Friday, August 20, 2021

Charak Jayanti 2021

Charak Jayanti Day was celebrated at Samhita Department,  Bharati Vidyapeeth Deemed To Be University, College of Ayurved, Pune on 13 August 2021.



Monday, April 13, 2020

Charak siddhisthan chapter 10

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Tuesday, January 21, 2020

Wednesday, November 27, 2019

Full Text



Comprehensive Study of Association of Śukravikŗtīkara Hetus in Male Infertility

Scholar: Dr. Sachin Kulkarni,
Associate Professor, Bharati Vidyapeeth (Deemed to be University), College of Ayurved, Pune

Guide: Dr. Mrs. Yashashree Joshi
Professor, Bharati Vidyapeeth (Deemed To be University), College of Ayurved, Pune
INTRODUCTION:
Carakācārya has enlightened the importance of fertility in Vājīkaraņa chapter. A person without a child is like a tree just with one branch devoid of fruits and shadows with an unwanted smell[1]. Love, strength, happiness, excellence, wide spread influence, vastness of kinsmen, fame, utility to the world and pleasure are dependent upon children & to achieve all these fertility is required[2]. Nowadays numbers of patients of infertility are increasing due to various reasons. Infertility, the inability to conceive a child is an emerging public health priority. According to National Family Health Survey (NFHS-3) fertility is decreasing day by day[3]. In Indian society most of the time, females are blamed for infertility however infertility due to abnormalities in male partner is also equally important[4].
Epidemiology:
Infertility has been a concern through ages and is also a significant clinical problem today, which affects 8-12% of couples worldwide. Approximately 40-50% cases are due to "male factor" of all infertility[5]. Moreover, the fertility rate in men younger than age 30 years has also decreased worldwide by 15%.[6] As per the WHO, the overall prevalence of primary infertility ranges between 3.9% and 16.8%[7].Over 25% of infertility cases in India has no detectable cause & can be considered as unexplained infertility[8]
Etio-pathology of male infertility:
European Association of Urologists has mentioned various diagnosis of male infertility. Male infertility is classified as Idiopathic (48.5%), Idiopathic abnormal semen analysis (26.4%), Varicocele(12.4%), Infection (6.6%), Immunologic factor (3.1%), other abnormalities (3.0%), Acquired factor (2.6%), Congenital anomaly (2.1%), coital factor (1.7%), Endocrine abnormality (0.6%).[9]In this report idiopathic causes or diagnosis has major share in the list. In the latest report in 2014 also, it is found that 30 – 40 % of cases are of idiopathic male infertility[10].Idiopathic is an adjective used primarily in medicine, meaning arising spontaneously or from an obscure or unknown cause. It shows that there are some factors which cause infertility but are currently unknown to the medical fraternity.
W.H.O. multi-centric studies of infertility in India revealed that 40 percent of women and 73 percent of men had no demonstrable cause of infertility[11].
The known risk factors for male infertility are smoking, tobacco chewing, alcohol consumption, over usage or misuse of drugs such as chemotherapy or the anabolic steroids, wearing tight undergarments, working near hot places, taking extremely hot and long baths etc. These factors are already proved & hence care about these factors is advised in preventive andrology. There is need to enlighten more risk factors if any, in the light of Āyurveda theories.
Strength of Āyurveda approach:
Āyurveda concepts can play a key role to understand the cause of infertility. According to Āyurveda, Ŗtu, Kşetra, Ambu and Bīja i.e. Śukra & Śoņita are the factors responsible for conception. All these factors should be in the state of normalcy for proper conception and normal development of fetus.  Abnormalities in one or all above mentioned factors may lead to infertility[12].
Various Śukravikŗtīs are mentioned in Āyurveda classics. Amongst all of them Śukra Duşţī, Śukra Kşaya, Śukra Rodha, Śukra Apravŗttī are commonly seen in today’s society. It is need of hour to study Hetus of Śukravikŗtī in detail; so that appropriate treatment of the same can be done. After the review of the previous works, it was found that focus was on interventional studies than core work on pathogenesis considering the relation between Hetu of male infertility. Though work on disease management is important but study on etio-pathogenesis is also equally important. Hence comprehensive study of Hetus of Śukravikŗtī in male infertility was planned for this study.

