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Article: Nutritional Pharmacology Aspect in the Treatment of Male Infertility - by Abdulrahim Abu -Jayyab |
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Diagnosis of male infertility: 1-Fertility History The patients will provide the physician with a detailed history of any medical or sexual factors that might affect fertility. The history should include the following: Frequency and timing of sexual intercourse. Duration of infertility and any previous fertility events. Childhood illnesses and any problems in development. Any serious illness (diabetes, respiratory infections, cancer, previous surgeries). Sexual history, including any sexually transmitted diseases. Any exposure to toxins, such as chemicals or radiation). History of any medications and allergies. Any family history of reproductive problems. 2-Physical Exam A fertility specialist, usually a urologist, will perform a physical examination. A physical examination of the scrotum, including the testes, is essential for any male fertility work-up. It is useful for detecting large varicoceles, undescended testes, absence of vas deferens, cysts, or other physical abnormalities. • Varicoceles large enough to be associated with infertility can be felt during examination of the scrotum. In such cases, they are described as feeling like "a bag of worms." They disappear or are very reduced when the patient lies down, so the patient should be examined for varicocele while standing. • Checking the size of the testicles is helpful. Smaller-sized and softer testicles along with tests that show low sperm count are strongly associated with problems in sperm formation. Normal testicles accompanied by a low-sperm count, however, suggest possible obstruction. The physician may also take the temperature of the scrotum with a test called scrotal thermography. • The physician will also check the prostate gland for abnormalities. • The penis is checked for warts, discharge from the urinary tract, and hypospadias (incorrect location of the urethra opening). 3-Post-Ejaculatory Urine Sample • A urine sample to detect sperm after ejaculation may rule out or indicate retrograde ejaculation. It also may be used to test for infections. 4-Semen Analysis • The basic test to evaluate a man's fertility is a semen analysis. The sperm collection test for men who can produce semen involves the following procedures: • A man should abstain from ejaculation for several days before the test because each ejaculation can reduce the number of sperm by as much as a third. (The maximum number of sperm is usually obtained by abstaining for about four days.) • A man collects a sample of his semen in a collection jar during masturbation either at home or at the physician's office. Proper collection procedure is important, since the highest concentration of sperm is contained in the initial portion of the ejaculate. Specially designed condoms may be available that will enable collection of a sample during sexual intercourse. (Regular condoms are not useful, since they often contain substances that kill sperm.) • The sample should be kept at body temperature and delivered promptly, because if the sperm are not analyzed within two hours or kept reasonably warm, a large proportion may die or lose motility. • A semen analysis should be repeated at least three times over several months. • Both the man and the woman should be present when the physician discusses the results of this analysis so that both partners will understand the implications. The analysis report should contain results of any abnormalities in sperm count, motility, and morphology as well as any problem in the semen. Sperm Count. A low sperm count should not be viewed as a definitive diagnosis of infertility but rather as one indicator of a fertility problem. Counts of less than 20 million per milliliter are currently considered strong indicators of infertility, although pregnancy is sometimes possible even with lower counts if the woman is fertile. If there are no sperm cells at all in the semen, the physician checks for obstruction in the tubes or for Sertoli cell-only syndrome, in which there are no sperm-producing cells in the testes. Sperm Motility. At least half of total sperm count and no less than 10 million/mL of the sperm should be motile for normal fertility. Motility (the speed and quality of movement) is graded on a 1 to 4 ranking system. For fertility, motility should be greater than 2. • Grade 1 sperm wriggle sluggishly and make little forward progress. (Sperm that, in fact, clump together may indicate that antibodies to the sperm are present.) • Grade 2 sperm move forward, but they are either very slow or do not move in a straight line. • Grade 3 sperm move in a straight line at a reasonable speed and can home on an egg accurately. • Grade 4 sperm are as accurate as Grade 3 sperm, but move at terrific speed. Testing for sperm motility is particularly valuable for predicting the success of artificial insemination and which men might be candidates for the intracytoplasmic sperm injection ICSI fertilization technique, in which the sperm is inserted directly into the egg and motility plays almost no role. Sperm Morphology. Morphology is the structure of the sperm. About 60% of the sperm should be normal in size and shape for adequate fertility. Determining the morphology of the sperm is particularly important for the success of the fertility treatments in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). Seminal Fluid. The seminal fluid (semen) itself is analyzed for abnormalities. The color is checked and should be gray colored. The amount of semen is important. Most men ejaculate 