Introduction

Dating back to the Vedic period, the pursuit of having healthy children has been held in high regard and esteemed as a significant ideal.

प्रीतिर्बलंसुखंवृत्तिर्विस्तारोविपुलंकुलम्||२१||
यशोलोकाःसुखोदर्कास्तुष्टिश्चापत्यसंश्रिताः| (च. चि २-१:२१)

Fertility has been an essential aspect of existence since ancient times. The key factors involved in conception include Ritu (reproductive age and ovulation period), Kshetra (female reproductive tract), Ambu (nutritional factors), and Bija (sperm and ovum). Successful conception relies on the proper functioning of the reproductive system; any dysfunction can lead to infertility. Ayurvedic texts indicate that reproduction is governed by Shukra dhatu. Ksheena Shukra is one of the eight types of Shukradushti outlined in these texts and is classified as a Vata Pittaja Vyadhi,^[1] predominantly affecting individuals in the Madhyama Vayas age group. This condition, stemming from the Apana Vata province, renders a person incapable of conceiving with their partner, resulting in infertility. An individual with Shukra dusti cannot achieve their Chaturvidha Purusartha. Ksheena Shukra is a specific type of Shukradusti.

Ksheena Shukra bears resemblance to Oligozoospermia, a condition where sperm count is below 15 million/ml. Shukra is regarded as the fundamental essence of all seven Dhatus, with its primary role being Garbhotpatti.^[2] The status of Shukra significantly influences factors such as Dhairya, Preeti, Dehabala, and various psychosomatic elements.^[3] In Ksheena Shukra, both the quantity and quality of Shukra Dhatu are impaired, while Oligozoospermia specifically refers to a reduction in sperm count. Ksheena Shukra is classified as one of the eight types of Shukradushti in classical literature and is identified as a Vata Pittaja Vyadhi,^[4] more prevalent in those of Madhyama Vayas. This condition originates from the Apana Vata region, preventing individuals from conceiving with their partners and resulting in infertility. Ksheena Shukra (Oligospermia) has been selected for this study to generate objective and quantitative data, such as sperm count and motility, which will enhance the clarity and scientific acceptance of the findings. Ayurvedic texts highlight the treatment of Ksheena Shukra as Upachaya of Shukra Dhatu,^[5]

2. Patients who fulfil the diagnostic criteria.
3. Patients from any religion, occupation or any socio-economic class.
4. Patients willing to participate in the study and ready to sign the informed consent form.

Exclusion Criteria:

1. Male patients with absolute Azoospermia and Teratozoospermia.
2. Male patients on certain medications like antineoplastic agents (e.g., Nitrogen mustard, procarbazine, vincristine, methotrexate), cimetidine, oestrogen and methyltestosterone.
3. Patients having chromosomal disorders like Klinefelter’s Syndrome.
4. Patients suffering from major systemic disorders like Tuberculosis, AIDS and Sexually Transmitted Diseases (STD) & other gonadal disorders like Testicular Atrophy, Testicular Failure, Orchitis which may interfere with study will be excluded.
5. Patients having any anatomical deformity in gonads (e.g., Cryptorchidism, Monorchidism)

Subjective Parameters:

1. Bhrama
2. Sadana
3. Dourbalya
4. Pandutva

Objective Parameters:

1. Semen Volume
2. Seminal pH
3. Liquefaction Time
4. Sperm Count

Intervention:

Table 1: Intervention

Investigation: Semen Analysis / Seminogram

Observation Period: The patients were assessed clinically on the baseline 0^th day and during the treatment on 31^st and after the treatment on 61^st day and 76^th day.

Follow Up: The follow up of patient was done on 76^th day, i.e., 15 days after study duration.

Table 4: Effectiveness of Trial drug before and after on the Semen Volume

Table 5: Effectiveness of Trial drug before and after on the Liquefaction Time

Table 6: Effectiveness of Trial drug before and after on the Semen pH

Ghrita might have corrected the metabolism at Dhatvagni level due to its Vanhimandyapranashana property, while the Medhya and Rasayana property of Ashwagandha probably enhanced the hypothalamic-pituitary-testicular axis which further helped in maintaining the physiology of testicular tissues leading to increase of semen volume.

On Semen pH: There was statistically significant difference between Semen pH values before treatment and after treatment with p < 0.001 in paired-t test. All the drugs possess antioxidant property and this might be the reason for the reduction of ROS and oxidative stress at testicular level further result in the maintenance of pH.

Probable mode of action of the drug:

Table 8: Ingredients of the trial drug along with their properties.

Conclusion

In this study, Mashadi Ghrita was considered as the trial drug for the management of Ksheena Shukra (Oligospermia). After the treatment there was statistically significant improvement in the objective parameters, while the subjective parameters didn’t show much improvement.