Hypothesis:
Śukravikŗtīkara Hetus mentioned in Bŗhattrayī are associated with male infertility


AIM AND OBJECTIVES:
Aim:
To study the association of Śukravikŗtīkara Hetus in male infertility
Objectives:
1.   To study the effect of Śukravikŗtīkara Hetus on pathogenesis of male infertility on literary basis
2.   To validate the observations of literary study with the data generated from survey study
METHODOLOGY:
Study design:
This is an observational case-control study comparing presence of Śukravikŗtīkara Hetus in patients of male infertility and fertile men.
The methods adopted for this study has been divided into 4 steps. In first step literature study has been carried out regarding Śukra, Śukravikŗtī, and male infertility. Case Record Form (CRF) has been designed in second step. Then in next step actual survey has been carried out. In this survey study patients were examined with the help of CRF and investigations of semen in laboratory and by Śukra Parīkşā by Āyurveda Methods. In the fourth step data was organized and analyzed with the help of statistical methods in purview of aim and objectives. Observations were noted and results were drawn.
1.   Literature Study:
Detailed review of literature has been done as per following points
a.    Hand-search: Extensive review of Bŗhattrayī with the necessary part of commentaries, text books on anatomy, physiology, pathology and medicines and other allied literature was done. Scattered references of Śukravikŗtīkara Hetus like Śukraghna, Avŗşya, Punstopaghātakara and male infertility have been compiled.
b.   Electronic search: Software’s like AyuSoft, Ayuta Nidan and various database websites like AYUSH portal, Dharaonline portal was extensively reviewed for keywords related to Śukra, Śukravikŗtī and male infertility. The appropriate data have been collected. 
c.    Research Papers: 177 research papers &previous works done for MD & PhD in Āyurveda related to causes and pathogenesis of male infertility, abnormalities in semen, spermatogenesis, sexual inadequacy, Oligospermia, Azoospermia, Premature Ejaculation and Śukra Duşţī, Śukra Kşaya have been reviewed through print and electronic media.
d.   Expert Guidance: Ten experts in the field of Āyurveda, research and infertility have been consulted and their guidance regarding carrying out this work has been taken. After completion of survey, guidance of two experts has been taken for analysis and interpretation of the data generated from survey.
2.   Development of Case Record Form (CRF): A draft CRF was developed on the basis of the data collected from literary study. It was pretested on 5 patients. Then it was finalized after required modifications.
          The variables used for data collection are as follows:
·         Demographic: Age, BMI, Occupation, Nature of work, Type of work, Education, Socio-economic status, Religion
·         Daśavidha Parīkşā: Prakŗtī, Vikŗtī, Sāra, Sahanana, Pramāņa, Sātmya, Satva, Āhāraśakti (Abhyavaraņa & Jaraņa),Vyāyāmaśakti, Vaya, Agni
·         Hot/cold water bath, Sleep etc
·         Diet related: Madhura Sevana, Amla Sevana, Lavaņa Sevana, Kaţu Sevana, Tikta Sevana, Kaşāya Sevana, Viruddhānna, Paryuşita, Hotel food, Junk Food, Bakery Items, Consumption  of  water, Tea, Coffee, Milk, Meals timings
·         Mala Related: Mala, Mūtra, Sveda Pravŗittī
·         Addictions: Smoking, Tobacco, Alcohol, Other
·         Mānasa Related: Cintā, Krodha, Bhaya, Śoka, Other
·         Maithuna Related: H/O Masturbation, relation with wife, Diva Maithuna, Duration between food & coitus, Freq. of coitus
·         Semen Analysis: Abstinence, Volume, Appearance, Leqification Time, Viscosity, (Ph) Reaction, Fructose, Sperm count, Motility (% and grades), Pus cells, RBC, abnormal forms.ŚukraParīkşā by Āyurveda method.
Operational Definitions:
The operational definitions which are used for this were included in the thesis. A few of them are mentioned in Table-1.
Table -1: Operational Definitions
Variables
Operational Definitions
Āhāra related Hetu
Ati Madhura, Ati Amla, Lavaņa, Kaţu,Tikta, Kaşāya Rasa Sevana
Consumption of food having that particular tastes, combined or separate, for more than 60 Annakāla/month (67%) in moderate quantity.
Viruddha Anna Sevana,  Vidāhi Anna Sevana, Kşāra Sevana, Rūkşa Anna Sevana
Consumption of such food, combined or separate, for more than 60 Annakāla/month (67%) in moderate quantity.
Maithuna related Hetu
Ati Maithuna
Intercourse for >3times/week is considered as Ati Maithuna irrespective of season.
H/O. masturbation>3times/week is considered Shukra Vega Udirana.
Divā Maithuna
Day time intercourse is considered as Divā Maithuna
Ajīrņe Maithuna
Interval between consumption of food(lunch/dinner) and intercourse if less than 2 hours, it is considered as Ajīrņe Maithuna
Mānasa related Hetu
Cintā,  Śoka, Bhaya, Krodha
It is considered positive if patient gives answer ‘Yes’ for more than 60 percent questions related to Physcological condition.
Śukra Parīkşā
Colour (Sphaţikābha/ Vivarņa)
Colour of the sample if matches with the alum cube (as standard) then it is considered as normal. Yellowish white or greenish white or any other colour is considered as Vivarņa type of Śukra Duşţī.
Dravatā / Granthibhùta Śukra
Consistency of the sample is observed to access the Dravatā, It is done by tilting the test tube containing sample. Liqification time 20 to 40 min is considered as normal. If Liqification time is > 40 min. it is considered as Granthibhùta.
Snigdhatā / Picchilatā
It is done by pouring the sample with dropper; if it falls drop by drop then it is considered as normal. If thread is formed it is considered as abnormal.(Picchila)
Mādhurya
If fructose is present in semen analysis, it is considered as normal
Madhu Gandha
Seminal odour is considered as normal
Kşīņa Śukra
If volume of the semen is less than 1.5 ml it is considered as Kşīņa Śukra
Tanu Śukra
If Liqification time is less than 30 min. and sperm count is less than 20 million/ml
Phenila
Bubbles in semen are generated with aquarium bubbler for 30 seconds. If size of froth increases more than 1 cm and froth remains for 5 min., it is considered as Phenila type of Śukra Duşţī.
Anya Dhātu Saşiśţha
In semen sample if R.B.C. or epithelial cells are found it is considered as Anya Dhātu Saşŗiśţa Śukra Duşţī


