homoeopathic management of infertility

INFERTILITY

Dr.K.Saji. MD(Hom)

What I am going to tell you

Infertility in general Male & Female infertility

Theory Lab investigations Management : General & Therapeutic Clinical Cases

Infertility

Definition The inability of a couple to achieve

conception after a year or more of regular, unprotected coital exposure.

Failure to have a baby because of repeated abortion also is a form of infertility.

Duration - Exceptions

Incidence in India

15-20 % 80-85 %

Types

Primary Secondary

Male and Female factors

30%

30%

30%

10%

Male

Female

Both

Un-explained

Male

Female

Both

Conditions that warrant seeing a doctor

Female Frequent menses ( 3 weeks or less ) Amenorrhoea longer than 3 months Irregular menses History of pelvic infection Two or more abortions Women over the age of 35

Male History of prostate infection Un-descended testes

Male Infertility

Male factors

Defects ofSpermatogenesisEfferent duct systemSperm depositionSeminal fluid

Defective Spermatogenesis

Congenital : Un-descended testes

Thermal factor : Varicocele

Infections : Mumps, Systemic

General factors : Habits, Nutrition

Endocrinal : DM, Thyroid, Pituitary

Genetic :Klinefelter’s (47xxy),Reifenstein’s (46xy)

Iatrogenic : Radiation, Drugs

Immunological : ASA

Defects of Efferent ducts

Congenital absence of vas

Obstruction which may be due to Infection : Tubercular, Gonococcal Accidental : During Surgeory

Defects in sperm deposition

Impotency Defective ejaculation

Premature Retrograde Absence

Hypospadius

Defects of Seminal fluid

High or low volume High viscosity Low fructose High prostaglandin

Varicocele

Varicocele is the commonest cause of

low sperm count with poor motility

Incidence of Varicocele : 15 % of the general male population 40 % of men evaluated for primary infertility & 50 % of men evaluated for secondary infertility

Grades of Varicocele

Grade III or Large On inspection one can see the 'bag of worms‘

Grade II or Moderate On palpation without coughing one can feel the

'bag of worms‘ Grade I or Small

Only on coughing can one feel the 'bag of worms‘ Subclinical Varicocele

Detected only by color doppler

Causes of varicocele

Suggested theories Left testicular vein enters the left renal

vein perpendicularly Long (8 - 10 cm) left testicular vein

(aided by gravity) Compression of left renal vein between

aorta and superior mesenteric artery ('nut cracker' effect)

Absence or incompetent valves in testicular vein

Adverse effects of a varicocele

Suggested theories Hyperthermia Pooling of warm venous blood

leads to impaired spermatogenesis (Heat Injury).

Toxins Increased concentration of metabolic waste products (Nitric oxide / reactive oxygen free radicals). Abnormal concentration of adrenal and renal substances.

Hypoxia Decreased availability of oxygen and nutrients.

Hormonal Impairment of testosterone production and concentration.

Theory of Cremasteric Compartment Complex

The encircling cremasteric muscle creates a tight compartment around the structure of the spermatic cord.

This leads to venous stasis and secondary venous dilatation and tortuosity.

According to this theory, it is 'venous stasis' and not 'venous reflux' that leads to the effects of varicocele.

MAIN SPERMAL ANOMALIES

Aspermia Azoospermia Oligospermia Aesthenospermia Teratospermia Necrospermia Polyspermia Globozoospermia Haematospermia

LAB INVESTIGATIONS - MALE

Semen Analysis Color Doppler Study of Scrotum Hormone Assay

FSH,LH,Testosterone,TSH Sex Chromatin Study Testicular biopsy

SEMEN ANALYSIS

Abstinence : 3-7 Days Collection : Coitus Interruptus Specimen Submission Delay :

Less than 30 minutes Volume : 2-6 ml. Liquifaction : Within 60 minutes

SEMEN ANALYSIS

Count : 40-250 million/ml Motility Active : 20-30 % Total : > 60 % Vitality : > 65 % Morphology : > 60 % Normal

Cells Fructose : 150-600 mg/ml

LAB ERRORS

Count Total Count

OLIGOSPERMIA

• Sperm densities of less than 20 million/ml or a total count of less than 50 million

