Male Fertility

Two main functions of the paternal factor, that is, a male partner for the process of fertilization, are the production of healthy sperm & Deposition of sperm in the female genital tract through coitus. Defects in either of these functions may lead to male infertility.

Ayurveda explains two pathological conditions, namely Shukrakshaya and Shukradushti.

Shukrakshaya means deficiency of one or more testes functions, testosterone synthesis, and spermatogenesis. It may cause male infertility as well as sexual dysfunction too. The three types are
*  Alpa Retas (mildly low levels of sperm)
*  Kshina Retas (moderately low level of sperm)
* Visushka Retas (low level of sperm)

Shukradushti refers to the vitiation of seminal fluid. Sexual function is not necessarily affected in Shukradushti.
• Defective Spermatogenesis
• Disorders in an efferent duct system
• Flaccid penis leading to non-deposition of sperm high in the vagina
• Errors in seminal fluid.

Causative factors of Shukra Dushti-

The three-fold causative factors for the vitiation of semen are improper diet, unhealthy lifestyle, and psychological factors - Excess coitus, stress, anxiety, excess intake of dry food items, bitter, salty, spicy food, caffeine, alcohol, and tobacco.

Treatment Approach

Samanya Chikitsa includes Snehana (Oleation), Swedana (Fomentation), and Uttarabasti (Trans-urethral enema)

Medicated enema is administered through the urethral route in men. Uttarabasti is a Panchakarma performs detoxification, strength promoting, and Dosha pacification actions and possess superior qualities by the herbs used in treatment. As Basti is the best treatment to pacify Vata Dosha, Uttara Basti normalizes the functions of Vata Dosha, mainly Apana Vata, the vitiation of which causes infertility issues. The detoxifying action of Uttarabasti
in the genital passages helps to restore normal sexual functions. Also, inflammation, irritation, and discomfort will be reduced. The oil or ghee used in treatment has nutritive functions and will improve blood circulation and nerve conduction and nourish the genital organs.

Medicated oils used for Uttarabasti-

Different medicated oils or ghee are used for other purposes. In erectile dysfunction, Ashwagandha oil is beneficial, whereas, in premature ejaculation, Ashwagandha ghrita is useful. Kshirabala oil is good for Azoospermia, whereas Mahamasha oil is helpful in Oligospermia. Pippalyadi oil is helpful in Asthenospermia.

Method of Administration

To cleanse the alimentary tract, Niruha Basti (Cleansing enema) is administered first using Triphala Decoction before the Uttarabasti procedure. Following local massage and steam over the low back region, abdomen, and groin, Uttarabasti is administered. About 20 to 30 ml of lukewarm medicated oil or ghee is taken in the Uttarabasti syringe, and the nozzle is greased with oil. The nozzle is carefully introduced into the urethra by holding the penis erect, and the medicine is injected slowly and steadily (uniformly). The patient is made to rest for 30 minutes. This procedure is done for six days every month, every day, or every alternate day for up to 3 to 6 months.

1) Visesha Chikitsa includes the administration of specific Vajikarana herbs according to the type of vitiation of sperm.

Vajikarana is one of the eight branches of Ayurveda which helps to enhance the status of Shukra Dhatu, improve sexual health and male fertility. Vaji means Stallion. As stallion cohabits, uninterruptedly and for a long duration, and also produces abundant sperm, it is used to denote sexual potency, hence the term Vajikarana (Ref Sloka 2). Herbs used in Vajikarana therapy are known as Vrishya Dravyas. These herbs improve sexual vigor and promote sperm quantity and quality.

Classification of Vajikarana Dravyas

Vajikarana dravyas are broadly classified into three types -

1. Shukrajanaka or Shukravrddhikara
2. Shukrapravartaka or Shukra srutikara
3. Shukrajanaka pravartaka or Shukra srutivrddhikara

1. Shukra Vriddhikara Dravyas: They nourish the tissues in a sequential pattern right from Rasa Dhatu to the Shukra Dhatu thus initiates or increases semen. Herbs possess properties similar to sperm and enhance sperm production qualitatively and quantitatively come under this category. These herbs enhance spermatogenesis, androgen synthesis, or both. Example are Mamsa (meat), Ghrita (ghee), Shatavari (Asparagus racemosus), Sarkara (jaggery), and Musali (Chlorophytum borivilianum).

i. Sadhya Shukra Vriddhikara: These herbs possess the specific action of enhancing the transformation of the nutrient portion of food into tissues bypassing the normal metabolic process, thereby increasing the production of sperm in a short period. Milk and Sugarcane juice possess this property.
ii. Kramasha Shukra Vriddhikara: These herbs increase sperm production after passing through the normal metabolic process; hence the effect is gradual as Shukra dhatu being the last among the seven tissues, the more significant time-period is required for its production by these herbs.