3.   Survey study:
Settings:
Bharati Vidyapeeth Medical Foundation’s Ayurved Hospital, Pune; Pune based infertility clinics & Glo –Vision Pathology Lab, Pune.
Groups:
For the comparison, it was designed as Case & Control type study. Fertile males were taken as control and named as Group-I. Male patients who were suffering from infertility with known diagnosis in modern medicine were grouped under Group-II. Patients of male infertility without known diagnosis in modern medicine i.e. functional or unexplained infertility were considered under Group-III.
Ethical Clearance:
As per the ICMR guidelines for Ethical Research, the proposal of this study was presented before ‘Institutional Ethics Committee’ (IEC), BVDU, College of Ayurved, Pune and work was started after IEC approval. (Dated: 06/01/2011)
Sample size:
Sample size was 90. 60 patients of infertility were divided into two groups as 30 patients of infertility with known cause (Gr.-II) & 30 patients of unexplained infertility (Gr.-III). 30 healthy fertile individuals have been taken as control group (Gr.-I)
Inclusion Criteria:
Married male patients of age group between 25 to 50 years, and whose female partners are normal as far as fertility is concerned, were included in the study. For control group fertile healthy individuals of same age group have been included.
Exclusion Criteria:
Patients who were suffering from major systemic & chronic disorders were excluded from the study.
Study Population:
Total 195 patients were screened. Out of these 103 (Cases & Control) patients befitted the study criteria. 90 patients out of these were enrolled in the study after their informed consent. Random numbering & bar-coding method was adopted to assure the two layer confidentiality of the participants.
Survey Study:
Included patients were examined with the help of CRF. The information was noted in the form. Then patients were posted for semen analysis.
Semen Examination:
All patients were given clear oral instructions regarding Standard Operating Procedures (SOP)of collection of sample. Semen examination was carried out in the lab as per standard method. For examination of Śukra by Āyurveda method criteria was finalized on the basis of the methods adopted by the scholars in the previous research works.[13],[14]
Analysis:
The data collected from the survey study was compiled, tabulated and analyzed in the view of aim and objectives of study by using Odds Ratio (OR) for specific Hetu & Chi-Square test for categorical variables. This data was cross checked with the help of observations of literary study.
OBSERVATIONS AND RESULTS:
Literature Study: After the thorough study various Śukravikŗtīkara Hetus have been complied. They are classified under –
§  Āhāriya Hetus: Ati Amla Sevana, Ati Kaţu Rasa Sevana, Rūkşa Āhāra Sevana etc.  
§  Vihāriya Hetus: Atimaithuna, Duşţayoni Maithuna, Ayoni Maithuna, Tirayak Yoni Maithuna, Jāgaraņa etc
§  Mānasa Hetus: Cintā, Krodha, Bhaya, Śoka, Irşya
§  Other Hetus: As a Upadrava of Sahaja Arśa, Kşatakşīņa,  Duşivişa
§  Auşadha etc like Kşāra Sevana, Yavakshāra Sevana
Causes of Male Infertility: Sperm Factors, Environmental Factors, Social Factors, Stress Factors. The details have been expounded in the thesis.
Survey Study: Observations in the survey study were organized, analyzed, evaluated.  These observations are mentioned in detail in the thesis.



