Int. J. Pharm. Sci. Rev. Res.

, 18(1), Jan – Feb 2013; nᵒ 23, 155-164 ISSN 0976 – 044X

Review Article

An Updated Overview on Causes, Diagnosis and Management of Infertility

Amudha.M*, [Link], [Link], [Link]

Department of Pharmacy, Annamalai University, Annamalainagar, Chidambaram-608002, Tamilnadu, India

Accepted on: 04-12-2012; Finalized on: 31-12-2012.

ABSTRACT
Infertility is the disorder which can alter the mankind and also the man mind to cause major problems. Infertility i.e. childlessness
causes physical and mental worries which can obstruct the family happiness. Male and female fertility can be limited or diminished
by number of factors such as hormone imbalance, illness and infections on reproductive organs, obstruction or sexual dysfunction.
In this scientific era, infertility is also caused by lack of healthy food, stressful world, excess radiation, changing lifestyle, exposure to
various toxins, smoking, addiction to alcohol and drugs. This review deals with fertilization, implantation and infertility. It also deals
with the factors which cause infertility and diagnosis and management of infertility in both male and female. This review will be
more useful not only to the scientific people and also normal peoples.
Keywords: Fertilization, Implantation, Infertility, Causes, Diagnosis, Treatments.

INTRODUCTION To fertilize the ovum, coitus must take place within the
period that begins one or two days before ovulation &

P regnancy is the most intimate and heart- warming

experience in the life of married couples. Not only
are the events which lead up to it very personal,
but the actual incident represents a merging of the
essential features of both partners.
lasts until one or two days after ovulation. Most women
ovulate between the twelfth and sixteenth days after
beginning of the last period2.
Fertilization
Becoming pregnant and giving birth to a child is the In human reproduction, the process by which the male’s
climatic point in the life of every couple. Now a day’s sperm unites with the females ovum, is called conception.
more and more couples are showing up at fertility centre By this event, a new life is created. This is accomplished
for attaining fertility in their married life. Due to through the act of intercourse or coitus during which the
childlessness many couples are socially isolated and thus erect penis helps in the deposition of spermatozoa into
emotionally distressed in many part of the world. Many the vagina3.
childless couples are applying for divorce. It may be due
The spermatic fluid is a combination of sperms mixed
to male or female infertility.
with secretions of the seminal vesicles and prostate
Knowledge of infertile couples about sex education is a gland. These secretions are necessary to keep the sperms
fundamental parameter to optimize infertility. This review in a viable and motile state.
reveals about Fertilization, Implantation, Infertility and
Once inside the vaginal tract, the sperms move with the
the factors which cause infertility and Diagnosis of
help of tail. Out of nearly 300 million spermatozoa in a
infertility in both male and female. It will be very useful to
single ejaculation, only one is needed for the fusion with
all kinds of people.
the egg. The act of fertilization or the union of sperm and
“THINK RIGHT AND ACT RIGHT” egg takes place in the oviduct.
4
Reproduction The act of fertilization fulfills at least four requirements ,
It is the process by which a living entity or organism  It combines the characters of two parents.
produces a new individual of the same kind. The gonads
 Restores the diploid number of chromosomes.
or sex glands – on the ovaries in the female & the testes
in the male- produces the germ cells that unite & grow  Determines the sex of offspring.
into a new individual. Reproduction begins when the
 Initiates the process of development of the
germ cells unite and the process is called fertilization1.
zygote after establishing pregnancy.
Fertilization typically occurs only at the average of four
Development of embryo & fetus
days in every menstrual cycle. The mature ovum lives only
one or two days after ovulation & the sperm have only Soon after conception (the fertilization of an ovum by a
about the same amount of time before they perish in the sperm), the cells begin to divide. The fertilized ovum
female reproductive tract. moves slowly down the fallopian tube to the uterus,

