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INTRODUCTION
Infertility affects approximately 8-12% of couples worldwide, with male-related factors contributing to nearly half of the cases (Agarwal et al., 2021). A significant number of individuals dealing with infertility opt for Complementary and Alternative Medicine (CAM) as part of their treatment approach. According to a global systematic review and meta-analysis, around 54% of infertile patients make use of CAM therapies, with prevalence varying between 26.3% and 96.1% dependency (Sharifi et al., 2024). In Siddha literature, Oligozoospermia is referred to by several synonymous terms, including Thathu Rogam, Thathu Kuraivu, Vinthu Kuraivu, Vinthu Anu Kuraivu, and Sheena Vinthu (Commission for Scientific and Technical Terminology, 2003).
In the Siddha system of medicine, the Uyir Thathukal (bio-energetic principles) consist of Vatham, Pitham, and Kabam, collectively known as the Tridoshas. Vatham is responsible for initiating and regulating the functions of the seven Udal Kattugal (physical constituents of the body). Sadhaka Pitham plays a key psychosomatic role, particularly influencing the formation of semen and the stimulation of sexual desire. It also supports and harmonizes the activity of the physical constituents. Tarpaka Kabam, which corresponds to Cerebrospinal Fluid (CSF), is believed to contribute significantly to the production of Sukilam (semen). Therefore, the goal of this case study is to address the specific imbalance of these Doshas and work toward restoring optimal seminal health (National Institute of Siddha, 2014). The aim of this case report is to demonstrate the management of male infertility due to oligoasthenospermia through the correction of dosha imbalances and strengthening of Sukila dhatu (reproductive tissue) using Siddha-based personalized herbal-mineral formulations, diet, and lifestyle measures.
CASE PRESENTATION
A 38-year-old male presented with a four-year history of primary infertility to the Siddha outpatient department, Primary Health Centre, Malankinaru, Virudhunagar District, Tamil Nadu, India.
He was a non-smoker and non-alcoholic, married for four years, and had a history of Type 2 Diabetes Mellitus and Hypertension, both well-controlled with Metformin 500 mg twice daily and Telmisartan 40 mg once daily.
Clinical Findings
Vital signs: BP 130/90 mmHg, Pulse 72 bpm, HR 80 bpm, RR 19/min, Temperature 98.6°F
General examination: Well-nourished, no acute distress, normal secondary sexual characteristics
Genital examination: Bilaterally small testes (~12 mL each), non-tender epididymis and vas deferens, no palpable varicocele
Laboratory Investigations
| Parameter | Pre-treatment | Reference range |
|---|---|---|
| Fasting Blood Sugar | 123 mg/dL | 70-110 mg/dL |
| Postprandial Blood Sugar | 154 mg/dL | <180 mg/dL |
| HbA1C | 6.5% | <7% |
Semen Analysis (Pre-treatment)
Volume: 2 mL,
pH: 7.8,
Liquefaction: 39 min,
Sperm count: 18 million/mL,
Motility: 20%,
Normal morphology: 30%,
Fructose test: Positive,
Diagnosis: Oligoasthenospermia.
Therapeutic Intervention
Based on Siddha diagnostic principles, the patient had combined Pitha and Vatha derangement. Treatment was aimed at pacifying these doshas using medicines with Inipu (sweet) and Thuvarpu (astringent) tastes and Thapaveppa Veeriyam properties.
Dietary and Lifestyle Recommendations
Avoid Macrotyloma uniflorum (horse gram), yam, unripe mango, bitter gourd, Sesbania leaves, pond water, and red water (Durairajan, 1993; Mudaliyar, 2003).
Avoid intercourse during daylight or immediately after meals; sunset coitus is discouraged as per Siddha principles (Uthamarayan, 2003).
Follow-up and Outcomes
| En vagai thervu | Result | Interpretation and Dosha affected |
|---|---|---|
| Naadi (Pulse) | Pitha vatham | Heat-induced semen quality deterioration (Pitha) poor motility (Vatha). |
| Neer (Urine) | Pale yellow color Neikuri- Aali pol paravuthal | Indicates Pitha imbalance. |
| Malam (Stool) | Irregular bowel movements, occasional constipation | Coating indicates Ama (toxins), dryness reflects dehydration or Vatha. |
| Naa (Tongue) | Slight white coating, dryness at edges | Coating indicates Ama (toxins), dryness reflects dehydration or Vatha. |
| Niram (Body Complexion) | Slightly dull, lacking brightness | Points toward reduced Ojas (vital energy). |
| Mozhi (Voice) | Low-pitched, lacking clarity, slow speech | Indicates nervous weakness general virility decline. |
| Vizhi (Eyes) | Mild dryness, dark circles, lack of luster | Sleep disturbance, and emotional stress - all impacting reproductive health. |
| Sparisam (Skin) | Dry, cool to touch | Classic sign of Vatha dominance, linked with semen dryness or low volume. |
DISCUSSION
In the current case, based on laboratory findings and clinical evaluation, the diagnosis has been established as Oligoasthenospermia. From the history and clinical symptoms of the patient Oligoasthenospermia is differentiated, where varicocele often presents with scrotal heaviness and a "bag of worms" feel on standing, infections of the reproductive tract are associated with scrotal pain, swelling, fever, and urinary symptoms, while genetic disorders like Klinefelter syndrome typically show features such as small, firm testes, gynecomastia, and reduced secondary sexual characteristics.