2. Shukra Srutikara: These herbs have hot and penetrating properties which initiate the ejaculation of semen. The effect of these herbs is at the psychic level as they stimulate the sex center of the brain leading to the excitation of sexual organs and the discharge of sperm. These herbs either improve ejaculation or improve the action of androgens. Herbs like Akarkarabha (Anacyclus pyrethrum), Kasturi (musk), Gunja (Abrusprecatorius), etc. possess this property.

3. Shukra Sruti Vriddhikara: Herbs having both qualities (Spermatogenesis and ejaculation) come under this category. Some diet articles and herbs have properties such as Kshira (Milk), Ashwagandha (Withania somnifera), Bhallataka (Semicarpus Anacardium), Kapikacchu (Mucuna pruriens), Ghrta (Ghee), Godhuma (Wheat), Masha (black gram) and Shatavari (Asparagus racemosus).

Based on this, Shukra Vriddhikara Dravyas drugs are helpful in improving semen quality, and Shukra Srutikara drugs are beneficial for the treatment of sexual dysfunctions. In contrast, Shukra Sruti Vriddhikara drugs are helpful in both of these conditions and in cases where both of these dysfunctions exist together.

Acharya Sharangadhara included Shukra Stambhaka and Shukra Shoshaka in the Vajikarana Dravya classification.

4. Shukra Stambhaka: Herbs that help in promotes the retention power of a male partner during the sexual act. e.g., Jatiphala (Myristica fragrans), Ahiphena (Papaver somniferum)
5. Shukra Shoshaka: The herbs which dry up the semen come under this category. E.g. Haritaki (Terminalia chebula).

In general, Vajikarana therapy can be broadly classified into two groups on the basis of its pharmacological action.
1. Those acting at the Psychic level
2. Those acting at the Somatic level

Those acting on a Psychic Level

Acharya Charaka has quoted 'Sankalpa' (Determination) and 'Stri' (Female) as the best aphrodisiac. These two agents stimulate the mind and act at the psychic level. Proper mental excitement is necessary for a good sexual act. Pleasant music and romantic place also come under this category.

Those acting at the somatic level

The effect of Vajikarana therapy on body may be divided into three groups as follows:
* Dravya Samanya
* Guna Samanya
* Karma Samanya

Dravya Samanya: Acharya Charaka states that diet articles and herbs have the same properties as that of the Dhatu, which increase the particular Dhatu in the body qualitatively and quantitatively. E.g., Eggs, Meat

Guna Samanya: Some herbs have properties similar to that of Shukra Dhatu, such as sweet taste, unctuous and slimy properties, nourishing and strengthening qualities, etc. These are subclassified into herbs and diet. E.g. Milk, ghee, meat, Vidarikanda (Pureria tuberosa), Musli (Chlorophytum borivilianum).

Karma Samanya: The action performed by a person which increases Shukra comes under this category. E.g., Body massage, foot massage, exercise.

Method of Administration of Vajikarana

Depending upon one's body strength, the status of Doshas, Prakriti (Constitution), Agni (Digestive and Metabolic fire), one should administer Panchakarma first to detoxify the body, after which Vajikarana herbs, a suitable diet, and lifestyle are suggested.

Shukra Dushti Chikitsa-

Shukra Shodhana (Purification of semen), will help in the treatment of Shukra Dushti. Panchakarma, mainly Vamana (Therapeutic emesis), Virechana (Therapeutic purgation), Niruha Basti (Decoction enema), Uttarabasti (Urethral enema), will help in the purification of semen. Acharya Susrutha says that 18 Basti will help to eliminate Shukra Doshas.

Vataja Shukra Dushti: Anuvasana Basti (Oil enema) and Vata balancing, strength-promoting herbs such as Ashwagandha and Kaunch are beneficial.

Ayurveda Formulations

* Jivaniya Ghrita, Ashwagandha Ghrita, Shatavari Ghrita, Chyavanaprash, Kaunch Pak, Ashwagandhadi Lehya, Shilajit vati, Chandraprabha vati, Gokshuradi Guggulu, Kapikacchu (Mucuna pruriens)

Herbs for infertility- Shilajit Paste, Safed Musli Capsules, and view more on Men's Health.

Wholesome Diet - Coconut water, milk, ghee, unsalted butter, honey, natural sugar, rice, wheat, black gram, dates, garlic, sesame seeds.

Unwholesome Diet - Excess use of salty, spicy and bitter tastes, trans-fat, caffeine, carbonated drinks, junk food, Tobacco and Narcotic drugs, alcohol and smoking.

By: Dr./ VD Lakshmi