Motility : Grading

Fast Progressive Swim forward fast, in a straight line

Slow progressive Swim forward slowly or in a curved line

Non progressive Move their tails but do not move forward

Immotile

AZOOSPERMIA

CENTRIFUGE SPECIMEN

SPERM ABSENT SPERM PRESENT

W/O for OLIGOSPERMIAR/O ABSENT VAS

VAS ABSENT

CBAVD

VAS PRESENT

HORMONE STUDIES

NORMAL FSH –

NORMAL SIZED TESTESFSH > 2x-3x NORMAL, LH,T – NORMAL

SMALL TESTES

FSH, LH ELEVATED

T NORMAL OR LOW

FSH,LH LOW

TESTES BIOPSY

SPERMATOGENESIS

NO SPERMATOGENESIS

VASOGRAM & SAMPLE VAS FLUID &

DEFINITIVE REPAIR

R/O ANY CORRECTABLE ABNORMALITIES

GERM CELL FAILURE TESTICULAR FAILURE

FULL ENDOCRINE EVALUATION

HYPOGONADOTROPIC HYPOGONADISM

OLIGOSPERMIA

HORMONE STUDY SEMEN FRUCTOSE

LOW

• CAVD

• Partial Duct Obstruction

TSH T FSH

HIGH

Hypothyroidism

LOW

Daily Injection Of HCG

5000 units X 4 doses

UNRESPONSIVE RESPONSIVE

Klinefelter’s Syndrome

Sex Chromatin Study

Hypogonadotropic Hypogonadism

HIGH NORMAL OR LOWTesticular Failure

Pus cells ++ No Infection

Prostatic Massage

Smear + Culture

TESTICULAR BIOPSY

NORMAL SPERMATOGENESIS

HYPO SPERMATOGENESIS

Obstruction to Efferent ducts

Vasogram

Damage of Tubular Epithelium

Rubrics : Semen Analysis

Volume : Ejaculation,copious,excessive

Ejaculation scanty,short,feeble Pus Cells : Ejaculation,purulent Blood Cells : Ejaculation, bloody Viscocity : Ejaculation,thick,sticky

Ejaculation,failing during sex,though the orgasm is present

RUBRICS OF RELATED PATHOLOGY

Atrophy,testes Cysts, genitalia.( Sil,Thuj ) Hydrocele, scrotum Injuries to,genitalia Kryptorchism ( Aur, Psor, Syph, Thyr, Tub ) Small, testes ( Bar-c,Iod,Puls,Sil,Spong,Tub) Varicocele, spermatic cord

RUBRIC - MALE INFERTILITY

COMPLETE REPERTORY

Male, Sterility : agn am-c arg bor calc cann-s caust cer

cic con cordy-a croc dam dulc dysp erb eur ferr graph holm hyos lant merc nat-c nat-m neod onc-t phos plat pras ruta sam sul-ac sulfa sulph 1terb 1thul x-ray ytte

Complete Repertory arg – argentum metallicum - Scholten cer - cerium mettallicum cordy-a _ cordyline australis - Marlow dysp – dysprosium metallicum erb – erbium metallicum eur – europium metallicum gad – gadolinium metallicum holm – holmium metallicum lant – lanthanum metallicum neod – neodymium metallicum onc-t –onchorynchus tschawythscha - Sherr pras – praseodymium metallicum sam – samarium metallicum terb – terbium metallicum thul – thulium metallicum ytte - ytterbium metallicum

Male, Sterility : 35 medicines

Agn, Alet, Aur.m, Bar.m, Bers.l, Borx, Caul, Cissu.c, Con, Dam, Erios.co, Fil, Form, Goss, Grew.oc, Gunn.p, Helon, Iod, Lapp, Mill, Nat.c, Nat.m, Nat.p, Phos, Pyren.sc, Roye.l, Rub.c, Sabal., Sol.so, Sul.ac, Ther, Trium.r, Vern.co, Wies, X-ray.

SYNTHESIS

Synthesis

Cissu-c – Cissus cuniefolia Erios-co – Eriosema cordatum Fil – Filix mas Grew-oc – Grewia occidentalis Pyren-sc – Pyrenacantha scandens Roye.l – Royena lucida Rub-c – Rubea cordifolia Sol-so – Solanum sodomoeum Trium-r – Triumfetta rhomboidea Vern-co – Vernonia corymbosa

SYNTHESIS

These medicines are taken from three authors

Dr. J.H.ClarkeDr.A.T.BryantDr.Jhar, and Dr.Stephenson

SYNTHESIS Dr.J.H.Clarke ( c2 ) : From ` A Clinical

Repertory to the Dictionary of Materia Medica'.