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floats freely in the uterus and is implanted in the uterine fetus is about three inches in size & the neuromuscular
wall. Fetal membranes begin forming. First is the amnion, system is developing rapidly. By this point, the basic
which surrounds the embryo and attaches to the chorion structure of the human is formed; the remainder of
that will ultimately carry nutrients to the embryo from pregnancy is a period of further differentiation, growth &
the mother. Differentiation is occurring rapidly. At two refinement to prepare the fetus for life outside the
weeks of age the embryo has attached to the uterine uterus. Figure 1 shows the sequences that takes place
wall, developed membranes and organized the germinal from ovulation to implantation. Figure 2 shows
layers – the endoderm, the ectoderm and the mesoderm. conversion of trophoblast stem cells into placenta,
embryonic stem cells in to embryo.
Endoderm: The gastrointestinal tract & its appendages &
the respiratory organs will develop from the endoderm. INFERTILITY
Ectoderm: The brain, nervous tissue, sense organs & skin The term Infertility refers to the biological inability of a
develops. person to contribute to conception. The term Infertility
may also refer to the state of woman who is unable to
Mesoderm: The gonads, kidneys, adrenal cortex, the
carry a pregnancy to full term7. However, the definition
abdominal cavity lining develop and further
of the term Infertility differs depending on the context.
differentiation produces the connective, vascular,
5 For example, The WHO defines the term as follows:
skeletal, muscular and hematopoietic tissues .
“Infertility is the inability to conceive a child. A couple
The uterine lining becomes enlarged and is prepared for
may be considered infertile, if after two years of regular
implantation of the embryo in the trophoblast layer.
sexual intercourse, without contraception, the woman
Twelve days after fertilization, the trophoblast has
has not become pregnant (and there is no other reason,
formed a two-layered chorion. Human chorionic
such as breastfeeding or postpartum amenorrhea).
gonadotropin (hCG) is secreted by the chorion, and it
Primary infertility is infertility in a couple who have never
prolongs the life of the corpus luteum until the placenta
had a child. Secondary infertility is failure to conceive
begins to secrete estrogen and progesterone 6.
following a previous pregnancy.
According to Med lexicon’s medical dictionary, the term
‘Infertility’ means diminished or absent ability to produce
off spring; in either the male or the female, not as
irreversible as sterility. Figure 3 shows causes of
infertility.

Figure 1

Figure 3
Infertility in women
Female infertility usually occurs when there is a problem
with ovulation, a damaged fallopian tube or uterus or a
Figure 2 problem with the cervix. Age may also contribute to
By three weeks, the embryo’s heart appears & a vascular fertility struggles because as a woman ages, her fertility
system develops. By the fourth week, circulation occurs decreases8.
within the embryo. The embryo becomes fetus by the end
When a woman is not able to become pregnant after one
of the second month, with the heart beating in a regular year of trying, or six months or if a woman is 35 or older,
rhythm. Skeletal muscles are present & arms, legs are it is a case of female infertility. Infertility in women may
forming. Viscera are formed & beginning to function.
be caused by variety of conditions.
Organization is beginning for face, tongue, mouth, eyes &
9
ears. Fetal size is about an inch. By the third month, the Two major causes of infertility in women are :

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 Failure to ovulate (about 60% of cases) Hyperprolactinimia - Failure to ovulate arise from the
over secretion of hormone prolactin i.e.
 Obstruction of fallopian tube (about 40% of Hyperprolactinimia, nearly 30% menstrual abnormalities
cases)
are due to this, which suppress ovulation.
Figure 4 shows two major causes of female infertility.
Malfunction of the hypothalamus - The hypothalamus is
Figure 5 shows two major causes that are interrelated. the portion of the brain responsible for sending signals to
the pituitary gland, which, in turn, sends hormonal stimuli
Figure 6 shows the causes due to hormonal imbalance.
to the ovaries in the form of FSH and LH to initiate egg
maturation. If the hypothalamus fails to trigger and
control this process, immature eggs will result. This is the
cause of ovarian failure in 20% of cases.
Malfunction of the pituitary gland - The pituitary's
responsibility lies in producing and secreting FSH and LH.
The ovaries will be unable to ovulate properly if either too
much or too little of these substances is produced. This
can occur due to physical injury, a tumor or if there is a
chemical imbalance in the pituitary.
Female hypogonadism - This means that production of
the normal sex hormones is deficient.
Figure 4
Early menopause – “cessation of menses,” and refers to
that period in a woman’s life when reproductive function
has come to an end, there is a decline in hormonal
secretion by the ovary.
Ovarian virilism – The normal ovary does not secrete a
significant amount of androgen. In the presence of
enzyme defects in the ovary, considerable amount of
androgen causing not only menstrual disorders but also
varying degree of hirsutism.
Figure 7 shows the causes due to infections.