2.5 to 5 cc (1/2 to 1 teaspoon) of semen: • Amounts greater than 1 cc but lower than 2.5 cc may indicate prostate problems or frequent intercourse. • A semen sample that is less than 1 cc could indicate a blockage of the ejaculatory ducts or other tubular abnormalities. • No ejaculate at all may signal retrograde ejaculation. • High amounts of ejaculate may, in some cases, also contribute to infertility. The semen will be tested for how liquid it is. (Normal semen is liquefied within 20 minutes after adding certain enzymes.) Abnormal results suggest the following: • Overly sticky fluid suggests problems in the prostate gland (which adds fluid to sperm). • Overly watery fluid suggests lack of sperm. The amount of sugar (fructose) in sperm will be measured. • Since fructose is added to the semen in the epididymis, an absence of fructose indicates that an obstruction has occurred either in the vas deferens or the epididymis. • Conversely, if there is fructose in the semen but no sperm, then the channel from the epididymis is open but there is a defect in sperm production. Other factors may also be measured in semen. • White blood cell counts are taken to detect infection. • Low levels of inhibin B, which appears to be produced only in the testes, may indicate blockage or abnormalities in the seminiferous tubules. • Low levels of another compound, alpha-glucosidase, may also indicate blockage in the epididymis. The normal results of semen analysis: • volume of ejaculate • 2.0 ml or more • pH • 7.2-8.0 • sperm concentration • 20 million per ml spermatozoa or more • total sperm count • 40 million per ml spermatozoa per ejaculate or more • motility • 50% or more with forward progression • morphology • 30% or more with normal forms • vitality • 75% or more live,i.e.,excluding dye • white blood cells • fewer than 1 million per ml Semen Analysis - What terms might the doctor use ? • normozoospermia • normal results as shown above • oligozoospermia • sperm concentration fewer than 20 million per ml • asthenozoospermia • fewer than 50% spermatozoa with forward progression • teratozoospermia • fewer than 30% spermatozoa with normal morphology • oligoasthenoteratozoospermia • signifies disturbance of all three variables above • azoospermia • no spermatozoa in the ejaculate • aspermia • no ejaculate • polyzoospermia • Over production (more than 350 million/ml)of spermatozoa is also adviation in spermiogram ,although its contribution to infertility is not known. 5-Hormone Tests Tests for hormonal levels are indicated if semen analysis is abnormal (especially if sperm concentration is less than 10 million per milliliter) or there are other indications of hormonal disorders. • Blood tests for testosterone and follicle-stimulating hormone (FSH) levels are usually taken first. • If testosterone levels are low, then luteinizing hormone (LH) and prolactin levels are measured. The balance of these four hormones can help determine specific problems are present. Very high FSH levels, for example, with normal levels of other hormones indicate abnormalities in initial sperm production. Usually this occurs only if the testicles are severely defective, causing Sertoli cell-only syndrome in which sperm-manufacturing cells are absent. 6-Postcoital Test The postcoital test, also known as the cervical mucus penetration test, is designed to evaluate the effect of a woman's cervical mucus on a man's sperm. Typically, a woman is asked to come into the physician's office within two to 24 hours after intercourse at mid-cycle (when ovulation should occur). A small sample of her cervical mucus is examined under a microscope. If the physician observes no surviving sperm or no sperm at all, the cervical mucus should then be cultured for the presence of infection. The test cannot evaluate sperm movement from the cervix into the fallopian tubes or the sperm's ability to fertilize an egg. 7-Sperm Antibodies If a man has had a vasectomy reversed and still cannot conceive or if semen analysis shows sperm clumping together, blood tests for anti-sperm antibodies will be conducted. Anti-sperm antibodies may also develop after genital infection or injury to the testes. The primary negative effect of these antibodies is to bind the sperm to the woman's cervical mucus, preventing the sperm from swimming further up 8-Testicle Biopsy Occasionally, a testicle biopsy may be performed, particularly for the following: • If Sertoli cell-only syndrome is suspected, in which sperm-producing cells in the testes are absent. It should be noted that specific cellular patterns can determine whether this condition is congenital (in-born) or caused by some later injury. This distinction is important in predicting the potential success of later sperm retrieval procedures. • For detecting obstruction in the transport system when sperm production looks normal but the count is low. The standard biopsy procedure requires incisions (called an open approach) under anesthesia. It can be painful afterward. More than one biopsy may be needed in the case of suspected Sertoli cell-only syndrome, since one area may not have cell-producing cells, but other regions may contain normal sperm. Biopsies of both testes are more accurate than one. (Physicians must be careful not to avoid the epididymis during a biopsy, since it is a continuous tiny tube and would be destroyed.) The use of needle aspiration, which is less invasive than standard biopsies, is proving to be as effective in evaluating infertility as the open approach and is able to retrieve sperm. Patients may consider freezing any sperm retrieved during biopsy for later use in assisted reproductive technologies. 