Agn, Alet, Aur.m, Bar.m, Borx, Caul, Con, Dam, Fil, Form, Goss, Helon, Iod, Lapp, Mill, Nat.c, Nat.m, Nat.p, Phos, Sabal, Sul.ac, Ther, Wies..

SYNTHESIS

These medicines are mentioned under the rubric sterility in Clinical repertory . But whether it is male or female is not specified.

The medicines seems more deviated to the female side on reference

SYNTHESIS

In Synthesis these medicines are seen added to the rubric -sterility in both the chapters, Male and Female.

So, medicines under the rubric are to be further studied clinically to arrive at a conclusion whether they are to be considered as valuable and reliable for the treatment of male sterility.

RUBRIC

SYNTHETIC REPERTORY : Male Sterility : Sulfa, X-ray.

REPERTORY TO THE HERING’S GUIDING SYMPTOMS OF OUR MATERIA MEDICA. : Dr.K.B.KNERR.

Male sexual Organs : Testicles : Sterility : Ferr.

RUBRIC

Dr.K.N.MATHUR : DIABETES MELLITUS,ITS DIAGNOSIS AND TREATMENT .

In the therapeutic part : Concomitants of

Diabetes -

Sterility : Aur.m.n, Aur.m, Borx, Con, Graph, Helon, Iod, Med, Nat.c, Nat.m, Phos, Thyr.

( No specification- whether Male or Female )

RUBRIC

Dr.BERKELEY SQUIRE : A REPERTORY OF NOSODES AND SARCODES.

Male Genital : Aspermatogenesis, Oligospermia : Lepr.

Male Genital, Male Sterility , Impotence : Ambr, Bac.7, Cortico, Lac.d, Lepr, Med, Psor, RNA, Syco, Thal, X-ray.

RUBRIC

Dr.C.M.BOGER : SYNOPTIC KEY.

Sexual Impulse :

Sterility : Aur, Bor, Merc, Nat.m, Phos.

( No specification- whether Male or Female )

RUBRIC

Dr.RAUE.C.G. :

SPECIAL PATHOLOGY AND DIAGNOSTICS WITH THERAPEUTIC HINTS.

Under the section Impotence and Sterility, the medicines mentioned are :

Agar, Agn, Baryt, Calad, Eup.pur, Gels, Hamam, Helon, ,Lyco, Nat.m, Nit.ac, Phos, Phytol, Selen, Stilling.

RUBRIC

CLARKE.J.H. :

A CLINICAL REPERTORY :

Sterility : Agn, Alet, Ar.lp, Aur.m, Bar.m, Bor, Caul, Con, Fil, ( For ), Gos, Hlon, Iod, Mil, nat.c, Nat.m, Nat.p, Pho, Sbl, Su.x, ( Ther ), Tur, Wis.

RUBRIC

RAI BAHADUR Dr. BISHAMBAR DAS : SELECT YOUR REMEDY :

Azoospermism : ( Absence or diseased condition of spermatozoa in the semen )

Chininum sulph, Conium, Damiana, Iodium, Strychninum.

RUBRIC

KAMAL KANSAL Dr. :

HAND BOOK OF HOMOEOPATHIC MOTHER TINCTURES :

Sterility, males : Turnera.

RUBRIC

Dr.O.A.JULIAN:

DICTIONARY OF

HOMOEOPATHIC MATERIA MEDICA.

Clinical Repertroy part by P Freche and M Haffen

Sterility : Arg.m, Cobalt.nitr, Foll, Mandr of, Nep, Rauw serp, Sulfanil, Thyr.

RUBRIC

Dr.SAYEED AHMAD : STERILITY IN FEMALE AND MALE :

Chin sulph, Con.mac, Damiana, Iodium, Strychninum.

RUBRIC

Dr.J.N.SHINGHAL : QUICK BEDSIDE PRESCRIBER :

Sterility male : Agnus, Bufo, Nat.m, Phosphorus, Sel

EVALUATION OF MEDICINES

Among this medicines., Agn, Arg.m, Bac.7, Bufo, Chin.s,

Cobalt.nitr, Con , Dam , Ferr , Iod, Lepr, Nat-m, Phos , Rauw.serp, Sel, Strych, Sulfa , X-Ray. could be taken as confirmed medicines as they are mentioned under the heading male sterility or a synonymous term.


