A. Male Reproductive System
The human male reproductive system is a series of organs located outside of the body and around the pelvic region of a male that contributes to the reproductive process. The primary direct function of the male reproductive system is to provide the male [gamete] or [spermatozoa] for fertilization of the ovum.
The major reproductive organs of the male can be grouped into three categories. The first category is sperm production and storage. Production takes place in the testes which are housed in the temperature regulating scrotum, immature sperm then travel to the epididymis for development and storage. The second category is the ejaculatory fluid-producing glands which include the seminal vesicles, prostate, and the vas deferens. The final category is those used for copulation, and deposition of the spermatozoa (sperm) within the male, these include the penis, urethra, vas deferens, and Cowper’s gland.
Major secondary sexual characteristics include larger, more muscular stature, deepened voice, facial and body hair, broad shoulders, and development of an adam’s apple. An important sexual hormone of males is an androgen, and particularly testosterone. The testes release a hormone that controls the development of sperm. This hormone is also responsible for the development of physical characteristics in men such as facial hair and a deep voice.
B. Female Reproductive System
The human female reproductive system is a series of organs primarily located inside of the body and around the pelvic region of a female that contributes towards the reproductive process. The human female reproductive system contains three main parts: the vagina, which leads from the vulva, the vaginal opening, to the uterus; the uterus, which holds the developing fetus; and the ovaries, which produce the female’s ova. The breasts are involved during the parenting stage of reproduction, but in most classifications, they are not considered to be part of the female reproductive system.
The vagina meets the outside at the vulva, which also includes the labia, clitoris, and urethra; during intercourse, this area is lubricated by mucus secreted by the Bartholin’s glands. The vagina is attached to the uterus through the cervix, while the uterus is attached to the ovaries via the fallopian tubes. Each ovary contains hundreds of egg cells or ova (singular ovum).
Approximately every 28 days, the pituitary gland releases a hormone that stimulates some of the ova to develop and grow. One ovum is released and it passes through the fallopian tube into the uterus. Hormones produced by the ovaries prepare the uterus to receive the ovum. The lining of the uterus called the endometrium, and unfertilized ova are shed each cycle through the process of menstruation. If the ovum is fertilized by sperm, it attaches to the endometrium and the fetus develops.
Sexual Conditions Overview
Sexual conditions such as STDs & other sexual problems need medical evaluation & treatment. Frequently there are no STD symptoms, although there is sometimes a discharge from the vagina or the penis & burning & pain during urination Tests are performed to diagnose sexual conditions like Chlamydia, gonorrhea, syphilis & trichomoniasis. STD treatments can help resolve these conditions, practicing safe sex can prevent STDs.
When to Seek Medical Care
Not all sexual problems require medical attention. Many people have temporary sexual problems, usually due to medical problems, anxiety, or stress in another area of life. If you are distressed by the problem or you are afraid your relationship is threatened, don’t be afraid or embarrassed to seek outside help. If your health care provider is unable to help you beyond ruling out physical problems, a mental health counselor should be able to help or point you in the right direction.
Any sexual problem that persists for more than a few weeks is worth a visit to your health care provider. He or she can rule out medical or medication causes of the problem and can offer advice on solving other types of problems. He or she can help you sort out exactly what the problem is if you aren’t sure. He or she can refer you to other specialists if necessary: a psychotherapist, a marriage counselor, or a sex therapist.
- If intercourse suddenly becomes painful when it wasn’t before, for example, you may have an infection or other medical condition that requires prompt attention.
- If you have reason to believe you have a sexually transmitted disease, you and your partner both need to be treated right away, as do any other sexual partners either of you may have.
- Any unusual reaction to sexual activity, such as headache, brief chest pain, or pain elsewhere in the body, also warrants a visit to your health care provider.
What is Infertility?
Infertility is defined as a disease of the reproductive system that impairs the body’s ability to perform the basic function of reproduction. Although conceiving a child may seem to be simple and natural, the physiological process is quite complicated and depends on the proper function of many factors, including the following,
production of healthy sperm by the man
- production of healthy eggs by the woman
- unblocked fallopian tubes that allow the sperm to reach the egg
- the sperm’s ability to fertilize the egg
- the ability of the fertilized egg to become implanted in the uterus
- adequate embryo quality
Who is affected by Infertility?
Infertility affects about 12 percent of couples of childbearing age. Infertility is not just a woman’s concern. A problem with the male is the sole cause, or a contributing cause, of infertility in about 50 percent of infertile couples. About one-third of infertile couples have more than one cause or factor related to their inability to conceive. About 20 percent of couples have no identifiable cause for their infertility after medical investigation.
