by Alakananda Devi (Alakananda Ma), M.B., B.S. (Lond.)
The man alone without progeny looks like a tree with only one branch... He is a lamp in a picture, a pond dried up. (1)
The dismal picture Charak paints of the infertile male is an image many a man suffering from infertility may have of himself. Approximately 15% of couples are infertile (defined as failure to conceive after a year of unprotected sex) and about half of these cases are due to male infertility(2.3) Sperm counts appear to have declined significantly over the last thirty years. Yet according to a study by Norwich Union healthcare, men perceived fertility as being a female issue, even though in fact as many as 9% of men in the UK may be infertile.
In a previous article we discussed potency and erectile dysfunction. Potency refers to the ability to obtain and sustain an erection and fertility to the ability to ejaculate semen with adequate sperm count, quality and motility. Hence it is possible for a man to be potent but infertile and vice versa, although both potency and fertility are needed for unassisted conception. In this article we will look at issues of fertility and sperm count.
Male infertility can have an array of causes:
- At the level of the brain and hypothalamus
- At the level of the pituitary
- At the level of the testes
- At the level of the epididymis or urethra
Many complex conditions requiring or resulting from major medical or surgical interventions may lead to male infertility. We will confine our discussion to causes that may present to an Ayurvedic practitioner and that may be susceptible to simple lifestyle changes and Ayuvedic therapeutics.
The most common congenital cause of male infertility is Klinefelter Syndrome. This is an XXY chromosomal anomaly affecting one in 500 men. Patients with Klinefelter may be unusually tall, with lack of facial hair, gynaecomastia, learning issues and a shy, gentle personality. Typically the Klinefelter patient presenting as an adult to an Ayurvedic practitioner has already been diagnosed earlier, due to late onset of puberty, and has been treated with androgenic hormones. Although these treatments help male sexual development, men with Klinefelter typically remain infertile due to oligospermia or aoospermia (low or non-existent sperm count). They may be able to father children with advanced technology such as intracytoplasmic sperm injection.
Ayurveda cannot cure Klinefelter because it is a congenital condition. However, those with Klinefelter who have oligospermia rather than azoospermia may be helped by vajikarana herbs to increase libido and sperm count. It is worth noting that Charak recommends goats testes boiled in milk(1), i.e. treatment with exogenous testosterone. Couples with a Klineflter male are often desperate and grasping at straws. It is important to be clear and straightforward regarding what Ayurveda can and cannot do for them. There are vaidyas in India who build their reputations on Klinefelter fertility cures, often involving rasa shastra or mercury containing substances. Due caution should be advised.
Infectious causes of male factor infertility include diseases that lead to testicular atrophy, such as mumps, as well as infections like gonorrhoea that lead to epidydimal blockage. Chlamydia, a common STD, is now understood to be associated with low sperm count.(4) Where an infectious disease such as mumps has atrophied the testes, vajkarana herbs may be of assistance, depending upon how far the atrophy has gone and whether it may still be reversible. Epidydimal blockage may require surgery but may also be susceptible to lekhan (scraping) herbs such as turmeric (of proven effectiveness), yogaraj guggulu and shilajit.(5) Chlamydial infertility typically reverses once the infection is resolved and so could be addressed using anti-infective herbs like turmeric and neem.
Occupational and environmental causes of low sperm count include pesticide exposure, solvent exposure, heavy metals such as lead, mercury and cadmium, and ionizing radiation.(6). Hence agricultural workers, greenhouse staff and industrial workers are at risk for male factor infertility, as well as chemists, house painters and artists. As always in the Ayurvedic approach, it is first important to identify and remove the cause and then only to institute the relevant treatment. Although not all affected industrial, chemical, construction and agricultural personnel may be able to undergo a career change, some may be able to shift to a less toxic version, such as organic instead of industrial agriculture or watercolour instead of oil paint. Others who are locked into such careers may heed advice about protective clothing, use of respirators, better ventilation at the jobsite and showering and changing clothes as soon as they get home, all of which will at least modify their level of exposure. Once potential causative factors are addressed as well as possible, panchakarma should be undertaken to remove toxins from shukra dhatu, followed by rasayana and vajikarana treatments.
Excess heat exposure is another important occupational factor affecting not only bakers, welders, ceramics workers and metal workers but also men with sedentary jobs or hobbies. (7) Being seated for long periods affects scrotal thermoregulation, a factor that is pertinent for office and computer personnel, taxi and truck drivers, bicyclers and internet addicts. Tight clothing and underwear similarly are important in blocking scrotal thermoregulation, while a sedentary job plus tight clothing provides compounding factors.(7). Advise use of loose-fitting cotton or wool clothing and frequent standing or short walks to allow scrotal temperatures to normalize, and offer vajikarana herbs.
Lifestyle and prajnaparadh play an important role in male factor infertility and are readily susceptible to Ayurvedic lifestyle counselling. Cellular phones are a known cause of deficient shukra dhatu (3), so it is extremely important to advise men not to wear their phone or pager on their belt or in a pants pocket. Body mass index is related to male factor infertility, probably because adipocytes secrete oestrogen. A body mass index of 26 and above has been found to carry a higher incidence of male infertility. (8). Smoking cigarettes has been shown to lower sperm count, although there is no evidence to implicate cigarette smoking as a sole cause of infertility. It should be considered as a remediable cofactor where there are additional male or female factor causes of subfertility.(9) Similarly, marijuana smoking can lower fertility by reducing sperm motility--a fine example of the long term tamasic and kaphagenic effects of marijuana! (10). Excess alcohol consumption has been established as an independent cause of male infertility.(11). Stress is also a cause of lowered fertility. Given the prevailing male ethos--hard drinking, smoking, heavy eating, cell phone on the belt, tight jeans, it is interesting to note how many things that have become associated with manliness actually have a negative effect on the male's basic instinct of sperm survival. Again, the first step is to remove the lifestyle factor that is causing or contributing to infertility. If you would like to review Banyan Vine archival articles addressing alcohol, smoking, marijuana and weight issues, click here. After addressing the cause, panchakarma should be done to remove residual toxins, followed by rasayana and vajikarana therapies.