9-Ultrasound Ultrasound imaging may be used to accurately determine the size of the testes or to detect cysts, tumors, abnormal blood flow, or varicoceles that are too small for physical detection (although such small veins may have little effect on fertility). It also can detect testicular cancer, which some experts believe make it worthwhile as a routine procedure for any male infertility work-up. 10-Fertilization Tests In men who wish to undergo fertility treatments, certain tests will help determine the right strategies. The Hamster Test. The hamster test, or micro-penetration assay test, uses the sperm sample to fertilize hamster eggs that have had their covering removed to allow penetration. If less than 5% to 20% of the eggs are fertilized, infertility is diagnosed. It may be useful for determining the best assisted reproductive treatment options for men with infertility. The Human Zona Penetration Test. A newer procedure, the human zona penetration test, uses sperm to fertilize dead human eggs, which are usually obtained from an ovary that was removed for medical purposes. (Like the hamster test, the procedure cannot result in a living embryo.) Researchers hope it will provide the same information as the hamster test and also indicate whether the sperm can penetrate the outer coating of an egg. V- GENERAL GUIDELINES FOR TREATING MALE Many men diagnosed as sterile in past years would be considered treatable now, even some men with spinal cord injuries. Unless a man produces no sperm at all, recent developments in treatment have made fertility possible for many men willing to undergo treatment and bear the expense. Before undergoing more advanced procedures, some simple lifestyle changes should be attempted. Nutritional Pharmacology 1- Timing Sexual Activity for Best Results Both male and female hormone levels fluctuate according to the time of day and they also vary from day to day and month to month. Some timing tips might be helpful. Male Hormone Levels and Sexual Activity. Male hormone levels are highest in the morning. (Sexual interest also tends to be higher in the morning.) In one study of men, their sexual activity was highest in October, when conception rates were also high. Fertility and Seasonal Changes. Different studies have reported higher sperm counts in the winter than in the summer. For women, fertility rates as measured by treatment success are highest in months when days are longest. Female Menstrual Cycle and Peak Fertility Times. A woman's sexual peak is usually around the second week of her menstrual cycle. (A menstrual cycle is counted starting from the first day of a woman's period.) This sexual peak coincides with ovulation. Studies indicate conception is most likely when intercourse occurs during the two days before or on the day of ovulation. (A woman can use a special thermometer to measure her body, or basal, temperature, which also surges at ovulation.) Frequency of Intercourse. The question of how often a couple should have intercourse is in debate. Some experts say that having sex more than two days a week adds no benefits. And, in fact, frequent sexual activity lowers sperm count per ejaculation. Some studies have indicated, however, that having intercourse every day or even several times a day, before and during ovulation improves pregnancy rates. Although sperm count per ejaculation is low, a constantly replenished semen supply is more likely to result in a fertilized egg. 2-Other Lifestyle Changes A man who wants to increase his sperm count should also improve his lifestyle: • Avoid cigarettes and any drugs that may affect sperm count or reduce sexual function. • Eat healthy foods low in fat and rich in whole grains, fruits, and vegetables. Be sure the diet has sufficient minerals (zinc and selenium). • One study suggested that fish oil supplements might have some benefits on sperm. Such supplements contain fatty acids that are found in certain oily fish (eg, salmon, tuna, mackerel, sardines). Choosing fish in any case is always a healthy choice. • Overweight men should try to reduce their weight. • Get sufficient rest, and exercise moderately but regularly. (Those who exercise excessively might cut back, but not stop altogether.) • Stress may contribute to reduced sperm quality. It is not known if stress reduction techniques can improve fertility but they may help couples endure the difficult processes involved in fertility. • Although studies now indicate that tight underwear and pants pose no threat to fertility, there is no harm in wearing looser clothing. • To prevent overheating of the testes men should avoid hot baths, showers, and steam rooms. • Because oxidant particles may play a harmful role in infertility, some research has focused on antioxidant supplements. They include vitamins C and E, glutathione, selenium, and coenzyme Q10. Vitamin C may help the body absorb trace elements of zinc, copper, magnesium, potassium, and calcium, which improve the vitality and longevity of the sperm. • In one study, vitamin E improved fertility in men who had normal sperm count but evidence of excess free-oxygen radicals. (One 1999 study reported, however, that taking high doses of vitamin C, E, or a combination of the two had no effect on fertility in men with defective sperm.) 3. Naturopathic Treatment: Positively impact male reproductive health. 