A Case Study Based on a Complementary and Alternative Medicine Approach on an Oligoasthenoteratozoospermic Patient and its Effect on Assisted Reproductive Technology Outcome

ABSTRACT

A couple visited the IVF clinic to seek treatment for primary infertility. A 45-year-old quadragenarian female and her 49-year-old male partner were recommended infertility treatment after 2 years of unsuccessful attempts to conceive. The woman had a recent history of dengue and chickenpox. The male partner was advised to do a semen analysis. The report showed asthenoteratozoospermia and the semen sample viscous. On the other hand, the female was diagnosed with hypothyroidism. The male patient was given a 3-month medication treatment that included probiotic supplements and cranberry juice to treat bacterial infections and urinary tract infections. The male partner also advised medication, and regular semen analysis was performed after every 3 months. The treatment plan included intrauterine insemination (IUI), which increased the possibility of pregnancy. Fourteen days following the IUI and pregnancy test, the outcomes were positive. The case illustrates the difficulties in treating primary infertility by combining reproductive procedures, medication, and lifestyle modifications. Regularly monitoring semen quality and hormonal levels is crucial in assessing treatment success. The positive outcome of IUI suggests the effectiveness of the fertility treatment plan.

INTRODUCTION

Infertility is defined as the breakdown of a male and female partner to conceive after enrolling in constant and unprotected sexual movement for more than a year. Oligoasthenoteratozoospermia is described as a low number of sperms, count, and motility and an abnormal form of spermatozoa present in ejaculation.[1] It affects both men and women and can result from factors such as age, hormone imbalances, or reproductive system abnormalities. Highly active thyroid functions lead to thyroid hormone production as a sign of hypothyroidism. The symptoms such as allergy, weight gain, irregular menstruation, and autoimmune thyroiditis can be the outcome of iodine deficiency, drugs, and congenital causes.[2] Hypothyroidism harmfully impacts fertility in both sexes, with men experiencing abnormal sperm production and women facing disruption to their menstrual cycle and ovulation. FSH increases the production of eggs and sperm, LH initiates ovulation, and AMH indicates ovarian reserve. Analysis of these hormones supplies information on ovarian function, fertility, and the efficiency of treatments.[3] In semen analysis, sperm motility, quantity, and morphology were examined. A patient’s conception may be impacted by their genes, lifestyle, and hormonal disorders. Agar plates indicate microorganisms in microbial culture. Both uncertain and benign species of Bacillus can cause infections. While respiratory tract illnesses have been related to Klebsiella pneumonia, urinary tract disorders are caused by Staphylococcus bacteria. Microbial cultures suggest information about the best antibiotic treatment plan. Genitourinary tract infections are often asymptomatic and are linked to abnormal semen quality, making it challenging to choose the proper treatment. There are several microorganism profiles and antibiotic sensitivity patterns in semen cultures among males with primary and secondary infertility.[4]

CASE PRESENTATION

Patient medical history

A 45-year-old quadragenarian female patient and her 49-year-old male patient faced 2 years of infertility. The couple visited the ART clinic situated in the rural area of Vidarbha region. The patient’s significant health history includes chickenpox, which occurred from June 10 to July 5, 2019. The female had dengue fever. She had hypothyroidism disease; hence, the female patient was treated with hypothyroidism before 8 months of infertility treatment. The male partner was advised for semen analysis, which demonstrated to have poor parameters for reproductive processes, indicating asthenoteratozoospermia, which is defined by a low number of sperms, poor sperm movement, and aberrant sperm morphology, which was present in the semen, along with increased viscosity. The semen sample’s limited volume was the cause of its hypothermia. These results point to possible difficulties for the couple when trying for a child.

Clinical findings

The patient received the diagnosis of having primary infertility to begin treatment for pregnancy. The patient’s follicle-stimulating hormone (oestradiol) was -123.82 pg/ml in the female patient. The female patient’s level of AMH was 0.247 ng/ml, IH was 0.34 IU/L, and the FSH level was 7.9 ml/MI. Because of her elevated thyroid stimulating hormone, which was around 6.2 mU/L, the normal range of T3 was 60–180 ng/dl and T4 was 4.2 μg/dl.