What causes Infertility?
Many different factors and problems can cause infertility, including problems in the female reproductive system, the male reproductive system, or a combination of the two. The following are some of the conditions or factors that are associated with infertility
A. Female Factors
- Ovulation Dysfunction: With this condition, the woman’s reproductive system does not produce the proper amounts of hormones necessary to develop, mature, and release a healthy egg.
- Anatomical Problems: Abnormal development or function of the female anatomy can prevent the egg and the sperm from meeting. The most common anatomical problem is the blockage of the fallopian tubes. Other anatomical problems may include the presence of pelvic scar tissue from previous surgeries or infections.
- Endometriosis : is a condition in which the tissue that lines the uterus develops outside the uterus, usually on other reproductive organs inside the pelvis or in the abdominal cavity. Each month, this misplaced tissue responds to the hormonal changes of the menstrual cycle by building up and breaking down, resulting in internal bleeding which can cause scar tissue to form and affect reproductive organ function.
- Birth Defects: Abnormal development and function of reproductive organs resulting from birth defects can affect fertility. One of the most common reproductive system birth defects occurs following a woman’s exposure to DES (diethylstilbestrol) taken by her mother during pregnancy. In years past, DES was given to women at risk for pregnancy loss. Fetal DES exposure often causes abnormal development of the uterus and cervix.
- Infection: Pelvic inflammatory disease (PID) is caused by a type of bacteria such as gonorrhea and chlamydia. PID can affect the uterus, fallopian tubes, and/or ovaries. It can lead to pelvic adhesions and scar tissue that develops between internal organs, causing ongoing pelvic pain and the possibility of an ectopic pregnancy (the fertilized egg becomes implanted outside the uterus).
- Immunological Problems: A problem with a woman’s immune system can lead to pregnancy loss. Antibodies (immune or protective proteins) in a woman’s system can fail to recognize a pregnancy, or there may be an abnormal immune response to the pregnancy. Women can also develop antisperm antibodies which attack and destroy sperm.
B. Male Factors
- Low or Absent Sperm Production: Without proper numbers of healthy sperm, the chance of fertilization is decreased.
- Abnormal Sperm Function: Sperm must have proper motility and the ability to penetrate the egg.
- Varicocele: This is a condition in which varicose veins develop around the testes. It is a very common cause of male factor infertility and is usually treatable and reversible with surgery.
- Lifestyle: Use of recreational drugs (i.e., marijuana, cocaine), heavy alcohol use, cigarette smoking, certain medications, and excessive heat to the genital area (as in hot tubs) can affect sperm quality and function.
- Hormonal Disorders: Improper male hormone or endocrine function can affect sperm production and fertilization ability.
- Chromosomal Defects: Certain chromosomal abnormalities are associated with male infertility.
- Birth Defects: Abnormalities in a man’s reproductive system can occur during fetal development. Some birth defects are due to a man’s exposure to DES (diethylstilbestrol) taken by his mother during pregnancy.
- Immunological Problems: A man may have antisperm antibodies (immune or protective proteins) which attack and destroy sperm
How is infertility diagnosed?
When conception does not occur after one year of unprotected intercourse, after six months in women over age 35, or if there are known problems causing infertility, a medical evaluation of both the male and female is recommended. Some obstetrician/gynecologists (OB/GYNs) are able to provide basic infertility evaluation and treatment. However, many causes of infertility are best treated by a board-certified reproductive endocrinologist. This is an OB/GYN who has had additional education and training in infertility and is certified with the American Board of Obstetrics and Gynecology in the sub-specialty of Reproductive Endocrinology and Infertility.
Generally, the OB/GYN or reproductive endocrinologist will evaluate specific situations and perform tests in both the male and female partners to determine the cause of infertility. The physician is looking for answers to the following questions
- Is the female ovulating regularly?
- Is the male producing healthy, viable sperm?
- Are the female’s egg and the male’s sperm able to unite and grow normally?
- Are there any obstacles to proper implantation and maintenance of the pregnancy?
The following tests are often part of the basic medical workup for infertility.
A. Both Partners
- medical and sexual history (to evaluate possible physical causes of infertility and if sexual intercourse has been appropriately timed)
- Physical Examination A complete physical examination (including a Pap smear and testing for infection) will be necessary.
- Ovulation Evaluation: An evaluation of ovulation function using an analysis of body temperatures and ovulation called the basal body temperature chart, or with ovulation prediction methods using urine samples, may be recommended.