Figure 5

Figure 7
13,14
Infections
Figure 6 Pelvic diseases – may cause infertility. The most common
of these are appendicitis and lead to scarring and
Hormonal imbalance is the most common causes of
blockage.
anovulation. The process of ovulation depends upon a
complex balance of hormones and their interactions to be Inflammation of genital organs – it is responsible for the
successful, and any disruption in this process can hinder production of mucus that is considered toxic or poisonous
ovulation.10-12 to sperms. The mucus also tends to obstruct passage of
male germ cells into the uterus.
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Cervical cancer – when cancer develops in the cervix, it is Thus, for a woman to get pregnant,
at first confined to this organ. But, depending on the type
 She must release an egg from one of her ovaries
of growth, spreads at different rate to the adjacent
(ovulation).
organs.
 The egg must go through a fallopian tube toward the
Trichomonas vaginalis – a parasitic protozoan, may infect
uterus (womb).
the vagina, producing an irritative discharge. Monilasis, a
fungus infection caused by Candida albicans, may affect  A man’s sperm must join with the egg along the way
the vaginal wall causing white discharge or white patches. (fertilization).
Veneral disease – it can damage the fallopian tube.  The fertilized egg must attach to the inside of the
uterus (implantation).
Vulvitis – inflammation of vulva may be caused by
number of factors. It occurs in obese and diabetic Infertility in men
patients, produces irritation and provides favorable
Infertility in married life may be due to the problem with
environment for the growth of fungi.
husband or wife. If the problem is with husband, it is
Figure 8 shows the factors associated with PCO called male infertility. The main cause of male infertility is
syndrome.13-15 low semen quality. Another possible cause is a low sperm
count. Infertility in men may be caused by variety of
2
conditions . Figure 9 shows two major causes of male
infertility. Figure 10 shows the causes for impotence.

Figure 9

Figure 8
Endometriasis – the lining (endometrium) of the womb
sometimes behave abnormally. Growth occurs not only in
the uterus but also elsewhere in the abdomen, such as in
the fallopian tubes, ovaries and the pelvic peritoneum.
The patient with this condition may suffer irregularities in
the menstural cycle. Approximately 10% of infertile
couples are affected by endometriosis.16
Amenorrhea – absence of mensturation.
Incresed level of testosterone – in PCO syndrome,
symptoms reflect an excess of testosterone, including
increased body hair with balding and deepening of voice. Figure 10
17-20
Cyst and tumors in reproductive organs: IMPOTENCE

Ovarian tumors – the extensive growth of tumors of the Impotence means an absence of normal spermatozoa and
ovary can be prevented only by early discovery and therefore failure of reproduction. It is considered as a
removal. major clinical problem of adult man.

Infection and tumors of the fallopian tube – infection of Hormonal imbalance – it is the most common causes of
fallopian tubes frequently cause permanent sterility. impotence. The process of spermatogenesis i.e. formation
of spermatozoa depends upon a complex balance of
Uterine tumors – it is one of the most frequent sites of hormones.
tumor formatgan. Tumor develops in any part of the
organ. The patient may have a group of small fibroids. In Pituitary deficiency – it also disturb the sexual function in
the male.
early stages, many of these growths can be treated
successfully either surgically or radiologically.