Method of Statistical analysis:
Ø  This study is case – control type study. Possible causative factors in patients of infertility compared to fertile male were observed in this study.
Ø  Proportion of outcome (Infertility) to exposure (specific Hetu) was studied using Odds Ratio (OR)
Ø  Gr.-II & Gr.-III are of infertile males. Both these groups has clubbed for the purpose of comparing infertile males versus fertile males.
Ø  Interpretation of OR:
          OR > 1- Exposure is associated with higher odds of outcome (significant)
          OR = 1- Exposure does not affect odds of outcome
          OR < 1- Exposure associated with lower odds of outcome
Factors which are found significant are noted in the Table- 2. There are various factors which are not found significant in the study, are mentioned in the thesis.
Table -2: Observations of the Survey study
Variables
Fertile
Gr. I
n=30(%*)
Infertile
(Known Cause)
Gr. II
n=30 (%*)
Infertile
(Unknown Cause)
Gr. III
n=30 (%*)
Odds  Ratio
95% CI
Āhāra related Hetu



Amla Rasa
17 (57)
17 (57)
18 (60)
1.07
0.44 –2.60
Lavaņa Rasa
16 (53)
20 (67)
19 (63)
1.63
0.67 – 3.97
Kaţu Rasa
15 (50)
21 (70)
22 (73)
2.53
1.02 – 6.28
Tikta Rasa
08 (27)
10 (33)
08 (27)
1.18
0.44 – 3.14
Viruddha Anna Sevana
21 (70)
23 (77)
21 (70)
1.18
0.45–3.10
Vidāhi Anna Sevana
16 (53)
18 (60)
18 (60)
1.31
0.54 – 3.18
Kşāra Sevana
16 (53)
20 (67)
19 (63)
1.21
0.49 – 3.00
Rūkşa Anna Sevana
14 (47)
22 (73)
19 (63)
2.47
1.00 – 6.07



Maithuna related Hetu



Ati Maithuna
22 (73)
24 (80)
24 (80)
1.45
0.52 – 4.06
H/O Śukra Vegodiraņa
12 (40)
18 (60)
17 (57)
2.10
0.86 – 5.13
Divā Maithuna
10 (33)
11 (37)
11 (37)
1.16
0.46 – 2.91
Ajīrņe Maithuna
22 (73)
24 (80)
23 (77)
1.31
0.48 – 3.63



