This document provides an overview of the male reproductive system and infertility (Klaibya) from an Ayurvedic perspective. It discusses the Sukra and Sukravaha srotas, defining characteristics and qualities of semen. It describes semen production, transportation of semen through the vas deferens and epididymis, and the role of hormones in spermatogenesis. It then discusses signs and causes of low semen count and infertility. Finally, it provides definitions of key terms like conception from a classical Ayurvedic viewpoint.

1. APPLIED ANATOMY OF SUKRAVAHA SROTHAS-KLAIBYA(MALE INFERTILITY)Done ByUnnikrishnan S

3. The most important among the 7 srothasas as health of the individual can be estimated through the Ojas and Sukra, which spread all over the body.

4. Sukra in one of the 13 non suppressible natural urges.

6. Sukradhatu Purusha are of Srotomayam, Shaturvimshatitatwayuktam, Shatdhatuyuktam, Tridosha & Saptadhatuyuktam, etc. ¨ Out of the very important factor of reproduction is semen i.e.Sukram. ¨ The health of the individual can be estimated through the Ojas and Sukra, which spread all over the body

7. Qualities of Sukra ¨ Susruta defines the semen as – crystalline whitish luster’s, liquid, soft, sweet taste and equal to that of honey smelled. In further it resembles the Oil or Honey consistency (Su.Sh.2/20). ¨ The semen is dominant of “Udaka” with its soft (Sowmya) nature but all the bhutas are interrelated and associated. (Su.Sh.3/1) ¨ At opine of Charaka the semen is “Vishwaroopasya Roopadravyam” with the qualities of thick (Bahalam), sweet, soft, white and much (Bahu). Such semen is strong.

8. º¡òÊ]õEòɦÉÆpù´ÉÆκxÉMvÉÆ ¨ÉvÉÖ®Æú ¨ÉvÉÖMÉÎxvÉSÉ ¶ÉÖGòʨÉSUôÎxiÉEäòÊSÉkÉÖiÉè±ÉIÉÉèpùÊxɦÉÆiÉlÉÉ - ºÉÖ¶ÉÞiÉ ¶ÉÉ®úÒ®ú 2/20 ºÉÉ訪ÉÆ ¶ÉÖGÆò - (ºÉÉ訪ÉÆ ºÉÉä¨ÉMÉÖhɦÉÚʪɹ]õ¨É - b÷±½þhÉ) ºÉÖ¶ÉÞiÉ ¶ÉÉ®úÒ®ú 3/3 SÉ®úiÉÉä Ê´É· É°ü{ɺªÉ °ü{Épù´ªÉÆ ªÉnÖùSªÉiÉä ¤É½þ±ÉÆ ¨ÉvÉÖ®ÆúκxÉMvɨÉÊ´É»ÉÆMÉÖ¯û Ê{ÉÎSUô±É¨É ¶ÉÖC±ÉÆ ¤É½Öþ SÉ ªÉSUÖôGÆò ¤É±É´ÉkÉnùºÉƶɪÉÆ/(SÉ®úEòÊSÉÊEòiºÉ 2/4/49) ¶ÉÖGÆò ¶ÉÖC±ÉÆ MÉÖ¯ûκxÉMvÉÆ ¤É½Öþ±ÉÆ ¤É½Öþ, PÉÞiɨÉÉÊIÉEòiÉè±ÉɦÉÆ ºÉnÂùMɦÉÉÇªÉ – (+¹]õÉÆMÉ ¾þnùªÉ¨É ¶ÉÉ®úÒ®ú 1/18)

9. ShukraUtpatti: • AxjÉlÉÉåqÉ‹ÉiÉiÉ: zÉÑ¢ÇümÉëeÉÉrÉiÉå | cÉ.ÍcÉ.15/15, A.WØûû.zÉÉ. 3/62 • qÉ‹ÉzÉÑ¢ÇüiÉÑeÉÉrÉiÉå || xÉÑ.xÉÔ.14/11 • iÉxqÉÉlqÉ‹ÉxiÉÑrÉ: xlÉåWû: zÉÑ¢ÇüxÉÇeÉÉrÉiÉåiÉiÉ: | cÉ.ÍcÉ.15/31-32