Herbs traditionally used for vajikarana and shukrak purposes(1) include kapi kacchu, which has been found to increase sperm concentration and motility, (12), Gokshura, which raises testosterone levels (13), Ashwagandha, which enhances spermatogenesis via a presumed testosterone-like effect (14), Shatavari, which appears to enhance fertility by reducing oxidative stress (15), licorice, found to improve semen quality (16), pippali and Vidari. These should be given with milk as anupan or combined with a vajikarana diet that includes urad dal, milk, basmati rice, wheat, ghee, honey and for non vegetarians, chicken soup and fish. Mens Support provides a god combination of vajikarana herbs. Thus by addressing simple lifestyle factors and providing vajikrana remedies offered in the Ayurvedic texts,the Ayurvedic opractitioner can help male clients optimize their fertility. An thus increase wellbeing.
"Pleasure, strength, happiness...and contentment depend on progeny" (1)
- Charak Samhita, tr PV Sharma, Chaukkhambha Orientalia, Chikitsasthanam Ch 2.
- Fábio Firmbach Pasqualotto; Antônio Marmo Lucon; Bernardo Passos Sobreiro; Rev. Hosp. Clin. vol.59 no.6 São Paulo 2004Effects of medical therapy, alcohol, smoking, and endocrine disruptors on male infertility
- EVALUATION OF THE EFFECT OF USING MOBILE PHONES ON MALE FERTILITYArtur Wdowiak1, Leszek Wdowiak2, 3, Henryk Wiktor1 Ann Agric Environ Med 2007, 14, 169-172
- Chlamydia trachomatis infection in male partners of infertile couples: incidence and sperm function. Andrologia. 34(3):155-161, June 2002. Vigil, P. 1; Morales, P. 2; Tapia, A. 1; Riquelme, R. 1; Salgado, A. M
- The anti-inflammatory compound curcumin inhibits Neisseria gonorrhoeae-induced NF-[kappa]B signaling, release of pro- inflammatory cytokines/chemokines and attenuates adhesion in late infection. CELL BIOLOGY AND SIGNALING Biological Chemistry. 386(5):481-490, May 2005.Wessler, Silja 1,a; Muenzner, Petra 2,a; Meyer, Thomas F. 3; Naumann, Michael 4,*
- Human Reproduction, Vol. 16, No. 8, 1768-1776, August 200 Contribution of environmental factors to the risk of male infertility Alejandro Oliva1, Alfred Spira2 and Luc Multigner2,3
- Richard M Sharpe Lifestyle and environmental contribution to male infertility British Medical Bulletin 56:630-642 (2000)
- BMI AND INFERTILITY Sallmen, M. Epidemiology, September 2006; vol 17: pp 520-523. Markku Sallmen, PhD
- Semen quality of male smokers and nonsmokers in infertile couples References and further reading may be available for this article. To view references and further reading you must purchase this article. Robert Künzle M.D.a, Michael D. Mueller M.D.a, Willy Hänggi M.D.a, Martin Fertility and Sterility, Volume 79, Issue 2, Pages 287-291
- Effects of delta-9-tetrahydrocannabinol, the primary psychoactive cannabinoid in marijuana, on human sperm function in vitro Lynne B. Whan Ph.D.a, Mhairi C.L. West Ph.D.a, Neil McClure M.R.C.O.G Human Reproduction, Vol. 16, No. 8, 1768-1776, August 2006
- Ethanol-induced male infertility: impairment of spermatozoa RA Anderson , BR Willis, C Oswald and LJ Zaneveld Volume 225, Issue 2, pp. 479-486, 05/01/1983 Pharmacology and Experimental Therapeutics
- Effect of Mucuna pruriens on semen profile and biochemical parameters in seminal plasma of infertile men Fertil Steril Volume 90, Issue 3, Pages 627-635 (September 2008)Top of FormMohammaKaleem Ahmad, M.Sc.a, Abbas Ali Mahdi, M.A.M.S., Ph.D
- P. G. Adaikan a; K. Gauthaman a; R. N. V. Prasad History of herbal medicines with an insight on the pharmacological properties of Tribulus terrestris a The Aging Male, Volume 4, Issue 3 September 2001 , pages 163 - 16
- The effect of aqueous extracts of Cynomorium coccineum and Withania somnifera on testicular development in immature Wistar rats References and further reading may be available for this article. To view references and further reading you must purchase this article. E. M. Abdel-Magied, H. A. Abdel-Rahman and F. M. Harraz J Ethnopharmacol Volume 75, Issue 1, April 2001, Pages 1-4
- Pharmaceutical Biology May 2009, Vol. 47, No. 5, Pages 390-395 Effect of Asparagus racemosus on sexual dysfunction in hyperglycemic male rats Mayank Thakur, Shilpi Bhargava, V.K. Dixi
- Effect of Licorice Extract on Semen Quality and Libido in Awassi RamsAzhr Al -Haboby 1, A. H. A. H. Hamra 2 and A. K. Mabdi 3 www.aaaid.org/pdf/magazine
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Alakananda Devi (Alakananda Ma) is director of Alandi Ayurvedic Clinic in Boulder, Colorado, and principal teacher of Alandi School of Ayurveda, a traditional ayurvedic school and apprenticeship program. She can be reached at 303-786-7437 or by email at: firstname.lastname@example.org.