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Eunuchoidism – primary failure of testicular Obstruction of vasdeferens - may be due to repeated

development. infection, inflammation, or a developmental defect that
prohibits sperm transport.
Cryptorchidism – undescended testicles, failure of one or
both testicles to descend from the abdomen, and it can Testicular Trauma - An injury, surgery, or infection can
impair spermatogenesis. cause testicular trauma and trigger an immune response
in the testes that may damage sperm. Though the effects
Sickle cell anemia - may cause hypogonadism; a
are not fully understood, antibodies can impair a sperm
decreased functionality of the testicles.
cell's ability to swim through cervical mucus or to
Over heat - very hot baths, or working in extremely hot penetrate a female egg.
environments can raise the temperature of the testicles.
Orchitis – when the testes are involved in a case of
Tight clothing may have the same effect on some people.
mumps, the infection is known as orchitis.
Drug and chemotherapy – addiction to alcohol and other
Figure 11 shows causes due to infection.
addictive drugs and the side effects of using various drugs
used for hypertension, depression and antipsychotic
drugs. Chemotherapy can impair the sperm production.
Varicocele - Varicocele is defined as a dilation of the veins
of the pampiniform plexus allowing for excessive blood
flow, secondary to deficient venous valves, leading to
increased scrotal temperatures and thus an adverse
influence on spermatogenesis
Klinefelter’s syndrome – in these patients are found to
have an extra chromosome complex is composed of 47
instead of 46, it leads to absence of sperm.
Infections:18,19
Prostatitis - Inflammatory infections of the prostate
(prostatitis), epididymis (epididymitis) and testicles Figure 11
(orchitis), can cause irreversible infertility if they occur
before puberty. DIAGNOSIS OF FEMALE INFERTILITY21-23

Testicular cancer - Can limit or destroy the ability for General Physical exam – woman has to undergo a
spermatogenesis. complete medical check up including a gynecological
examination to understand her medical history,
Restrograde ejaculation - This occurs when impairment medications, menstruation cycle, and sexual habits.
of the muscles or nerves of the bladder neck prohibit it
from closing during ejaculation, allowing semen to flow Blood test – several things will be checked, for example,
backwards into the bladder. It may result from bladder whether hormone levels are correct and whether the
surgery, a developmental defect in the urethra or woman is ovulating (progesterone test).
bladder, or a disease that affects the nervous system, Hysterosalpingography – fluid is injected into the
including diabetes. woman’s uterus which shows up in X-ray pictures. X-rays
Ductal obstruction - This is most often caused by a are taken to determine whether the fluid travels properly
vasectomy, but may also be due to repeated infection, out of the uterus and into the fallopian tubes. If the
inflammation, or a developmental defect that prohibits doctor identifies any problems, such as a blockage,
sperm transport. surgery may need to be performed.

Spinal cord injury - these injuries occur in healthy men of Laparoscopy – a thin, flexible tube with a camera at the
reproductive age, producing sexual and reproductive end (laparoscope) is inserted into the abdomen and pelvis
difficulties. Many factors may predispose spinal cord to look at the fallopian tubes, uterus and ovaries. A small
injured men to infertility. Ejaculatory dysfunction, incision is made below the belly button and a needle is
abnormalities of sperm production, chronic infections and inserted into the abdominal cavity; carbon dioxide is
blockage of sperm within the male reproductive tract are injected to create a space for the laparoscope. The doctor
all potential factors. will be able to detect endometriosis, scarring, blockages,
and some irregularities of the uterus and fallopian tubes.
STD’S – Sexually Transmitted Diseases can cause
obstruction, infection, and scarring. Ovarian reserve testing – this is done to find out how
effective the eggs are after ovulation.
Genitourinary tract infection – it producing sexual and
reproductive infection. Genetic testing – this is to find out whether a genetic
abnormality is interfering with the woman’s fertility.