Based on the diagnostic principles of the Siddha system as outlined in the table, the patient presents with a combined disturbance of Pitha and Vatha doshas. When Pitham-the energy responsible for transformation-is imbalanced, it can disrupt both spermatogenesis (the fomation of immature sperm from primary spermatocytes) and spermiogenesis (the maturation of sperm cells) (Tables 1 and 2). Asthenozoospermia, or poor sperm motility, is associated with an imbalance in Vatham, the principle responsible for movement and kinetic activity (Agathiyar. n.d.).
To address this imbalance, the treatment approach involves selecting medicines that harmonize the affected doshas (Table 3). Specifically, formulations with sweet (Inipu) and astringent (Thuvarpu) tastes are recommended in this case, as these are known to effectively soothe both Pitha and Vatha energies. The internal medicines prescribed in this case possess Thapaveppa Veeriyam and are intended to correct imbalances in Pitha and Vatha doshas (Shanmughavelu, 2003).
| Sl. No. | Medicine | Dose | Adjuvant | Route | Duration |
|---|---|---|---|---|---|
| 1 | Thaneervitan nei (Government of India, Part I, 1992). | 5 mL bd | - | Oral | 3 months |
| 2 | Venthamarai choornam (Government of India, Part II, 1992). | 1 g | Luke warm water | Oral | 3 months |
| 3 | Amukkara choornam (Government of India, Part I, 1992). | 1 g | Milk | Oral | 3 months |
| 4 | Silasathu parpam (Government of India, Part I, 1992). | 200 mg | Milk | Oral | 3 months |
| 5 | Seeraga thylam (Government of India, Part I, 1992). | 30 mL | - | External (0il bath) | 3 months (weekly twice) |
Thaneervitan Nei and Amukkara Chooranam have also been shown to enhance sperm count and motility from the study Dr. Beneti Kaniz Fatima et al., (Fatima and Sonika, 2021).
Venthamarai Chooranam, as prescribed in this case, has been scientifically demonstrated to exhibit anti-hypertensive activity in renal hypertensive rat models. In traditional medicine, hypertension (referred to as Pitha Athikam) is attributed to an imbalance of the Pitha dosha (Babu et al., 2014). Silasathu Parpam has been shown to significantly improve sperm count and motility, as reported in the study H. Mubarak1 et al., (Mubarak et al., 2016). Asai Thylam is traditionally used for oil baths to manage Pitha Noi (disorders associated with Pitha dosha).
From Tables 4 and 5, after three months of Siddha-based treatment, semen volume increased to 2.5 mL with normal viscosity and faster liquefaction. Sperm count rose from 18 to 52 million/mL, normal morphology improved from 30% to 60%, and motility enhanced significantly. Semen color prognosis shifted from "fair" to "good," reflecting improved seminal quality and fertility potential.
| Seminal Parameters | Pre-treatment | Post-treatment |
|---|---|---|
| Volume | 2 mL | 2.5 mL |
| Viscosity | Normal | Normal |
| Liquefaction | Complete within 39 min | Complete within 30 min |
| Sperm count | 18 Millions/mL | 52 Millions/mL |
| Morphology | Normal | Normal |
| Motility | Actively motile: 20% Non-motile: 80% | Actively motile- 50% Sluggish motile - 35% Non motile - 15% |
| Fructose | Positive | Positive |
| Pus cells | 5-6/HPE | 4-6/HPE |
| Colour prognosis | State | Before Treatment | During Treatment | After Treatment |
|---|---|---|---|---|
| White and butter like | Excellent | |||
| White and curd like | Very Good | |||
| White and milk like | Good | | ||
| White and akin to buttermilk | Fair | | | |
| Akin to the honey in colour and consistency | Average | |||
| Akin to the ghee in colour and weight | Poor | |||
| Akin to the toddy in colour and thickness | Very poor | |||
| Akin to the water | Bad |
This case illustrates the potential effectiveness of a Siddha-based integrative approach in the management of oligoasthenospermia. However, limitations include the absence of a control group and reliance on a single case. Larger clinical studies are required to validate these findings and better understand the mechanisms involved.
CONCLUSION
This case demonstrates the clinical value of a dosha-based therapeutic approach in Siddha medicine for managing oligoasthenospermia. This case underscores the importance of tailoring infertility management based on individual doshic constitution and imbalance, a core principle in AYUSH systems. It supports the integration of personalized dosha-based interventions in primary care settings for effective and holistic male infertility management.