- Hormone Testing: Hormone testing may be recommended, as certain hormones increase and decrease in production at various times in the monthly cycle.
- Ultrasound: can show the presence of follicles (the sacs containing developing eggs) and the thickness of the uterine tissues. Ultrasound can also show abnormal conditions, such as ovarian cysts or fibroids (benign tumors in the uterus).
- X-rays: A hysterosalpingogram may be recommended. This test uses a radio-opaque dye injected into the cervical opening to visualize the inside of the uterus and determine if the fallopian tubes are open.
- Semen Analysis A collection of a semen sample obtained by masturbation that is analyzed in the laboratory for the sperm count, sperm motility, sperm shape, quantity, and evaluation of the ejaculate liquid may be recommended. According to the ASRM, a normal ejaculate contains more than 20 million sperm per milliliter of liquid, more than 50 percent of the sperm should be moving forward, and more than 30 percent of sperm should have normal shapes.
- Other Tests: may be performed that evaluate the sperm’s ability to penetrate the egg, as well as male hormone testing
Men may be referred to a urologist for further evaluation.
Treatment for infertility
Specific treatment for infertility will be determined by your physician based on
- your age, overall health, and medical history
- the extent of the disorder
- cause of the disorder
- your tolerance for specific medications, procedures, or therapies
- expectations for the course of the disorder
- your opinion or preference
Once a diagnosis is made, the specialist can work with you to determine the course of treatment. According to the ASRM, most infertility cases (85 to 90 percent) are treated with conventional therapies, such as drug treatment or surgical repair of reproductive abnormalities. Depending on the cause of infertility, there are many options to offer an infertile couple.
Types of treatments for women may include the following
What percentage of ART cycles results in a pregnancy?
In 2005, of ART cycles that used fresh, non-donor eggs or embryos, 66 percent of these cycles did not produce a pregnancy in women less than 35 years old.
Clinical pregnancy was achieved in 34 percent of these ART cycles.
21.4 percent resulted in a single-fetus pregnancy.
11.2 percent resulted in a multiple-fetus pregnancy.
Source: National Center for Chronic Disease Prevention and Health Promotion
- Ovulation Medications: These medications help regulate the timing of ovulation and stimulate the development and release of mature eggs. They can also help correct hormonal problems that can affect the lining of the uterus as it prepares to receive a fertilized egg. Ovulation medications can stimulate more than one egg to be released which increases the possibility of having twins and other multiples. Some of the common ovulation medications include the following
human menopausal gonadotropins – medications containing follicle-stimulating hormone (FSH) and luteinizing hormone (LH)
follicle-stimulating hormone (FSH)
- Intrauterine Insemination: For some conditions, including low sperm count and cervical mucus problems, a procedure that places specially washed and prepared sperm directly into the uterus through a small catheter (flexible tube) helps increase the chances for conception. This procedure is often used in combination with ovulation medications.
- Surgery: Surgery may be used to treat or repair a condition that is causing infertility such as fallopian tube blockage, or endometriosis. A common surgical procedure often used as part of the diagnostic workup of infertility is laparoscopy. In a laparoscopy, a small telescope inserted into the abdominal or pelvic cavity allows internal organs to be visualized. Some procedures to treat infertility can be performed using instruments inserted through the laparoscope.
- Assisted Reproductive Technology (ART): For some couples, more extensive treatment is needed. With most forms of ART, the sperm and egg are united in the laboratory and the fertilized egg is returned to the woman’s uterus where it can implant and develop. Although ART procedures are often costly, many are being used with success. These include the following
In Vitro Fertilization (IVF): involves extracting a woman’s eggs, fertilizing the eggs in the laboratory with sperm, and then transferring the resulting embryo(s) into the woman’s uterus through the cervix (embryo transfer) where it can develop. Most couples transfer two embryos; however, more may be transferred in certain cases. IVF is the most common form of ART and it is often the treatment of choice for a woman with blocked, severely damaged, or absent fallopian tubes. IVF is also used for infertility caused by endometriosis or male factor infertility. IVF is sometimes used to treat couples with long-term unexplained infertility who have not been able to conceive with other infertility treatments. According to the ASRM, the average cost of one IVF cycle in the United States is $12,400. More than one IVF cycle, however, is usually needed.
Intracytoplasmic Sperm Injection (ICSI): a procedure in which a single sperm is injected directly into an egg; this procedure is most commonly used to help with male factor infertility problems.