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Pelvic ultrasound – high frequency sound waves create

an image of an organ in the body, which in this case is the
woman’s uterus, fallopian tubes, and ovaries.
Chlamydia test – if the woman is found to have
Chlamydia, which can affect fertility, she will be
prescribed antibiotics to treat it.
Thyroid function test – according to the National Health
Service (UK) between 1.3% and 5.1% of infertile woman
have an abnormal thyroid.
23
DIAGNOSIS OF MALE INFERTILITY
General Physical exam – the man has to undergo a Figure 12
complete medical checkup by a doctor to understand his
medical history. The testicles will be checked for lumps or Medicines:
deformities, while the shape and structure of the penis Various fertility medicines are used to treat women with
will be examined for any abnormalities. infertility conditions.
Semen analysis –They will be analyzed in a laboratory for Clomiphene24- It is an estrogen like hormone that acts on
sperm concentration, motility, color, quality, infections the hypothalamus, pituitary gland and ovary to increase
and whether any blood is present. As sperm counts can the levels of FSH and LH which is also in the process of
fluctuate, the man may have to produce more samples. ovulation. In women who ovulate irregularly,
Blood test – level of testosterone and other male approximately 80% who take clomiphene will ovulate and
hormones. 30-40% of all women who take clomiphene become
pregnant. These numbers apply to women who have
Ultrasound test – to determine whether there is any taken up to three cycles of clomiphene.
ejaculatory duct obstruction, retrograde ejaculation, or
other abnormality. hCG - Some women do not have an increase in their LH
level at mid cycle and don’t ovulate. Treatment with
Chlamydia test – if the man is found to have Chlamydia, human chorionic gonadotropin triggers ovulation.
which can affect fertility, he will be prescribed antibiotics
to treat it. hMG, FSH, Gn-RH25 – Human menopausal gonadotropin
is used for women who don’t ovulate due to problems
Scrotal ultrasound - This test uses high-frequency sound with their pituitary gland hMG acts directly on the ovaries
waves to produce images inside the body. A scrotal to stimulate ovulation. Follicle Stimulating Hormone
ultrasound can help the doctor look for evidence of a works much like hMG. It causes the ovaries to begin the
varicocele or obstruction of the part of the testicle that process of ovulation. Gonadotropin releasing hormones
stores sperm (epididymis). are used for women who don’t ovulate regularly each
INFERTILITY TREATMENTS month. It acts on the pituitary gland.

Before any infertility treatment begins, a woman and her Metformin - Doctors use this medicine for women who
partner should undergo an infertility evaluation. This have PCOS. This drug helps lower the high levels of male
evaluation may include a complete history and physical hormones in women with these conditions. This helps the
examination, blood test and other tests depends upon body to ovulate women.
the individual situation. Bromocriptine - It is used for women with ovulation
Figure 12 shows categories of infertility treatment. problems due to high levels of prolactin. It suppresses the
lactation.
Allopathy:
Urofollitrophin, Somatropin26 - It is prescribed for
The preliminary treatment begins with weight loss or amenorrhea, delayed puberty, anovulatory infertility.
24
weight gain :
Antibiotics - In case of infection, infertility is treated by
Weight loss: It is an inexpensive and low risk treatment antibiotics. Prostatitis causes decrease motility of the
with no side effects that has been proven to improve the sperms and decrease the levels of zinc and acid
chances of ovulation and pregnancy in women who are phosphatase. Treatments are usually with broad
overweight. spectrum antibiotics for prolonged periods like 8-12 week
Weight gain: Women, who are under weight, have eating hCG and rFSH27 – rFSH stimulated follicular development
disorders or who participate in strenuous exercise and induced significant increases in serum oestrodiol.
regimens may ovulate irregularly or not at all. These Clinical experience with rFSH has shown it is more
women may be advised to gain weight, increase calorie effective at stimulating ovarian follicle growth than
intake and modify exercise habits.