1- Nutrition The importance of a healthy diet cannot be overstated. To function properly, the reproductive system requires the proper vitamins and minerals. Nutritional deficiencies can impair hormone function, inhibit sperm production, and contribute to the production of abnormal sperm. • Eat a natural foods diet that focuses on fresh vegetables, fruits, whole grains, fish, poultry, legumes, nuts, and seeds. • Drink ½ of body weight in ounces of water daily (e.g., a 150 lb man would drink 75 oz of water). • Eliminate processed and refined foods (e.g., white flour), junk food, sugars, alcohol, and caffeine. • Avoid saturated fats and hydrogenated oils (e.g., margarine); use olive oil. • Pumpkin seeds are naturally high in zinc and essential fatty acids which are vital to healthy functioning of the male reproductive system. Eat ¼ to ½ cup a day of pumpkin seeds to help maintain a healthy reproductive system. 2-Supplements The following supplements may increase sperm count and/or motility. Allow 3-4 months for the supplements to work. -Arginine—Take 4 gr daily. Needed to produce sperm. If the sperm count is below 10 million per ml, arginine probably will not provide any benefit. The amino acid, arginine, has several roles in the body, such as assisting in wound healing, helping remove excess ammonia from the body, stimulating immune function, and promoting secretion of several hormones, including glucagon, insulin, and growth hormone. The effect of arginine on growth hormone levels1 has interested body builders. In a controlled trial, when arginine and ornithine (500 mg of each, twice per day, five times per week) were combined with weight training, a greater decrease in body fat was obtained after only five weeks, than when the same exercise was combined with a placebo. In another study, however, 5 grams of arginine powder, taken orally 30 minutes prior to exercise, failed to affect growth hormone release and may have even impaired the release of growth hormone in younger adults. Arginine is also needed to increase protein synthesis, which can in turn increase cellular replication. Therefore, arginine may help people with inadequate numbers of certain cells. For example, some, though not all, studies have found that men with low sperm counts experienced an increase in the number of sperm when they supplemented with arginine. Arginine’s effect on increasing protein synthesis improves wound healing. This effect has been shown in both animals and people (at 17 grams per day). Arginine is also a precursor to nitric oxide, which the body uses to keep blood vessels dilated, allowing the heart to receive adequate oxygen. Researchers have begun to use arginine in people with angina and congestive heart failure. Nitric oxide metabolism is also altered in people with interstitial cystitis, a condition of the bladder. Preliminary research found that supplementation with 1.5 grams of arginine per day for six months led to a significant decrease in most symptoms, including pain, though short-term supplementation (five weeks) has not been effective, even at higher (3–10 grams per day) intakes, a double-blind study using 1.5 grams of arginine for three months in a group of women with interstitial cystitis, reported considerable improvement compared with the effect of a placebo in a variety of indices. Perhaps due to the small size of the study, some of these changes did not quite reach statistical significance. Preliminary evidence suggests that arginine may help regulate cholesterol levels. Arginine also appears to act as a natural blood thinner by reducing platelet aggregation. -Coenzyme Q10—Take 10 mg daily. Increases sperm count and motility. Coenzyme Q10 (CoQ10) is a powerful antioxidant that protects the body from free radicals and helps preserve vitamin E, the major antioxidant of cell membranes and blood cholesterol. CoQ10 is also called ubiquinone, a name that signifies its ubiquitous (widespread) distribution in the human body. CoQ10 is used by the body to transform food into the energy on which the body runs, ATP. CoQ10 supplementation has been investigated as a way to improve physical endurance because of its effect on energy production. However, most research shows that CoQ10 does not improve athletic performance. In other research, investigators reported no differences in CoQ10 in muscles or blood from patients with fibromyalgia compared to healthy people. Synthesis of sperm requires considerable energy. Due to its role in energy production, CoQ10 has been studied in infertile men. Preliminary research reports that supplementation of CoQ7, a related molecule, increased sperm counts in a group of infertile men. Healing of periodontal tissue (the gums of the mouth) may require increased energy production; therefore, researchers have explored the effects of CoQ10 supplementation in people with periodontal disease, which has been linked to CoQ10 deficiency. Double-blind research shows that people with gum disease given CoQ10 achieve better results than those given a placebo. The role of CoQ10 in energy formation also relates to how the body uses carbohydrates. Preliminary research suggests that a close relative of this nutrient lowered blood sugar levels in a group of people with diabetes. People with type 2 diabetes have been found to have significantly lower blood levels of CoQ10 compared with healthy people. • Flaxseed oil—Take 1 tbsp daily. Is a source of essential fatty acids. • L-carnitine—Take 3-4 grams daily. Required for normal sperm function. • Multivitamin-mineral—Buy a high-quality product and take one serving size (differs from brand to brand). • Selenium—Take 200 mcg daily. Improves sperm motility. Selenium activates an antioxidant enzyme called glutathione peroxidase, which may help protect the body from cancer. Yeast-derived forms of selenium have induced “apoptosis” (programmed cell death) in cancer cells in test tubes and in animals. A double-blind trial that included over 1,300 people found those given 200 mcg of yeast-based selenium per day for 4.5 years had a 50% drop in the cancer death rate compared with the placebo