Gamete Intrafallopian Transfer (GIFT): involves using a fiber-optic instrument called a laparoscope to guide the transfer of unfertilized eggs and sperm into the woman’s fallopian tubes through small incisions in her abdomen. GIFT is only used in women with healthy fallopian tubes.
Zygote Intrafallopian Transfer (ZIFT): involves fertilizing a woman’s eggs in the laboratory and then using a laparoscope to guide the transfer of the fertilized eggs (zygotes) into her fallopian tubes. ZIFT is only used in women with healthy fallopian tubes.
Donor Eggs involve an embryo formed from the egg of one woman (the donor) being transferred to another woman who is unable to conceive with her own eggs (the recipient). The donor relinquishes all parental rights to any resulting offspring. ART using donor eggs is much more common among older women than among younger women. The likelihood of a fertilized egg implanting is related to the age of the woman who produced the egg. Egg donors are typically in their 20s or early 30s.
Embryo Cryopreservation: a procedure in which embryos are preserved through freezing (cryopreservation) for transfer at a later date. This procedure is often used when an IVF cycle produces more embryos than can be transferred at one time. The remaining embryos can be transferred in a future cycle if the woman does not become pregnant.
There is a range of treatment options currently available for male factor infertility.
Treatment may include
Assisted Reproductive Technologies (ART)
This type of treatment may include the following
Artificial Insemination: Artificial insemination involves the placement of relatively large numbers of healthy sperm either at the entrance of the cervix or into the partner’s uterus, bypassing the cervix, to have direct access to the fallopian tubes.
IVF, GIFT, and Other Techniques In vitro fertilization (IVF) or gamete intra-fallopian transfer (GIFT) have been used for the treatment of male infertility. As is the case with artificial insemination, IVF and similar techniques offer the opportunity to prepare sperm in vitro, so that oocytes are exposed to an optimal concentration of high-quality, motile sperm.
Microsurgical fertilization (microinjection techniques such as intracytoplasmic sperm injection, or ICSI): This treatment is used to facilitate sperm penetration by injection of a single sperm into the oocyte. Fertilization then takes place under the microscope.
A small percentage of infertile men have a hormonal disorder that can be treated with hormone therapy. Hormonal imbalances caused by a dysfunction in the mechanism of interaction between the hypothalamus, the pituitary gland, and the testes directly affect the development of sperm (spermatogenesis). Drug therapy may include gonadotrophin therapy, antibiotics, or another medication deemed appropriate.
Surgical therapy in male infertility is designed to overcome anatomical barriers that impede sperm production and maturation or ejaculation. Surgical procedures to remove varicose veins in the scrotum (varicocele) can sometimes serve to improve the quality of sperm.
What is unexplained infertility?
About 20 percent of couples have unexplained infertility, for which a cause, despite all investigations, is not found. Unexplained infertility does not mean there is no reason for the problem, but that the reason is unable to be identified at the present time. If you suspect you are experiencing infertility, seek medical consultation early. The age of the woman and the duration of the couple’s infertility may influence the success of treatment.
Erectile dysfunction commonly referred to as ED is the inability to achieve and sustain an erection suitable for sexual intercourse. This condition is not necessarily considered normal at any age and is different from other problems that interfere with sexual intercourse, such as lack of sexual desire and problems with ejaculation and orgasm.
How Common Is Erectile Dysfunction?
According to the National Institutes of Health, approximately 5% of 40-year-old men and between 15% and 25% of 65-year-old men experience ED on a long-term basis.
A much more common problem that affects the majority of men at some point in their life is the occasional failure to achieve an erection, which can occur for a variety of reasons, such as from drinking too much alcohol or from being extremely tired.
Failure to achieve an erection less than 20% of the time is not unusual and treatment is rarely needed. Failure to achieve an erection more than 50% of the time, however, generally indicates there is a problem requiring treatment.
What Causes Erectile Dysfunction?
In order to achieve an erection, these conditions must occur
- The nerves to the penis must be functioning properly.
- The blood circulation into the penis must be adequate.
- The veins must be able to “trap and keep” the blood inside the penis.
- There must be a stimulus from the brain.
If there is something interfering with any or all of these conditions, a full erection will be prevented. Common causes of ED include diseases that affect blood flow, such as atherosclerosis (hardening of the arteries) or venous leakage (weak veins); nerve diseases; psychological factors, such as stress, depression, and performance anxiety; and injury to the penis. Chronic illness, certain medications, and a condition called Peyronie’s disease (scar tissue in the penis) can also cause ED.