10. Sukra as a Vega ¨ÉäfÅäø ´ÉÞ¹ÉhɪÉÉ䶶ÉÚ±ÉÆ +ÆMɨÉnùÉæ ¾þÊnù´ªÉvÉÉ ¦É´Éäi|ÉÊiɽþiÉä ¶ÉÖGäòÊ´É´ÉqÆù ¨ÉÚjɨÉä´ÉSÉ - - SÉ.ºÉÚ. 7/10 ¶ÉÖGòÉkÉi»É´ÉhÉÆMÉÖÁ´ÉänùxÉÉ º´ÉªÉvÉÖV´ÉÇ®ú: ¾þnÂù´ªÉlÉɨÉÚjÉ ºÉÆMÉÉÆMɦÉÆMÉ ´ÉÞnÂùt¶¨É¹ÉÆb÷iÉÉ: - +.¾þ.ºÉÚ. 4/20 ¶ÉÖGòºªÉ nùÉä¹ÉÉiÉ C±É褪ɨɽþ¹ÉÇhɨÉ - SÉ.ºÉÚ. 28/27 ®úÉäÊMÉhÉÉÆ C±ÉҤɨɱ{ÉɪÉÖÆ Ê´É°ü{ÉÆ ´ÉÉ |ÉVÉɪÉiÉäxÉ´ÉÉ ºÉÆVÉɪÉiÉä MɦÉÇ: {ÉiÉÊiÉ, |ɻɴÉiªÉÊ{É ¶ÉÖGÆòʽþ nÖù¹]Æõ ºÉÉ{ÉiªÉÆ ºÉnùÉ®úÉÆ ¤ÉÉvÉiÉäxÉ®ú¨É - SÉ.ºÉÚ. 28/27

11. Shukravahasrotas: Shukravahasrotomulas are Vrushana and Shepha. Cha.Vi.5 Shukravahasrotomulas are Sthana and Vrushana. Shukravidalakshana it produces Klaibhya, Alpashukrapravritti and Raktashukrata. Su.Sha. 9/12 Srotodhushtikarana: Akalayonigamana,Shukravegadharana, AtyadhikamaithunaShalyakarma, Ksharakarma leads Shukravahasrotodhusti. Cha.Vi.5

12. Shukrakshayalakshana: Vedhana in Vrushana and Shishna, Shukrasrava with Raktamishrita, Dourbalya,Mukhashosha,Kalibhya and Pandu. Cha.Su.17,Su.Su.15,A.H.S.11/20 Shukrakshayakaranalakshana: Chinta, Shoka, Krodha, Bhaya, Irsha, Madaadiatiyoga, The krusha is doing upavasa or alpa, ahitarukshaannapanaaushadhasevana, Adikashareerika and Manasikasrama, VruddhavasthaHrudayasthitaRasadhatuksheena which further leads to Shukradhatukshaya.Cha.Chi.3/181-186

13. Shukravrudhilakshana: Adikaiccha with Stree, Adikashukramatrapravritti and Shukrashamari, AlparaktayuktaShukradarshanam. Su.Su.15/14,A.H.S.11/11 AcharyaCharaka explained Dourbalya, Mukhashosha, Pandutvam, Angashaithilya, Shrama, Klaibhya, Shukraachyuti, Ksheenashukra.Cha.Su.17/69

14. zÉÑ¢ü 8 SÉåwÉ: • TåüÌlÉsÉÇiÉlÉÑ Â¤ÉÇ cÉÌuÉuÉhÉïÇmÉÔÌiÉÌmÉÎcNûsÉqÉç | AlrÉkÉÉiÉÔmÉxÉÇxÉ×¹qÉuÉxÉÉÌS iÉjÉÉŹûqÉqÉç || cÉ.ÍcÉ. 30/139 AshtaShukradoshas are: Phenila Tanu Ruksha Vivarna Puti Picchila Anyadhatusamsrusta and Avasadi

15. Shukradoshajarogas: ♦ Kleebata ♦ Aharshana ♦ Maithunaashakti ♦ Shukrashmari ♦ Shukrameha because of all these, there is no formation of Garbha. Cha.Su.28/, Su.Su.24/9

18. Developmental source of the Male Reproductive System

19. Anatonomical Importance

20. TESTES Primary male sex gland Weighs approx. 30 – 45 gms. Approx. 4.5 cms long and 2.5 cmswide with a mean volume 0f 20 cc. A sac (tunica vaginalis) derived from peritoneum acquired during its descent during fetal development covers it. A thick capsule of collagenous tissue called Tunica Albuginia surrounds each testes under visceral layer of tunica vaginalis. Each testes is composed of about 900 coiled semineferous tubules.