group. Another study found that men consuming the most dietary selenium (assessed indirectly by measuring toenail selenium levels) developed 65% fewer cases of advanced prostate cancer than did men with the lowest levels of selenium intake. Selenium is also essential for healthy immune functioning. Selenium supplementation has reduced the incidence of viral hepatitis in selenium-deficient populations, presumably by enhancing immune function. Even in a non-deficient population of elderly people, selenium supplementation has been found to stimulate the activity of white blood cells—primary components of the immune system. Selenium is also needed to activate thyroid hormones. In a double-blind trial, selenium supplementation of infertile men improved the motility of sperm cells and increased the chance of conception. • Vitamin B-12—Take 1000 mcg daily. A B-12 deficiency reduces sperm motility and sperm count. Even if no deficiency exists, B-12 supplementation may help men with a sperm count of less than 20 million per milliliter or a motility rate of less than 50% Vitamin B12 is needed for normal nerve cell activity, DNA replication, and production of the mood-affecting substance SAMe (S-adenosyl-L-methionine). Vitamin B12 acts with folic acid and vitamin B6 to control homocysteine levels. An excess of homocysteine is associated with an increased risk of heart disease, stroke, and potentially other diseases such as osteoporosis and Alzheimer’s disease.Vitamin B12 deficiency causes fatigue. Years ago, a small, double-blind trial reported that even some people who are not deficient in this vitamin had increased energy after vitamin B12 injections, compared with the effect of placebo injections. In recent years, however, the relationship between B12 injections and the energy level of people who are not vitamin B12-deficient has been rarely studied. In a preliminary trial, 2,500–5,000 mcg of vitamin B12, given by injection every two to three days, led to improvement in 50–80% of a group of people with chronic fatigue syndrome (CFS), with most improvement appearing after several weeks of vitamin B12 shots.2 The ability of vitamin B12 injections to help people with CFS remains unproven, however. People with CFS interested in considering a trial of vitamin B12 injections should consult a doctor. Oral or sublingual (administered under the tongue) B12 supplements are unlikely to obtain the same results as injectable B12, because the body’s ability to absorb large amounts is relatively poor. • Vitamin C—Take 500 mg 2 times daily. Is an antioxidant. Vitamin C is a water-soluble vitamin that has a number of biological functions. Acting as an antioxidant, one of vitamin C’s important functions is to protect LDL cholesterol from oxidative damage. (Only when LDL is damaged does cholesterol appear to lead to heart disease, and vitamin C may be one of the most important antioxidant protectors of LDL.)Vitamin C may also protect against heart disease by reducing the stiffness of arteries and the tendency of platelets to clump together.The antioxidant properties of vitamin C are thought to protect smokers, as well as people exposed to secondhand smoke, from the harmful effects of free radicals. A controlled trial demonstrated the ability of 3 grams of vitamin C, taken by non-smokers two hours prior to being exposed to cigarette smoke, to reduce the free radical damage and LDL cholesterol oxidation associated with exposure to cigarette smoke. The smoke-induced decline in total antioxidant defense was also diminished. These beneficial effects were not observed in non-smokers under normal conditions (no free radical exposure). Vitamin C is needed to make collagen, the “glue” that strengthens many parts of the body, such as muscles and blood vessels. Vitamin C also plays important roles in wound healing and as a natural antihistamine. This vitamin also aids in the formation of liver bile and helps to fight viruses and to detoxify alcohol and other substances. Recently, researchers have shown that vitamin C improves nitric oxide activity. Nitric oxide is needed for the dilation of blood vessels, potentially important in lowering blood pressure and preventing spasms of arteries in the heart that might otherwise lead to heart attacks. Vitamin C has reversed dysfunction of cells lining blood vessels.The normalization of the functioning of these cells may be linked to prevention of heart disease. Evidence indicates that vitamin C levels in the eye decrease with age and that supplementing with vitamin C prevents this decrease, possibly leading to a lower risk of developing cataracts. Healthy people have been reported in some, but not all, studies to be more likely to take vitamin C and vitamin E supplements than are people with cataracts. Vitamin C has been reported to reduce activity of the enzyme, aldose reductase, in people. Aldose reductase is the enzyme responsible for accumulation of sorbitol in eyes, nerves, and kidneys of people with diabetes. This accumulation is believed to be responsible for deterioration of these parts of the body associated with diabetes. Therefore, interference with the activity of aldose reductase theoretically helps protect people with diabetes. Vitamin C may help protect the body against accumulation or retention of the toxic mineral, lead. In one preliminary study, people with higher blood levels of vitamin C had much lower risk of having excessive blood levels of lead. In a controlled trial, male smokers with moderate to high levels of lead received supplements of 1,000 mg per day of vitamin C, 200 mg per day of vitamin C, or a placebo. Only those people taking 1,000 mg per day of vitamin C experienced a drop in the blood lead