All the additions from J.H.Clarke’s Repertory, which are found to be of female part on reference to the Materia Medica, may be removed from the list. They are :

Alet, Bar.m, Bor, Caul, Fil, Goss, Helon, Nat.c, Sul.ac, and Wies.


Those medicines which are found under the `clinical’ section of Clarke but not under female may be included as medicines for male sterility, but with less marks.

They are : Aur.m, Lapp, Mill, Nat.p., Sabal.


Among the additions from Raue’s Pathology, as the medicines are given under the combined heading – impotence and sterility, we should find out which ofthem actually cover the condition - sterility.

On studying the symptomatology,among them,

Baryt, Calad, Lyco, Nit.ac, Eup.pur, Gelsem, Helon, and Phyt covers only impotency.

Some symptoms which may be related to infertility are found under Agar (scanty emission) & Hamam ( Varicocele ).Stillingia is found not to cover impotence and sterility.


Medicines mentioned in Synoptic Key are for female sterility only.

Those medicines under the rubric Impotence in Berkeley squire’s Repertory could be taken as medicines for sterility because, Male sterility is cross referred to this rubric and more over separate rubrics erection absent and incomplete is found in the male chapter with a different group of medicines.

From the list, Syc.co can be avoided as no Materia Medica gives the symptom sterility for Syc.co. It is indicated in Impotency. Bac.No.7 is also half correct as the symptom found under it is `loss of sexual function’ and `premature senility’ ( under genitalia )


Those medicines mentioned by Dr.K.N.Mathur (Diabetes Mellitus its Diagnosis & Treatment ) are mainly for infertility in female. The doubtful ones are Aur.m & Con in which sterility is mentioned under the heading `clinical’. The term male sterility was not found under the medicines Medorrhinum and Thyrioidinum.

RUBRIC : MALE INFERTILITY

Agn, ARG.M, Bac.7, Bufo, Chin.s, COBALT.NITR, Con , Dam , FERR, Iod, Lepr, Nat.m, Phos , RAUW.SERP, Sel, Strych, SULFA , X-RAY.


Agar, Aur, Aur.m, Ham ,Lapp, Mill, Nat.p, Sabal, Still, Thyr

( Bers.l, Cissu.c, Cortico, Erios.co, Grew.oc, Gunn.p, Lac.d, Pyren.sc, Rub.c, Sol.so, Trium.r, vern.co. )


Azoospermia :

COBALT. NITR, Chin.s, Con, Dam, Iod, Strych.

Oligospermia :

Lepr., Sulfa.

MANAGEMENT - GENERAL Avoidance of tight undergarments. Avoidance of working in high temperatures. Avoidance sitting long in warm rooms. Avoidance of smoking or tobacco in any form. Avoidance of Alcohol. Stoppage of narcotic habit if any. Avoidance of the intake of cytotoxic drugs. Control of the occupational exposure to toxic substances Avoidance of Nutritional supplements which have an adverse

effect on spermatogenesis.

Cases – Male Infertility

1. Azoospermia

1.Azoospermia

2.Aesthenospermia

3.Oligo-aesthenospermia

4.Oligospermia

6.Severe Oligospermia

9.Aesthenospermia

Female Infertility

Causes

Ovarian Factors Tubal factors Peritoneal factors Uterine factors Cervical factors Vaginal factors

Ovarian factors

An-ovulation Infrequent ovulation Corpus luteum insufficiency Lutinisation of un-ruptured follicle

Anovulation or Infrequent ovulation

Hypothalamic or cortical factors Drugs : reserpine Stress

Pituitary Tumor, Vascular disturbance

Gonadal factors Dysgenesis, premature ovarian failure, PCO,

Resistant ovarian syndrome Others

Thyroid dysfunction, Substantial weight loss, DM, Adrenal hyperfunction, Endometriosis

PCO

Syndrome with Oligoovulation or anovulation, Excess androgen activity, Polycystic ovaries.

Symptoms

Oligomenorrhea, amenorrhea Hirsutism Hair loss appearing as thinning hair

on the top of the head Acne, oily skin, seborrhea. Obesity Depression

Review

Infertiity Definition Incidence

Male infertility Causes Semen Analysis Sperm anomalies

Female Infertility Causes PCO

Thank you…………………

for your patient listening……

homoeopathic management of infertility

Documents

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low fsh

normal cells

effects of varicocele

varicocele infections

lh low testes biopsy

general male population

primary infertility