21. Epididymis Located postero-laterally on the testes Has 3 anatomical parts – caput or head, corpus or body and cauda or tail. The tail leads to vas deferens. Human Epididymis is 4 – 5 cms long and connected to testes through epididymal ligaments. The vasal ligament attaches the vas to tail of Epididymis and maintain the acute epididymal-vasal angle.

22. Vas deferens A muscular duct 30 - 35 cms long, enlarges into ampulla immediately before it enters into substance of prostate gland. Seminal vesicle Located on each side and above the prostate gland. Empties into the prostatic end of the ampulla. The contents of both the ampulla and ducts of seminal vesicles join on each side to form the ejaculatory ducts passing through the body of prostate to empty into urethra.

26. Microscopic Anatomy of Testes The cytoplasmic membrane of adjacent Sertoli cells are tightly adherent to prevent penetration from capillaries in the interstitial tissues. These adherent membranes coupled with approximation of myoid cells of peritubular contractile cell layers serves to form tight junctions which constitute the blood – testes barrier. This barrier divides the germinal epithelium into basal and adluminal compartments. This barrier provides a unique microenvironment that facilitates spermatogenesis and maintains the germ cells in an immunologically privileged location.

28. Germ cells

29. Sertoli cells

30. -Interstitium

31. Leydig cells

35. Hormonal ; REGULATION OF H-P-T AXIS

36. SPERM TRANSPORTATION Liquifaction Capacitation Acrosome reaction Cortical reaction

37. Human sperm Mature sperm consists of a head and tail joined by the middle piece. Head is the condensed nucleus, its anterior 2/3rd has a cap known as acrosome. Acrosome contains hyaluronidase capable of digesting proteoglycan filament of tissues and powerful proteolytic enzymes. The tail or Flagellum has a central skeleton with 11 microtubules called axoneme, a very thin cell membrane and collection of mitochondria surrounding the axoneme in the proximal portion. The motility of sperm is achieved through energy supplied by the ATP and takes the form of rhythmic longitudinal sliding motion between the anterior and posterior tubules. A fertile sperm exhibit flagellated motion in a straight line at the rate of 1 – 4 mm/min.

38. Semen Semen is a combination of sperms and fluids from seminal vesicles, prostate and bulbourethral glands. It provides a watery environment in which sperms can swim and supplies nutrients for the sperm cells. Another function is its buffering effect on acidic vaginal environment. 65 % of semen comes from seminal vesicles and rests from prostate and bulbourethral glands (30 %). Sperms constitute 5 % of semen volume. Seminal vesicles – fructose, fibrinogen and prostaglandins. Prostate – calcium and fibrinolysin along with zinc, phospholipids, seminin and phosphatases.

39. Normal values as advocated by American Society for Reproductive Medicine Liquefaction : completed within 60 mins. Appearance : Homogenous, gray-opalescent ejaculate. Volume : 2 ml or more. Consistency : not viscous. Morphology : 30% normal shape Concentration : 20 million per ml. Total count : 40 million per ejaculate. Motility : 50% at one hour. pH : 7.2 WBC : < 1 million per ml.

40. conception “Conception is a complicated process that depends upon many factors: on the production of healthy sperm by the man and healthy eggs by the woman; unblocked fallopian tubes that allow the sperm to reach the egg; the sperm’s ability to fertilize the egg when they meet; the ability of the fertilized egg (embryo) to become implanted in the woman’s uterus; and sufficient embryo quality.”— The American Society ofReproductive Medicine

41. CONT… In summary, arousal, erection, emission, and ejaculation are controlled by a complex interplay between the sympathetic and parasympathetic divisions of the ANS.