levels, but the reduction in this group was dramatic. • Vitamin E—Take 400 IUs 2 times daily. Is an antioxidant and improves sperms’ ability to impregnate. Vitamin E is an antioxidant that protects cell membranes and other fat-soluble parts of the body, such as LDL cholesterol (the “bad” cholesterol), from damage. Only when LDL is damaged does cholesterol appear to lead to heart disease, and vitamin E is an important antioxidant protector of LDL. Several studies, including two double-blind trials, have reported that 400 to 800 IU of natural vitamin E per day reduces the risk of heart attacks. However, other recent double-blind trials have found either limited benefit, or no benefit at all from supplementation with synthetic vitamin E. One of the negative trials used 400 IU of natural vitamin E —a similar amount and form to previous successful trials. In attempting to make sense of these apparently inconsistent findings, the following is clear: less than 400 IU of synthetic vitamin E, even when taken for years, does not protect against heart disease. Whether 400 to 800 IU of natural vitamin E is, or is not, protective remains unclear. Vitamin E also plays some role in the body’s ability to process glucose. Some, but not all, trials suggest that vitamin E supplementation may eventually prove to be helpful in the prevention and treatment of diabetes. In the last ten years, the functions of vitamin E in the cell have been further clarified. In addition to its antioxidant functions, vitamin E is now known to act through other mechanisms, including direct effects on inflammation, blood cell regulation, connective tissue growth, and genetic control of cell division. • Zinc—Take 30 mg 2 times daily. Required for a healthy male reproductive system and sperm production. Zinc is a component of more than 300 enzymes needed to repair wounds, maintain fertility in adults and growth in children, synthesize protein, help cells reproduce, preserve vision, boost immunity, and protect against free radicals, among other functions. In double-blind trials, zinc lozenges have reduced the duration of colds in adults, but have been ineffective in children. The ability of zinc to shorten colds may be due to a direct, localized anti-viral action in the throat. For the alleviation of cold symptoms, lozenges providing 13–25 mg of zinc, in the form of zinc gluconate, zinc gluconate-glycine, or zinc acetate, are used, typically every two hours while awake, but only for several days. The best effect is obtained when lozenges are used at the first sign of a cold. Lozenges containing zinc gluconate, zinc gluconate-glycine, or zinc acetate have been effective, whereas most other forms of zinc and lozenges flavored with citric acid, tartaric acid, sorbitol, or mannitol, have been ineffective. Trials using forms other than zinc gluconate, zinc gluconate-glycine, or zinc acetate have failed, as have trials that use insufficient amounts of zinc. Therefore, until more is known, people should only use zinc gluconate, zinc gluconate-glycine, or zinc acetate. Zinc reduces the body’s ability to utilize the essential mineral copper. (For healthy people, this interference is circumvented by supplementing with copper, along with zinc.) The ability to interfere with copper makes zinc an important therapeutic tool for people with Wilson’s disease—a genetic condition that causes copper overload. Zinc supplementation in children in developing countries is associated with improvements in stunted growth, increased weight gain in underweight children, and substantial reductions in the rates of diarrhea and pneumonia, the two leading causes of death in these settings. Whether such supplementation would help people in better nourished populations remains unclear. A small, preliminary trial has found zinc sulfate to be effective for contact dermatitis (a skin rash caused by contact with an allergen or irritant). Participants with active skin rashes took approximately 23 mg of zinc (in the form of zinc sulfate) three times daily, for one month. 73% of those taking the zinc sulfate had complete resolution of their skin rashes, while the remaining participants had a 50–75% improvement. Further trials are needed to confirm these preliminary findings, • SAMe :is an important biological agent in the human body, participating in over 40 essential biochemical reactions. SAMe participates in detoxification reactions and in the manufacture of brain chemicals, antioxidants, joint tissue structures, and many other important components. SAMe appears to raise levels of dopamine, an important neurotransmitter in mood regulation, and higher SAMe levels in the brain are associated with successful drug treatment of depression. Oral SAMe has been demonstrated to be an effective treatment for depression in some, though not all, double-blind studies. While it does not seem to be as powerful as full amounts of antidepressant medications or St. John’s wort, its effects are felt more rapidly, often within one week. SAMe possesses anti-inflammatory, pain-relieving, and tissue-healing properties that may help protect the health of joints. Several double-blind studies have shown that SAMe is useful for people with osteoarthritis, reducing pain, stiffness, and swelling better than placebos and equal to drugs such as ibuprofen and naproxen. Intravenous SAMe given to fibromyalgia patients reduced pain and depression in two double-blind studies,but in a short (ten-day) trial no benefit was seen.Oral SAMe was tested in one double-blind study and significant beneficial effects were noticed, such as reduced pain, fatigue, and stiffness, and improved mood. Oral and intravenous treatment with SAMe replenishes important substances