Can ED Be Prevented?
For people who are at risk of developing ED due to personal behavior, such as drinking too much alcohol, steps may be taken to prevent it. However, other causes of ED may not be preventable.
What Doctors Treat ED?
The type of medical specialist who treats ED will depend on the cause of the problem. Based on your family’s medical history as well as your own medical history and current health, your doctor may treat you with oral medications such as Viagra or similar drugs. If this fails, he or she may refer you to a urologist or psychologist.
How Is Erectile Dysfunction Treated?
There are many different ways erectile dysfunction can be treated, including oral medications, sex therapy, penile injections, suppositories, vacuum pumps, and surgery. Each type of treatment has its own advantages and disadvantages.
Does Insurance Cover ED Treatment?
Insurance coverage of ED depends upon the type of treatment prescribed. If there is a documented medical condition that is shown to be causing ED, insurance will usually cover at least some of it. Sex therapy and medications that have not yet been approved by the FDA, however, are generally not covered. Talk to your insurance provider to determine if the treatment you are considering will be covered.
Alternative Treatments for ED
Alternative treatments include nutritional supplements, herbal remedies, and acupuncture. Some men may choose to use alternative treatments in addition to traditional treatments for ED. If you are considering an alternative form of treatment for ED, seek the advice of a health care provider before getting started.
- Nutritional Supplements: Nutritional supplements including the amino acid arginine, bioflavonoids, zinc, vitamin C, vitamin E, and flaxseed meal have been used to improve erectile function. In addition, certain ED patients with low levels of the hormone dehydroepiandrosterone (DHEA) showed improvement in erectile function after receiving supplemental doses of DHEA. However, because the long-term safety of DHEA is not known, most experts do not recommend its use.
- Herbal Remedies: Asian ginseng and Ginkgo biloba are believed to improve erectile function in some men
- Acupuncture: an ancient Chinese method of healing that involves sticking very fine, solid needles into specific points on the body, acupuncture stimulates the body’s ability to resist or overcome illnesses and conditions by correcting “imbalances.” Acupuncture has helped some men with ED.
- Common Sense Measures: Keep in mind that because most alternative and complementary treatments are not regulated, it is difficult to know what you are getting. Here are some tips to follow when considering using herbal remedies for erectile dysfunction.
Talk to your doctor about any herbal products you are considering before trying them.
If you experience side effects such as nausea, vomiting, rapid heartbeat, anxiety, insomnia, diarrhea, or skin rashes, stop taking the herbal product and notify your doctor.
Beware of commercial claims of what herbal products can do. Look for scientific-based sources of information.
Select brands carefully. Only purchase brands that list the herb’s common and scientific name, the name and address of the manufacturer, a batch and lot number, expiration date, dosage guidelines, and potential side effects.
Above all, if taking over-the-counter supplements, be sure your doctor is informed before combining them with prescription drugs he may recommend.
Impotence takes three forms.
- There is primary impotence when the man’s erectile dysfunction is there from the very beginning of sexual activity and he simply cannot have an erection.
- Secondary impotence is the commonest and this implies that the man can normally attain an erection but fail on one or more occasions in between normal activity.
- The third form is associated with advancing age.
Sexual impotence may result from psychological illness such as depression which lowers both sexual drive and erectile function, tiredness, alcohol abuse, the therapeutic use of oestrogens, paralysis of parasympathetic nerves by drugs or permanent damage to them, and diabetes. Other causes of impotence include a devitalized condition of the system in general. The main problem of secondary impotence is the apprehension created by an earlier failure, which generates a good deal of anxiety for the next time.
Ashwandha (Withania Somnifera)
Bhringraj (eclipta alba)
Gokharu (Tribulus terrestris)
Diet: Diet is an important factor, to begin with, the patient should adopt an exclusive fresh fruit diet. Take fresh fruits and fresh fruit juice twice daily. Concentrate on food like a nut, cereals, vegetables, fruits, milk, honey etc. Avoid smoking, alcohol, tea, coffee all processed canned refined and denatured foods especially white sugar and white flour and products made from them.
LifeStyle: A vigorous massage all over the body is highly beneficial in the treatment of impotency as it helps to revive muscular vigour which is essential for nervous energy. The nerves of the genital organs are controlled by the pelvic region. Hence acold hip bath for ten minutes in the morning or evening is very effective.
The Bow (Dhanur Asana)
The Shoulder Stand (Sarvang Asana)
The Plough (Hala Asana)