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urinary gonadotropins. It is also effective at initiating IUI (Intra-Uterine Insemination) - In this treatment, the
spermatogenesis when given together with hCG. sperm are transferred into the uterus via the cervix, is
commonly used in cases of low sperm count and quality.
α- Sympathomimetics28- These drugs are useful in the
treatment of retrograde ejaculation, as they improve the IVF (In vitro fertilization) - Means fertilization outside of
contractibility of the bladder. the body. IVF is the most effective ART. It is often used
when a woman's fallopian tubes are blocked or when a
When the above treatments are unsuccessful ART may be
man produces too few sperm. Doctors treat the woman
suggested29.
with a drug that causes the ovaries to produce multiple
ART – Assisted Reproductive Technologies eggs. Once mature, the eggs are removed from the
woman. They are put in a dish in the lab along with the
 Artificial Insemination with Husband’s semen (AIH)
man's sperm for fertilization. After 3 to 5 days, healthy
 Artificial Insemination with Donor semen (AID) embryos are implanted in the woman's uterus.
 Non obstructive azoospermia Figure 13 shows categories of ART treatment.
 Hereditary 19 genetic defect in the husband
 Rh incompatibility
 Severe oligozoospermia
 Intra-Uterine Insemination with either Husbands Or
Donor semen (IUI-H or IUI-D)
 Hostile uterine cervix
 Oligozoospermia
 Unexplained infertility
 In Vitro Fertilization (IVF) and Embryo Transfer (ET)
 Irreversible pathology of the fallopian tubes,
resulting from an inflammatory process or from Figure 13
previous surgery
ICSI (Intra Cytoplasmic Sperm Injection) - It is a technique
 Infertility due to subnormal male factor developed to achieve fertilization for couples with severe
male factor infertility or couples who have failure to
 Idiopathic infertility
fertilize in a previous IVF attempt. This technique involves
 Endometriosis very precise maneuvers to pick up a single live sperm and
inject it directly in to the centre of human egg. The
 Infertility of immunological origin
specialist picks up the single live sperm in a glass needle
 IVF- Associated Techniques and injects it directly in to the egg
 Gamete Intra-Fallopian tube Transfer (GIFT) or ZIFT (Zygote intrafallopian transfer) - or Tubal Embryo
Tubal Embryo Transfer (TET) has been Transfer is similar to IVF. Fertilization occurs in the
recommended for patients with healthy fallopian laboratory. Then the very young embryo is transferred to
tube the fallopian tube instead of the uterus.
 Intra Cytoplasmic Sperm Injection (ICSI) has been GIFT (Gamete intrafallopian transfer) - involves
recommended for patients with ejaculated, transferring eggs and sperm into the woman's fallopian
epididymal or testicular spermatozoa tube. So fertilization occurs in the woman's body. Few
practices offer GIFT as an option.
 Oocyte Donation (OD)
ICSI (Intracytoplasmic sperm injection) - is often used for
 Embryo Donation (ED)
couples in which there are serious problems with the
 Cryopreservation sperm. Sometimes it is also used for older couples or for
those with failed IVF attempts. In ICSI, a single sperm is
 Involves freezing of semen or embryo, oocyte injected into a mature egg. Then the embryo is
cryopreservation and ovarian tissue preservation.
transferred to the uterus or fallopian tube.
ART30 (Assisted Reproductive Technologies) - This is a
term that describes several different methods used to
help infertile couples. ART involves removing eggs from a
woman's body, mixing them with sperm in the laboratory
and putting the embryos back into a woman's body.