in damaged livers and improves the flow of bile. Preliminary research has indicated that SAMe may be helpful in a variety of liver conditions, including cholestasis, Gilbert’s syndrome, alcoholic liver injury, and cirrhosis. In alcoholic cirrhosis, damage to the liver prevents the natural formation of SAMe from the amino acid methionine. In a double-blind trial, people with cirrhosis of the liver due to alcoholism who took SAMe for two years had a 47% lower rate of death or need for liver transplantation, compared with those who received a placebo. However, the improvement did not quite achieve statistical significance. In people with less severe cirrhosis, the results were more impressive and were also statistically significant. Preliminary research also suggests oral SAMe may increase sperm activity in infertile men and may be helpful in the treatment of migraine headaches. One double-blind study found injections of SAMe significantly more helpful than placebo injections for reducing the symptoms of post-concussion syndrome. 3- Herbal Medicine Herbal medicines usually do not have side effects when used appropriately and at suggested doses. Occasionally, an herb at the prescribed dose causes stomach upset or headache. This may reflect the purity of the preparation or added ingredients, such as synthetic binders or fillers. For this reason, it is recommended that only high-quality products be used. As with all medications, more is not better and overdosing can lead to serious illness and death. The following herbs may be used to treat male infertility: • Ginseng (Panax ginseng)—Known as a male tonic (an agent that improves general health) and used to increase testosterone levels and sperm count. Siberian ginseng (Eleutherococcus senticosus) may also be used. • Astragalus (Astragalus membranaceus)—Increases sperm motility. • Sarsaparilla (Smilax spp.)—Known as a male (and female) tonic. • Saw palmetto (Serenoa repens)—Used for overall male reproductive health. 4- Acupuncture In the Gerhard (1992) study the men were treated Monday to Friday for two weeks using the following points: Bl23, Bl28, Du4, then St29, St36, Sp6, Ren3 and Ren2. During the last 4 days Bl67 and Ren2-6 were warmed with moxa. The points were the same for everyone, no explanation was given as to why points were chosen only that they used the principles of TCM. In both of the Siterman (1997 and 2000) studies the men were treated twice a week for five weeks and this constituted one cycle. The first of the Siterman (1997) papers the points used would be no more than 12 of out of the following 22 points: Lu7, Li4, Li11, St30, St36, Sp6, Sp9, Sp10, Ht7, Bl20, Bl23, Bl33, Ki6, Ki7, P6, Lv5, Lv8, Ren1, Ren2, Ren4, Ren6 and Du4. Specific combinations of the above points were selected according to the principles of TCM but again it was not explained as what points might have been used for which category of TCM. In the second paper by Siterman (2000) there was more of an explanation of the points used as they divided up their use into two broad categories. They also went on to repeat a cycle of treatment in a couple of cases. (1) Deficiency of the kidneys, Ki3, Bl23, Ki11 and Bl52. (2) Damp-heat in the genital system, Sp9, Lv5, Li11, St28, Gb41. Points used in both syndromes were Sp6, Ren4, Lu7, Ki6, St30. They also had a list of other points that would be used for less common categories of TCM in regard to male infertility Li4, St36, Sp10, Ht7, Bl20, P6, Ren1, Ren2, Ren6, Du4, Du20, Gb20, Lv3, Ki7, Gb27. There were many different points used in the three studies, over 30 in total.. This emphasises the possible need to understand and differentiate to TCM in order to prescribe the points needed Back Acupuncture Points Abdomen Acupuncture Points Results The results were promising. Gerhard (1992) found that : • Mean total motility before treatment was 42% whereas after acupuncture treatment, it was 48% at week 1, 50% at week 5, 48% at week 12. • Mean total vitality before treatment was 59% and after acupuncture treatment, it was 61% at week 1, 61% at week 5, 60% at week 12. Through looking at motility as the examination criteria they particularly found that acupuncture was most effective in treating : • younger men, where motility increases from 5.3 to 9.0% • non smokers, where motility increased from 5.5 to 8.2% (mean changes in motility pre and post treatment) • varicocele carriers, where motility increased from 4.5 to 8.3% (mean changes in motility pre and post treatment) There was also a positive feedback to the treatment. 24 out of the 30 questionnaires were returned, a high number enjoyed the treatment with effects such as feeling calmer, sleeping better and increased libido. Most of them would go through the experience of acupuncture again. Siterman (1997) in their first study where they were looking generally at the effect of acupuncture on sperm parameters showed the control group with no significant change, whereas the Treated Group • Vitality significantly increased from 52 ± 26.8% to 65.1 ± 21.5%. • Motility significantly increased from ( 17.7 ± 22.4 ) x 106 to ( 37.3 ± 35.4 ) x 106. Mean total functional sperm fraction (TFSF) significantly increased from 20 ± 33.6 to 53.8 ± 53.5. The second Siterman (2000) study where sperm density was looked at they again found no significant change in the control group, whereas in the treated group: • Azoospermia from 0 to ( 1.5 ± 2.4 ) x 106. • History of genital tract inflammation from ( 0.3 ± 0.6 ) x 106 to ( 3.3 ± 3.2 ) x 106. • Further improvement seen after a further two 5 week treatment cycles. One case improved from 1.3 x 106 to 8.8 x 106. REFERENCES References 1-http://www.viahealth.org/disease/urology/infertil.htm 