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(The Antiseptic (1984): 612) Management of Oligozoospermia, Asthenospermia and Necrozoospermia by Treatment with “Speman” Limaye, H.R., M.D., D.G.O., Associate Professor in Obstetrics & Gynaecology, and Madkar, C.S., M.D., Lecturer in Obstetrics & Gynaecology, B.J. Medical College and Sassoon General Hospitals, Pune. INTRODUCTION It has been an observed fact that contribution of the male factor in the causation of infertility is almost equal to that of the female. The male factor includes many causative entities, out of which abnormal semen is one of the important causes of infertility. Oligozoospermia and asthenospermia are the two important entities which can be improved by drug treatment. Different manufacturers have claimed different drugs to improve the quantity and quality of semen. Speman (a compound of indigenous drugs) of The Himalaya Drug Co., is reported to be effective in improving sperm count and motility, though its exact pharmacological action has not yet been proved. Hence we selected the first indigenous drug Speman for trial in our patients having oligozoospermia, asthenospermia and necrozoospermia. MATERIAL AND METHODS Two hundred and sixty-two (male) patients were included in this trial. A total of 662 male partners were investigated in the infertility clinic. Their semen was examined twice at weekly intervals with two days’ abstinence before the actual collection of semen. The semen was collected in sterilised wide mouth bottles by masturbation in the laboratory and examined within an hour and half. COMPOSITION Each tablet of Speman contains: Orchis mascula Lactuca scariola Hygrophila spinosa Mucuna pruriens Exts. Parmelia perlata Argyreia speciosa Tribulus terrestris Leptadenia reticulata Suvarnavang (Mosaic Gold) 65 mg 16 mg 32 mg 16 mg 16 mg 32 mg 32 mg 32 mg 16 mg. OBSERVATIONS Out of the 662 patients who underwent semen examination, 400 were within normal limits, while 262 had abnormalities in semen as shown in Table 1 and they were included in our study. Table 1: Showing the various types of disorders Total no. of patients 262 (100%) Azoospermia Oligozoospermia Asthenospermia Necrozoospermia 38 (14.5%) 93 (35.5%) 119 (45.40%) 12 (4.60%) Table 2 shows the presence of infection in different grades of oligozoospermia. Total no. of patients 93 Presence of infection Table 2: Showing presence of infection in various grades of oligozoospermia Severe Moderate Mild oligozoospermia oligozoospermia oligozoosperma 12 30 51 9 27 19 (75%) (90%) (37.25%) Table 3 shows the presence of infection in different grades of asthenospermia. Table 3: Showing presence of infection in various grades of asthenospermia Total no. of patients Grade ‘0’ motility Grade ‘1’ motility Grade ‘2’ motility 119 9 39 71 Presence of infection 6 36 23 (66.66%) (92.30%) (32.39%) Table 4 shows the presence of infection in the 12 necrozoospermia patients. Table 4: Showing presence of infection in necrozoospermia Total no. of patients : 12 Presence of infection : 12 (100%) After excluding 38 patients of azoospermia the remaining 224 patients were screened for infection. One hundred and thirty-two patients, i.e. 58.92%, showed presence of infection. (Presence of 5 pus cells or more in semen per high power field is taken as positive for infection). All these 132 patients were primarily treated with long-acting sulpha preparations for a period of one week or in some cases for two weeks. Clearance of the infection was confirmed by repeated semen examination. Eight patients did not respond even after two courses of long-acting sulphas for two or more weeks. Their semen samples were collected after prostatic massage and subjected to culture and sensitivity tests. They were treated with appropriate antibiotics to clear the infection. Once the infection was cleaned they were treated with two tablets of Speman, 3 times a day for 3 months (since the spermatogenesis cycle extends over 75 to 82 days). After 3 months of Speman treatment, they were subjected to semen examination with the same precautions. The following observations were then noted. Table 5 shows the improvement in sperm count in 93 patients of oligozoospermia. Table 5 Total no. of patients treated 93 Improvement after treatment Severe oligozoospermia 12 3 (25%) Moderate oligozoospermia 30 14 (46.66%) Mild oligozoospermia 51 29 (56.88%) Table 6 shows the improvement in sperm motility in 119 patients of asthenospermia. Total no. of patients treated 119 Improvement after treatment Table 6 Grade ‘0’motility Grade ‘1’ motility 9 39 3 19 (33.3%) (48.7%) (Two patients grade ‘2’ and (10 patients grade ‘2’ 9 one patient grade ‘1’) patients grade ‘3’) Grade ‘2’ motility 71 42 (59.15%) (24 patients grade ‘3’, 18 patients grade ‘4’) Table 7 shows the improvement in necrozoospermia patients. Table 7 Total no. of patients No. of patients showing improvement after treatment 12 3 (25%) (All 3 patients of grade ‘2’ motility) DISCUSSION Out of 224 patients on Speman with prior antibiotics wherever required, 113 showed overall improvement (50.45%). In the oligozoospermia group the overall improvement was 49.46% (46 patients out of 93). In severe oligozoospermia the improvement was not that dramatic. It is probable that the presence of infection in the majority of semen samples with low count could be hindering the action of Speman. But in the moderate and mild varieties the improvement was definitely encouraging and remarkable. In the asthenospermia group the over-all improvement was 53.78% (64 patients out of 119). In the grade ‘2’ motility group, improvement was observed in a good per cent of cases, i.e. 59.15%, while in the grade ‘0’ and grade ‘1’ groups, the results were neither hopeless nor very encouraging. It is probable that these unsatisfactory results were due to the high incidence of infection which might have similarly hindered the action of Speman. No side-effects or any toxicity were observed in any of the patients. CONCLUSION We opine that the indigenous compound Speman, which is free from any toxicity or side-effects, is worth trying in cases of oligozoospermia, asthenospermia and necrozoospermia after prior treatment with appropriate antibiotics wherever necessary. ACKNOWLEDGEMENT We are really thankful to our colleagues who have helped us in undertaking this long, complicated study. We also thank the Dean, B.J. Medical College, Pune, for allowing us to use the clinical material for this work and publish our clinical work. REFERENCES 1. Banerjee, N., Probe (1973): 4, 177. 2. Bhargava, N. C., Ind. J. Derm. Vener., (1970): 1, 62. 3. Khaleeludin, K., Probe (1973): 4, 203. 4. Mukherjee, M., Probe (1973): 4, 201. 5. Talaulikar, V. R., Mediscope (1976): 1, 9. 6. Vaze, V. H., Probe (1970): 4, 159.