Mānasa related Hetu



Cintā
20(67)
29 (97)
28 (93)
9.50
2.37-38.03
Śoka
14 (47)
19 (63)
18 (60)
1.34
0.54 – 3.33
Bhaya
14 (47)
27 (90)
23 (77) 
5.71
2.13 –15.34
Krodha
21 (70)
23 (77)
23 (77)
1.41
0.53 - 3.77
(*percentage is rounded to nearest whole number)
The observations of semen analysis and Śukra Parīkşā are noted in Table -3

Table -3: Semen Analysis
Variables
Fertile
Gr. I
n=30(%*)
Infertile
(Known Cause)
Gr. II
n=30 (%*)
Infertile
(Unknown Cause)
Gr. III
n=30 (%*)
Semen Analysis

Oligospermia
-
23 (77)
-
Asthenozoospermia
-
06 (20)
-
Azoospermia
-
01 (03)
-
Abnormal forms of sperm
-
02 (07)
-

Śukra Parīkşā

Abnormal Colour

Yellowish White
-
03 (10)
04 (13)
Greenish White
-
03 (10)
02 (07)
Abnormal Snigdhatā (Picchilatā)
-
04 (13)
01 (03)
Abnormal Rasa
(Fructose Absent)
-
02 (07)
01 (03)
Abnormal Gandha
-
01 (03)
04(13)

DISCUSSION:
It is revealed in this study thatvarious Śukravikŗtīkara Hetus mentioned in Āyurveda  classics are found associated with male infertility.

Āhāriya Hetu:
Kaţu Rasa Sevana:
It is found in the survey that consumption of Kaţu Rasa is found in50 % cases in Gr. I, 70 % in Gr. II & 73 % cases in Gr. III.  This difference is found to be significantly associated with infertility after applying odds ratio test (OR - 2.53). Kaţu Rasa due to its Kaţu Vipāka reduces fertility. Due to its Uşņa property it dries up the Drava Bhāva in the body leading to reduction in Saumya property of Śukra. Eventually it causes Śukra Duşţī. The effect of Kaţu Rasa is long lasting& fatal. It is so fatal that it can be transformed into next generation[15].
Amla (OR-1.07), Lavaņa (OR-1.63), Tikta Rasa (OR-1.18) are also found associated with the infertility in this study, but its lower values are less than 1 at 95% confidence interval.