2-http://www.urologychannel.com/maleinfertility/index.shtml 3-http://www.ivf.com/shaban.html 4-http://www.maleinfertilitymd.com/ 5-http://www.wernermd.com/maleinfertility.htm 6-http://www.advancedfertility.com/sperm.htm 7-http://www.malefertility.co.uk/causes.html 8-http://www.urologychannel.com/maleinfertility/index.shtml 9-http://www.geocities.com/a_impotence/male_infertility_add.html 10-http://www.reproductive-health.org/infertility/causes.html\ 11-http://www.male-female-infertility.com/ 12-http://www.ihr.com/infertility/provider/malereproduction.html 13-http://www.ivfrefundplan.com/andrology.cfm 14-http://www.reproductivecareofindiana.com/ 15-http://cornellurology.com/cornell/infertility/ 16-http://www.infertilitytutorials.com/sperm.cfm 17- 1. Ayala C, Steinberger E, Smith DP. (1996). The influence of semen analysis parameters on the fertility potential of infertile couples. J.Androl. Nov; 17(6):718-725. 2. Barrat,C.L.R, John J.C.St. (1998).Diagnostic tools in male infertility. Hum. Reprod. 13.Suppl.1., 51-61. 3. Burr,R.B.,Siegberg,R.,Flaherty,S.P. et al. (1996)The influence of sperm morphology and the number of motile sperm iseminated on the outcome of intrauterine insemination combined with mild ovarian stimulation. Fertil. Steril.,65,127-132. 4. Campana, A, deAgostini,A., Bischof, P., et al. (1995). Evaluation of infertility. Hum.Reprod.Update, 1, 6 .,586-606. 5. Campana,A.,Sakkas,D.,Stalberg,A., et al. (1996)Intrauterine insemination:evaluation of the results according to the woman’s age ,sperm quality,total sperm count per insemination and life table analysis., Hum.Reprod.,11,732-736. 6. Comhaire, F. and Vermeulen, L.(1995). Human semen analysis. Hum. Reprod. Update.,1, 4; 343-362. 7. Eimers,J.M.,Omtzigt,A.M.,Vogelzang,E.T., et al. (1997). Physical complaints and emotional stress related to routine diagnostic procedures of the fertility investigation. J Psychosom Obst Gynaecol, March;18(1):31-33. 8. Haugen,T.B.,Grotmol,T. (1998). Ph of human semen. Int.J.Androl., Apr;21(2):105-108. 9. Jorgensen,N., Auger,J., Giwerema,A.,et al. (1997). Semen analysis performed by different laboratory teams: an intervariation study. Int J Androl. Aug;20(4):201-208. 10. Kunathikom,S.,Worasatit, C., Toongsuwan, S. (1995) Relationship between the direct mixed antiglobulin reaction (MAR) test and spontaneous sperm agglutination in men from infertile couples. J Med Assoc Thai . Feb;78(2):89-93. 11. Nahoum,C.R.D. and Cardozo,D.(1980) Staining for volumetric count of leucocytes in semen and prostate-vesicular fluid. Fertil. Steril.,34 :68 -69. 12. Ombelet,W., Menkveld,R., Kruger,F.T., et al(1995) Sperm morphology assessment :historical review in relation to fertility. Hum. Reprod. Update; 1,6 ,543-557. 13. Ombelet,W.,Bosmans, E.,Janssen M., et al.,(1997).Semen parameters in a fertile versus subfertile population:a need for change in the interpretation of semen testing.Hum.Reprod.,12.5.987-993. 14. Opsahl, M.S.,Dixon, N.G.,Robins,E.R.,(1996).Single vs. multiple semen specimens in screening for male infertility factors.A comparison.J.Reprod.Med.,41(5).,313-315. 15. Rrumbullaku,L.,Comparison of methods for staining spermatozoa. Buletini Shkencave Mjekesore.Tirana.,Accepted in december 1996. 16. Rrumbullaku,L.,Boci,R.,Dedja,A.,Dautaj,K.,Sperm morphology in infertile men with varicocele (1998). 1st Balkan Symposium of Andrology. June 12-14, Alexandroupolis, Greece. (Oral presentation). 17. Seibel,M.M.,Zilberstain, M. (1995). The diagnosis of male infertility by semen quality.The shape of sperm morphology.Hum.Reprod.,10,2,247-252. 18. Siegel,M.S.,(1993) The male infertility investigation and the role of the andrology laboratory. J.Reprod.Med., 38(5).,317-334. 19. Sinisi,A.A.,Di Finizio,B.,Pasquali,D. (1993).Prevalence of antisperm antibodies by SpermMARtest in subjects undergoing a routine sperm analysis for infertility.Int.J.Androl.,16(5).311-314. 20. Sofikitis,N.V., Miyagawa,I.,(1993)Endocrinological ,biophysical,and biochemical parameters of semen collected via masturbation versus intercourse.J.Androl.,14(5).366-373. 21. Tomlinson,M.J., Barrat ,C.L., Cooke,I.D.,(1993) Prospective study of leucocytes and leucocyte subpopulations in semen suggests they are not a cause of male infertility.Fertil.Steril.60(6).1069-1075. 22. Trum,J.W.,Mol,B.W.,Pannekoek,Y.,(1998).Value of detecting leukocytospermia in the diagnosis of genital tract infections in subfertile men.Fertil.Steril.,70(2).,315-319. 23. Wolf,H.,(1998) Methods for the detection of male genital tract inflammation.Andrologia.30.Suppl.1.35-39. 24. World Health Organization (1987)WHO Laboratory Manual for the Examination of Human Semen and Semen-Cervical Mucus Interaction.2nd edn. Cambridge University Press,Cambridge. 25. World Health Organization (1992)WHO Laboratory Manual for the Examination of Human Semen and Semen-Cervical Mucus Interaction.3rd edn. Cambridge University Press,Cambridge. 18-http://www.acimc.com/pages/mi.htm 19-http://www.noah-health.org/english/pregnancy/fertility.html 20-http://www.gloucesteracupuncture.co.uk/maleinfertility.htm 21-http://www.northmemorial.com/HealthEncyclopedia/content/3053.asp 22-http://www.crhivf.com/Treatment/TreatmentPlans.aspx 23-http://www.applesforhealth.com/maleinf1.html 24-http://www.healthology.com/focus_article.asp?f=fertility&c=fert_male 25-http://www.infertilityherbalcure.com/ 26-http://www.stormpages.com/sisterzeus/male_inf.html |
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Abdulrahim Abu -Jayyab, PhD Pharmacology & Therapeutics Department,
Faculty of Pharmacy and Health Sciences Ajman University of Science &
Technology Al- Fujairah Campus P.O.Box 2202, Al-Fujairah U.A.E. Email: jayyab@yahoo.com |
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