Male infertility (Enah" or "Enanat")
As per Unani concept Male infertility termed as"ENAH" or "ENANAT" defined as inability to perform sexual act & reproduction while zofe bah termed as sexual debility, defined as weakness in the performance & reproductive organs. It's fact zofe bah lead to male infertility
Male infertility refers to a male's inability to cause pregnancy in a fertile female. In humans it accounts for 40–50% of infertility.[1][2][3] It affects approximately 7% of all men.[4] Male infertility is commonly due to deficiencies in the semen, and semen quality is used as a surrogate measure of male fecundity.[5]
Causes
Factors relating to male infertility include:[6]
Immune infertility
Antisperm antibodies (ASA) have been considered as infertility cause in around 10–30% of infertile couples.[7] ASA production are directed against surface antigens on sperm, which can interfere with sperm motility and transport through the female reproductive tract, inhibiting capacitation and acrosome reaction. Risk factors for the formation of antisperm antibodies in men include the breakdown of the blood‑testis barrier, trauma and surgery, orchitis, varicocele, infections, prostatitis, testi
Testicular factors
Testicular factors refer to conditions where the testes produce sperm of low quantity and/or poor quality despite adequate hormonal support and include:
Varicocele
Varicocele, is a condition of swollen testicle veins.
It is present in 15% of normal men and in about 40% of infertile men.
It is present in up to 35% of cases of primary infertility and 69-81% of secondary infertility.[9]
Other
Genetic defects on the Y chromosome
Abnormal set of chromosomes
Idiopathic failure
Acrosomal defects affecting egg penetration
Idiopathic oligospermia - unexplained sperm deficiencies account for 30% of male infertility.[13]
Pre-testicular causes
Pre-testicular factors refer to conditions that impede adequate support of the testes and include situations of poor hormonal support and poor general health including:
Hypogonadotropic hypogonadism due to various causes
Obesity increases the risk of hypogonadotropic hypogonadism.[14] Animal models indicate that obesity causes leptin insensitivity in the hypothalamus, leading to decreased Kiss1 expression, which, in turn, alters the release of gonadotropin-releasing hormone (GnRH).[14]
Undiagnosed and untreated coeliac disease (CD). In men, CD can reduce semen quality and cause immature secondary sex characteristics, hypogonadism
Medications, including those that affect spermatogenesis such as chemotherapy, anabolic steroids, cimetidine, spironol
Genetic abnormalities such as a Robertsonian translocation
Tobacco smoking
There is increasing evidence that the harmful products of tobacco smoking may damage the testicles[19] and kill sperm,[20][21] but their effect on male fertility is not clear.[22] Smoking tobacco increases intake of cadmium, because the tobacco plant absorbs the metal. Cadmium, being chemically similar to zinc, may replace zinc in the DNA polymerase, which plays a critical role in sperm production. Zinc replaced by cadmium in DNA polymerase can be particularly damaging to the testes.[23]
DNA damage
Common inherited variants in genes that encode enzymes employed in DNA mismatch repair are associated with increased risk of sperm DNA damage and male infertility.[24] These findings suggest that DNA damage is an important factor in male infertility.
Epigenetic
An increasing amount of recent evidence has been recorded documenting abnormal sperm DNA methylation in association with abnormal semen parameters and male infertility.[27][28]
Post-testicular causes
Post-testicular factors decrease male fertility due to conditions that affect the male genital system after testicular sperm production and include defects of the genital tract as well as problems in ejaculation:
Vas deferens obstruction
Dignosis
Medical history
The history should include prior testicular or penile insults (torsion, cryptorchidism, trau
Sexual habits, frequency and timing of intercourse, use of lubricants, and each partner's previous fertility experiences are important.
Physical examination
Usually, the patient disrobes completely and puts on a gown. The physician, physician assistant, or nurse practitioner will perform a thorough examination of the penis, scrotum, testicles, I vas deferens, spermatic cords, ejaculatory ducts, urethra, urinary bladder, anus and rectum. An orchidometer can measure testicular volume, which in turn is tightly associated with both sperm and hormonal parameters.[4] A physical exam of the scrotum can reveal a varicocele, but the impact of detecting and surgically correct a varicocele on sperm parameters or overall male fertility is debated.[4]
Sperm sample
The volume of the semen sample, approximate number of total sperm cells, sperm motility/forward progression, and % of sperm with normal morphology are measured. This is the most common type of fertility testing.[29][30] Semen deficiencies are often labeled as follows:
Aspermia - complete lack of semen
Hypospermia - reduced seminal volume
Azoospermia - absence of sperm cells in semen
Teratospermia - increase in sperm with abnormal morphology
Asthenozoospermia - reduced sperm motility
Necrozoospermia - all sperm in the ejaculate are dead
Leucospermia - a high level of white blood cells in semen
Normozoospermia or Normospermia - It is a result of semen analysis that shows normal values of all ejaculate parameters by WHO but still there are chances of being infertile. This is also called as Unexplained Infertility [31]
Blood sample
Common hormonal test include determination of FSH and testosterone
Ultrasonography
Scrotal ultrasonography is useful when there is a suspicion of some particular diseases. It may detect signs of testicular dysgenesis, which is often related to an impaired spermatogenesis and to a higher risk of testicular cancer.[4] Scrotum ultrasonography may also detect testicular lesions suggestive of malignancy.
