being. Few patients found the big dose consumption difficult. But majority who attended follow up were happy with the drug, since it caused a good bowel movement and felt energetic.
Rajan et al ’84 showed improvement in semen parameters 50% (27) with pregnancy rate 23.93% with Clomiphene citrate, average period of treatment was 6 months to 1 year. With HCG 34.61% (9) and conception rate of 26.92% with an average duration of treatment of 6 months to 1 year. Whereas the present series showed 30.02% (21) improvement in semen parameters and 25.35% (17) conception rate.CONCLUSION
This shows results of Asparagus R and Mucuna P are definitely comparable to the available modern medical lines of treatment.
Asparagus R is described as ‘Jeevaneeya’ in Ayurveda. It may help in regeneration of seminiferous tubule population and thus help in increase of spermatogenesis. Mucuna P has a good content of L-Dopa, thus it helps in improving the potency. It probably has also action on prolactin secretion and LH secretion which may be hypothalamic mediated.SUMMARY
These drugs are almost available everywhere in country and very cheap, without any significant side effects. No complications have been observed. The results of therapy are comparable to the very costly and powerful therapeutic agents with known side 2003; 326 : 1115.
CORTICOSTEROID
Stepping down the dose of inhaled corticosteroids in patients with chronic stable asthma can reduce the amount taken without compromising asthma control. Hawkins nd colleagues conducted a one year, randomised controlled, double blind trial among 259 primary care patients with asthma in western and central Scotland. The participants were randomised to treatment with inhaled corticosteroids which either remained unchanged or were reduced by 50% by stepping down the dose. The groups had similar rates of asthma excerbation and similar numbers of visits to general practice or hospital, as well as similar disease specific and generic measures of health status.
BMJ, 2003; 326 : 1115.