Ati Rūkşa Āhāra Sevana:
In this study it is revealed that 47 % cases in Gr. I, 73 % in Gr. II & 63 % cases in Gr. III consumes of Rūkşa Āhāra. This is found associated with infertility after application of Odds Ratio (2.47). Rūkşa Guņa vitiates Vāta and reduces Kapha Doşa. It dries up the Dhātus by Śoşana of the Dravāśa. As this Rūkşa Guņa is opposite to that of the Śuddha Śukra Guņas like Snigdha, Picchila etc. Ati Rūkşa Sevana causes Śukra Duşţī and also reduces the sexual strength. Rūkşa Dravyas are consists of Vāyu & Agni Mahābhūta. These are opposite to the qualities of Śukra. It dries up the Dhātus, reduces Bala and Varņa of the Śarīra[16].It finally leads to Viśuşka and Kşīņa Retas. The Rūkşa Guņa along with Uşņa Guņa causes Āśu Śukra Duşţī.
Vihāriya Hetu:
Ati Maithuna:
In the survey it is observed that 73 % patients in Gr-I, 80% in Gr.II & III are indulging excessive sexual intercourse. It is found associated significantly. (OR-1.45). Season wise frequency of Maithuna has been specified in Āyurveda classics[17]. In this survey it is found that, patients are not aware of such rules. Excessive indulgence in sexual intercourse directly leads to Śukra Kşaya[18]. As Ativyavāya leads to Śukra and Oja Kşaya which are the Sneha of the body, leads to the aggravation or vitiation of Vāta Doşa. This further leads to Pratiloma Gati Kşaya of the remaining Dhātus, which may further hampers the Śukrotpatti. Thus Ati Maihuna leads to Śukra Kşaya and eventually causes infertility.
Mānasa Hetu:
Stress developed due to Cintā (worry), Śoka (grief), Krodha (anger), Bhaya (fear), Irşya (jealousy) is one of the leading causes of infertility. It was observed in the survey study that Cintā & Bhaya induced stress has been found in maximum patients. These Mānasa Hetus are responsible for Śukra Kşaya[19]. Cintā, Bhaya, Śoka & Krodha was found significant in infertility after applying Odds Ratio. Cintā (9.50) followed by Bhaya (5.71) are found more significant at 95% Confidence Interval than Śoka & Krodha. In today’s competitive world everybody has stress. Stress is found in fertile group also as far as this study is concerned, but the stress found in infertile cases was of severe type (hampering their daily routine), whereas in fertile group it was moderate type.
Much research in the field of medicine has focused on the change of sperm quality in men exposed to stress induced by fear, anxiety, worries etc. Collodel G stated that stress is an additional risk factor for idiopathic infertility[20].
Krodha, Śoka, Bhaya & Cintā lead to vitiation of Pitta and Vāta, which causes Rasa-Rakta Duşţī. Duşita Rakta gets lodged in Śukravaha Srotas that result in Śukravaha Srotoduşţī, which finally leads to Śukra Vikŗtī[21].
Śukra Vikŗtī Lakşaņa:
Mukhaśoşa(10%) followed by Gātrasāda(7%) and Timīradarśana (7%) in Gr.-I, Maithuna Aśakti(20%) followed by Mukhaśoşa (17%) in Gr.-II, and Mukhaśoşa (20%) followed by Maithuna Aśakti (13%) Daurbalya (13%) Gātrasāda (13%) in Gr.-III were found in the survey study.
Semen Analysis:
In the survey it was found in Gr. II, that 77% cases were suffering from Oligospermia, 20% patients were of Asthenozoospermia, 1 patient (3%) was of Azospermia and 2 patients(7%) were of abnormal forms of sperm.
As per Āyurveda Śukra Parikşā it was found in the study that yellowish white colour of semen in 10% cases in Gr.-II, & 13% in Gr.-III whereas greenish white colour of semen in 10%cases in Gr.-II& 7% in Gr.-III. Dravatā was normal in all the cases. Picchilatā was found in 13% cases in Gr.-II & 3% in Gr.-III.  Madhura Rasa was found absent in 7% cases in Gr.-II & 3% in Gr.-III. Madhu Gandha was absent in only 1 patient (3%) in Gr.-II & 4 patients (13%) in Gr.-III




In a Nut Shell:
1.   Literary review shows that Śukravikŗtīkara Hetus mentioned in Āyurveda classics are linked with pathogenesis of male infertility.
2.   As per this survey study consumption of Ati Amla (1.07), Lavaņa(1.63), Kaţu(2.53), Tikta Rasa(1.18), Viruddha Āhāra(1.18), Rūkşa Āhāra (2.47), Kşāra Sevana (1.21)is found associated in Śukravikŗtī.
3.   Vihāriya Hetus like Ati Maithuna (1.45), Ajīrņe Maithuna (1.31), Divā Maithuna (1.16), Śukra Vegodiraņa (2.10) are found associated with male infertility in this survey study.
4.   Stress developed due to Cintā (9.50), Śoka (1.34), Bhaya(5.71), Krodha (1.41) are leading causes of infertility. It was observed in the survey study that Cintā induced stress has been found in maximum patients followed by Bhaya induced stress.
5.   This study shows that Āhāriya & Vihāriya Hetus along with Cintā, & Bhaya are contributing factor for development of infertility.
6.   This study shows that infertility should be considered as a psychosomatic entirety.
7.   Amongst all above Hetus, Cintā (9.50) & Bhaya (5.71), Kaţu (2.53) & Rūkşa Āhāra Sevana(2.47) are found significant at 95% Confidence Interval.

CONCLUSION:                                                      
Cintā (9.50) & Bhaya (5.71) along with Kaţu (2.53) & Rūkşa (2.47) Āhāra Sevana are associated with male infertility.




KEY REFERENCES:


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