43. TESTICULAR

49. Male infertility –other factors 1. Sperm factors a. arrest of primary sperm production i. primary testicular failure ii. secondary testicular failure b. apparent normal production, but subsequent deterioration i. rise in intratesticular temperature – varicocele ii. Inflammatory and infective factors iii. Immunological changes c. partial or complete obstruction in normal passage

50. Male infertility - causes 2. Erectile factors Failure to deliver sperms to the female genital. 3. Environmental factors a. gonadotoxic agents b. occupational hazards c. pollution 4. Societal factors – mainly individual 5. Stress factors

53. Etiologic Factors of Ejaculatory Failure 1.Congenital – Absence of vas or ejaculatory ducts, epispadias, extrophy of bladder 2. Systemic diseases – DM, MS, Bone marrow transplantation. 3. Iatrogenic factors – surgeries like sympathetectomy, retroperitoneal lymph node dissection, prostatectomy, posterior urethroplasty. 4. Drug induced 5. Inflammatory – prostatitis, tuberculosis, STD. 6. Traumatic – injuries to spinal cord and posterior urethra 7. Idiopathic .

55. Haemospermia – Blood present in semen.

56. Leucocytospermia – WBC’s present in semen.

57. Azoospermia – No spematozoa in semen.

60. Globospermia – round headed acrosome- less sperm.

61. Synonyms of impotency ¨ Ayurveda has clearly explained the situation of inactivity of the male in sex act. It has given different words as synonyms to Impotency are - 1.Napumsaka- neither female or male 2. Kleeba- unable do the sex act and produce offspring Ê´ÉOɽþ{ÉÖι]õ xÉè´ÉätxÉι]õ 3. Shanda(both sex) - Hermaphrodite 4. Vandhya (both sex) - non-conceived male or female 5. Triteeyaprakriti- third gender 6. Stapatya - who doesn't have "staman" (strength) 7. Stapathi - who can not achieve Orgasm (Staputa = ups and downs) 8. Kanchuka- male desires to wear ladies garments 9. Varshavara- who develops over-hydrosis by thinking sex act (over sweating) 10. Sama- equal; neither male or female character dominance

62. Classification of Klaibya – (Charaka) ¨ Four fold Impotency (Charaka): Charaka classify Klaibya by origin as – 1. Bejadosha – due to the defective Pumbeeja (semen) 2. Dhwajopaghta – due to the injury to the genital organs 3. Jara – due to the old age 4. Sukrakshaya – due to the deficiency of semen quantity (StulaSukra)

63. Classification of Klaibya – Susruta ¨ Six fold Impotency (Susruta) (Su.Chi.26/7-12) 1. Manasika or psychological – due to the bitter thoughts / recollection or a forced intercourse with a disagreeable women who fails to sufficiently rouse up the sexual desire 2. Aharaja – due to the excessive intake of Katu, Amla, Lavana rasa and Ushnaveeryadravya, which leads to loss of semen 3. Ativyavayaja – due to addiction to excessive sexual pleasure with out using aphrodisiacs 4. Abhighataja – due to chronic disease of the genitalia (syphilis, gonorrhea, AIDS) ordestruction of a local marma by injury 5. Sahaja – (congenital) due to beejadosha of either mother or father 6. Vegavarodhaja – due to voluntary suppression of natural urge – sex desire ¨ ¤ÉÒVÉv´ÉVÉÉä{ÉPÉÉiÉɦªÉÉÆ VÉ®úªÉÉ ¶ÉÖGò ºÉÆIɪÉÉiÉÂC±É褪ÉÆ ºÉÆ{ÉtiÉäiɺªÉ ¶ÉÞhÉÖ ºÉɨÉÉxªÉ ±ÉIÉhɨÉ - SÉ ÊSÉ 30/154

64. Klaibya reemphasized as Napumsaka SHANDA: - (Nara/nariShanda) A child born of an act of fecundation foolishly or ignorantlyeffected during the menaces of its mother by its progenitor by holding her on his bosom duringthe act is called a Shanda and invariably exhibits effeminate traits in his character. A daughterborn of a woman riding on her husband during the act of sexual intercourse will developmasculine traits in her character. Here Klinefelter's and Turner syndrome are applicable, which are said to be the beejadosha or chromosomal anomalies. ASEKYA: - A child born of scanty paternal sperm becomesanAsekya and feels no sex desire with out previously drinking the semen of another man.

65. SOUGANDHIKA: - A child begotten in a sordid vagina iscalled a Sougandhika, whose organ does not respond to the sexual desire without smelling the genitals of others. KUMBHIKA: - The man who first becomes a passive member of an act of sodomy and able to act as man with good erection is called as Kumbhika. IRSHAYAKA: - The man who can not copulate with a women without previously seeing the sexual intercourse of another is called as Irshaka (Voyeurism). KLEEBA: - Kleeba is defined as a person with ED under various etiological factors.