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31, 32
Herbal treatment
Botanical name Family Parts used Mode of application
4-5 crushed leaves were poured for overnight in a glass of water. Next morning the
Dalbergia sisoo Roxb. Fabaceae Leaf decoction is mixed with sugar and was given to the women in empty stomach for 15
days.
Withania somnifera Root, One cup of the juice of root and stem were mixed with milk. Seven such doses were
Solanaceace
Dun. Leaf. given from the 5th day of the menstrual cycle.
10 g of the root powder was used to prepare the decoction with one cup of water. The
Asparagus recemosus
Liliaceae Root. dose was prepared with this decoction mixed with honey. This dose was given to both
Willd.
the partners suffering from infertility for 7 days.
Tamarindus indica 5 numbers of flowers were crushed to make a paste and mixed with one cup of milk and
Caesalpiniaceae Flower.
Linn. that dose was continued for 7 days.
10-15 g of seed juice is mixed with one cup of goat milk and this dose is prescribed to
Mucuna pruriens Linn. Fabaceae Seed
take for one month.
Tylophora Equal amount of root of [Link], [Link] and leaf of Ocimum gratissium are mixed
Asclepiadaceae Root.
indica(Burm.f.)Merr. and make a juice. Half a cup of this juice is given daily for 15 days.
Dioscorea villosa Linn. Discoreaceae Leaf The leaves are boiled in water and the decoction is given at bed time daily for 21 days.
Ipomea aquatica. Decoction of the leaves is given for 14 days after the menstrual flow.
Convolvulaceae Leaf
Forssk.
Root One tea spoon of juice of root and stem is mixed with one cup of fresh goat milk for 21
Enhydra fluctans Lour. Astaraceae
Leaf. days.
Mangiera indica Linn. Anacardiaceae Seed 10 gms of dry seed cotylodns is grinded and mixed with goat milk.
Leaves of C asiatica, fruit of Allium sativum and seeds of Nigella sativa in equal amounts
Centella asiatica(L.)
Apiaceae Leaf are mixed to make a paste. One tea spoon of the paste is given as one dose for three
Urban.
days.
Vitex negundo Linn. Verbenaceae Leaf Fumigation from the dried leaves is given daily at night to increase libido.
Amaranthus viridis Juice of the root is made by grinding and one tea spoon of such juice is given orally for
Amaranthaceae Root.
Linn.. twenty five days.
Paederia scandens Leaf and Juice of stem and leaf is used to recover the post pregnancy related problems.
Rubiaceae
(Lour.) Merr. stem.
Ocimum americanum Leaf and Half a cup of the fresh leaf juice mixed with honey. The dose is given at morning time in
Lemiaceae
Linn. root empty stomach for 14 days after the fifth day of menstrual cycle.
Polygonum hydropiper One cup of the leaf juice is given daily to enhance fertility in women. The dose is
Polyganaceae Leaf.
Linn. continued for 15 days.
The tree trunk is cut at about 3 feet height from the base and a portion at the upper end
is removed to make a hole. Then the hole is covered with the leaf for overnight. In the
Musa balbisiana Colla Musaceae Body.
morning, the liquid deposited in the hole is collected and taken in empty stomach. This
will increase the total no of sperm and thus helps in overcoming impotency.
Musa velutina From the third day of menstrual cycle till the eighth day the root juice with water is given
Musaceae Root.
Wendl.& Drude in the morning in empty stomach. This helps in inducing the ovulation process.
Sida cordifolia Linn. Mulvaceae. Leaf. One cup of root juice is given for seven days.
Bark and Juice of fresh root and stem bark is mixed with goat milk in equal volume to make a final
Mesua ferrea linn. Clusiaceae
root volume of one cup.21 such dose is given at bed time daily.
Diplocyclos palmatus Cucurbitaceae Fruits Fruits are used in the treatment of impotency.
Terminalia arjuna (DC) Half a cup (50 ml) of the juice of stem bark is mixed with honey to make a dose. One
Combretaceae Bark.
W.& A. such dose is given orally daily for 15 days
Achyranthus aspera One half cup of the leaf juice is given for 15 days to cure the problem.
Amaranthaceae Leaf
Linn.
One tea spoon of the bark juice is mixed with honey and is given from the fifth day of
Bauhinia purpurea L. Caesalpiniaceae Bark
menstrual cycle three months.
Acacia arabica Mimosaceae Bark Pill prepared from fresh stem bark is given for seven days.
Alstonia scholaris [Link]. Apocynaceae Bark Stem bark decoction is mixed in equal volume with goat milk and given for 15 days.
10-15 leaves are soaked in a glass of water overnight. Next morning the decoction is
Lawsonia alba Lamb. Lythraceae Leaf
given in empty stomach and the dose is continued for three days.
Young leaves are mixed with the young leaves of Psidium guajava ,Punica granatum,
Centella asiatica and Allium sativum in equal amounts are mixed to make a paste. One
Ziziphus jujube Lamk. Rhamnaceae Leaf
tea spoon of such past is given orally in empty stomach from the last day of menstrual
flow and continued for seven days.
Juice of leaves is taken internally for 3 days before or after the menstrual period for 3 or
Carmona retusa Boraginaceae Leaf
4 months to induce fertility.
Pimpinella anisum Apiaceae Seed Beneficial in the treatment of impotence.