Prevention
Some strategies suggested or proposed for avoiding male infertility include the following:
Avoiding excessive heat to the testes.[33]
Maintaining optimal frequency of coital activity: sperm counts can be depressed by daily coital activity[33] and sperm motility may be depressed by coital activity that takes place too infrequently (abstinence 10–14 days or more).[33]
Wearing a protective cup and jockstrap to protect the testicles, in any sport such as baseball, football, cricket
Diet: Healthy diets (i.e. the Mediterranean diet) rich in such nutrients as omega-3 fatty acids, some antioxidants and vitamins, and low in saturated fatty acids (SFAs) and trans-fatty acids (TFAs) are inversely associated with low semen quality parameters. In terms of food groups, fish, shellfish and seafood, poultry, cereals, vegetables and fruits, and low-fat dairy products have been positively related to sperm quality. However, diets rich in processed meat, soy foods, potatoes, full-fat dairy products, coffee, alcohol and sugar-sweetened beverages and sweets have been inversely associated with the quality of semen in some studies.
Treatment
Treatments vary according to the underlying disease and the degree of the impairment of the male fertility. Further, in an infertility situation, the fertility of the female needs to be considered.
Pre-testicular conditions can often be addressed by medical means or interventions.
Testicular-based male infertility tends to be resistant to medication. Usual approaches include using the sperm for intrauterine insemination (IUI), in vitro fertilization (IVF), or IVF with intracytoplasmatic sperm injection (ICSI). With IVF-ICSI even with a few sperm pregnancies can be achieved.
Obstructive causes of post-testicular infertility can be overcome with either surgery or IVF-ICSI. Ejaculatory factors may be treatable by medication, or by IUI therapy or IVF.
Vitamin E helps counter oxidative stress,[35] which is associated with sperm DNA damage and reduced sperm motility.[36] A hormone-antioxidant combination may improve sperm count and motility.[37] However there is only some low quality evidence from few small studies that oral antioxidants given to males in couples undergoing in vitro fertilisation for male factor or unexplained subfertility result in higher live birth rate.[38] It is unclear if there are any adverse effects.[38]
Hormonal therapy
Administration of luteinizing hormone (LH) (or human chorionic gonadotropin) and follicle-stimulating hormone (FSH) is very effective in the treatment of male infertility due to hypogonadotropic hypogonadism.[39] Although controversial,[40] off-label clomiphene citrate, an antiestrogen, may also be effective by elevating gonadotropin levels.
Estrogen, at some concentration, has been found to be essential for male
Low-dose estrogen and testosterone combination therapy may improve sperm count and motility in some men,[48] including in men with severe oligospermia.[49]
Future potential treatments
Researchers at Münster University developed in vitro culture conditions using a three-dimensional agar culture system which induces mouse testicular germ cells to reach the final stages of spermatogenesis, including spermatozoa
Researchers from Montana State University developed precursors of sperm from skin cells of infertile men.[53][54][55]
Sharpe et al comment on the success of intracytoplasmic sperm injection (ICSI) in women saying, "[t]hus, the woman carries the treatment burden for male infertility, a fairly unique scenario in medical practice. Ironically, ICSI’s success has effectively diverted attention from identifying what causes male infertility and focused research onto the female, to optimize the provision of eggs and a receptive endometrium, on which ICSI’s success depends."[56][57]
UNANI Treatment
A.Treat the cause specially.
B. Generally zofe bah is treated under 3 stages
1. Taskeen o Tabreed
2. Taqweeat
3 . Tahreek
1. Taskeen o Tabreed. In this stage musakkinat o mubarridat advia are used locallly like natool post khadkhash, phitkiri mahlool, tila musakkin as well as orally such as talmakhana, toodari, moosli, beejband, singhara khusk, kushta qalyi and dawaus shifa etc
2. Taqweeat . In this stage muqavviyate bah advia are used orally such as laboob kabeer majun salab majun ard kurma etc.
3. Tahreek. In this stage muharrikat bah advia are used orally like majune falasfa, habbe ahmar etc. and as well as locally like tila shabab awar, tila Azam etc.
Islahe hazm o jigar are adopted in all stages.
Course of the treatment depends upon chronicity of the disease.
List of musakkinat o mubarridat
Kushta qalyi
Kushta nuqra
Kushta jast
Kushta musallas
Qurs jiryan
Laboob barid
Majun ard khurma
Majun jiryan khas
Majun mughalliz jawahar
Misali
Matosin
Balooti
Jernide
Tila musakkin
Fitkiri mahlool
Roguan khaskhash
List of muqavviyate
Laboob kabeer
Laboob Azam
Majun salab
Majun jalai
Majun momyayi
Majun ard khurma
Majun shabab awar
Majun jaleenoos lului
Habbe ambar momyayi
Habbe khas
Habbe jaleenoos
Habbe jadwar
Dawa tokore
List of musakkinat
Khusta sammul far
Qurs khrateen
Qurse alhahmar
Qurs kushta shangraf
Habbe ahmar
Majun flasfa
Habbe azaraqi
Tila Azam
Tila shabab awar
Tila Nishat angez
Tila ajeeb
Roghan beer bahooti
Roghan kharateen