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Int. J. Pharm. Sci. Rev. Res., 18(1), Jan – Feb 2013; nᵒ 23, 155-164 ISSN 0976 – 044X
33 37
Acupuncture: Healthy diet plays an important role in boosting fertility.
It comprise of fresh and organic juicy fruits such as
It is most popular and alternative therapy for infertility.
mangoes, peaches, plums and dried fruits dates, figs,
Acupuncture along with herbal medicine has been used
raisins , green leafy vegetables such as asparagus
for centuries to treat infertility. It can elevate FSH.
racemosus, legumes, broccoli, garlic, dairy proteins
Enhances egg quality, enhances the quality of uterine
including milk, butter milk, paneer, curd, cheese, nuts like
lining, reduces the risk of uterine contraction after IVF
soaked almonds, walnuts sprouts, beans and whole
procedures and treats menstrual cycle disorders.
grains, and spices like clove, cumin seed, cinnamon,
Yoga:34, 35 cardamom. Nutritional supplement containing chaste
berry, green tea extracts, L-arginine, vitamins (including
Take yoga poses such as the supported headstand
folate) and minerals that could be an alternative option
(Salamba Sirsasana), the bridge pose (Setu Bandha
for the optimization of reproductive health in some
Sarvangasana), the child’s pose (Balasana), the bound
women. Good nerve function, healthy hormone levels
angle pose (Baddha Konasana), the lotus pose
and an unobstructed blood flow to the pelvic area are
(Padmasana) which increase the supply of blood to the
essential to sexual performance. To keep these systems in
perineum and aid in curing infertility. Yoga and
working order, a diet should be based on legumes, grain
meditation can help women experiencing the challenges
products and plenty of fruits and vegetables.
of infertility. The practice of meditation and relaxation
can help to increase the clarity of mind and to maintain Drink Plenty of Water: Keeping your body hydrated at all
healthy body chemistry. Yoga is a scientific system to times is important for every aspect of fertility including
overcome general problem of infertility. Fertility Yoga aiding in vitamin absorption, cleansing the body from
Poses for Hormonal Stimulation fertility-inhibiting toxins, and warding off dehydration. It's
also necessary for optimizing cervical mucus which is
Alternative remedies:
what protects and nourishes sperm until it reaches the
Nutritional supplements36: According to American egg.
Dietetic Associations, antioxidants can help to prevent
Avoid: should not drink coffee, tea, soft drinks, fried and
and repair cell damage.
spicy foods. Also stay away from smoking and drinking
Antioxidants like N-acetylcysteine, vit C, vit E and alcohol.
selenium are used as antioxidants which help to improve
CONCLUSION
sperm function. The amino acid called L-carnitine turns
fat into suitable energy. L-carnitine is very important Childbearing and family are considered as a right of every
agent for sperm metabolism. The university of Maryland human being. Infertility is a health disorder that requires
medical centre says that sperm cells are one of the appropriate treatment strategy. Modern medical science
locations where the body stores carnitine and that low has developed advanced therapies to assist reproduction.
levels of amino acid may negatively impact sperm count The main causes of infertility are the problems of
and motility. fallopian tubes, hormonal imbalance, ovarian failure and
impotence. Many reasons are sorted out for female
CoQ10 is a fat soluble antioxidant made by human body.
infertility, but through proper diagnosis and counseling
Researchers from Italy concluded that oral CoQ10
for treatment of infertility can be only ray of hope.
supplement increase the amount of the substances in
Review reveals extensively all the major causes, diagnosis
semen and improves sperm cell movement.
and infertility treatments. This review will be helpful to all
Folic acid is a micronutrient which helps in DNA and RNA the scientific, medical researchers who can put efforts to
synthesis. Supplementation with zinc is known to improve put an end to infertility.
male infertility as it improves spermatogenesis and also
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Source of Support: Nil, Conflict of Interest: None.

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