Treatment

All parameters of the female were normal, and she was advised to continue levothyroxine 50 mg tablet. The male patient was advised for semen analysis. The report showed an increase in pus cells, as shown in Figure 1, and semen was highly viscous. The patient was advised to have a semen culture. The semen sample was cultured on blood agar, the Mac-Conkey agar plate was inoculated within 1 h of semen collection and incubated at 37 degrees Celsius for 24–48 hrs, and the microorganism was seen using the standard microbiological procedure in a semen sample. Then, the patient was suggested for the dosage of cranberry juice 15 ml and 400 mg twice a day orally. Probiotics medicine was taken for 3 months to reduce urinary tract infections (UTIs) and bacterial infections. The male partner was advised to check reproductive tissue every 3 months after the treatment. In the semen analysis, a puss cell was observed.

Figure 1.

Semen sample of male partner before intervention

After the 3 months, the patient was advised for semen analysis; the report showed a decrease in semen viscosity and pus cell count. The female patient was advised for an IUI procedure where good quality sperm was inseminated into the uterus of the female by using ultrasonography. Figure 2 shows sperms observed in the semen analysis.

Figure 2.

Semen sample of male partner post-intervention

Follow-up

The patient had been advised to take regular medication along with probiotics medicine and to change lifestyle modification, regular exercise, and walk to reduce the weight gain. Cranberry juice probiotics medicine was advised after undergoing a procedure of IUI. The male partner was also advised to maintain his lifestyle and diet and suggested to reduce stress. After the IUI procedure, the pregnancy was detected 10–14 days after the procedure. The result of testing a female blood sample for serum human chorionic gonadotropin (β-hCG) after 14 days was positive (811 Miu/Ml).

DISCUSSION

The purpose of this study, which Farangis Sharifi discovered, was to examine the needs of infertile women about CAM use. Research studies that address the needs of infertile women using complementary and alternative medicine (CAM) to increase or decrease their infertility are rare.[5] Suzanne C. Read stated that she analyzes the usage of CAM for infertility in a diverse healthcare environment and evaluates the causes and views of CAM use among infertility patients from the West and the non-West.[6] Skye A. Miner states that the review examines the evidence for 12 different CAM methods used to improve female and male fertility outcomes as well as their association with improving mental health outcomes during fertility treatment.[7] The presented case involves a couple experiencing primary infertility, where the female patient, a 45-year-old quadragenarian, and her 49-year-old male partner sought treatment after 2 years of unsuccessful attempts to conceive. The female’s health record included significant dengue cases, disease, and influenza, two conditions known to harm fertility. Also, the female patient’s high thyroid-stimulating hormone (TSH) levels caused the diagnosis of hypothyroidism. The study of the male partner’s semen revealed anomalies, including asthenoteratozoospermia and excessive viscosity, which were responsible for infertility issues. These results highlight the significance of thoroughly assessing both couples in infertility cases. The treatment approach involved addressing the identified issues in both partners. Anabel Starosta highlights the need for a comprehensive treatment strategy incorporating medicine, lifestyle changes, and reproductive treatments. The chance of becoming pregnant can be increased with the help of intrauterine insemination (IUI). It was decided that regular monitoring of hormone levels and the quality of the semen was essential to determining the success of the treatment.[8] This study includes the treatment of CAM on OATZ patients during IUI and the successful clinical pregnancy of the infertile patient.

CONCLUSION

This study is based on the complex interactions between several factors that lead to primary fertility loss in a married couple. Sperm motility, count, and morphology are all affected by the male partner’s oligoasthenoteratozoospermia, and the female partner’s history of dengue illness, a case of chicken and hyperthyroidism, further complicates matters. The entire fertility treatment plan comprises medication, semen exams, and direction in improving reproductive health. An all-encompassing three of four strategies for treating infertility problems include regular evaluations, hormone tracking, and antimicrobial assessments. The couple’s dedication to individualised counseling and medical guidance highlights how crucial a multidisciplinary strategy is to attaining excellent reproductive outcomes.

ADDITIONAL INFORMATION

Disclosures

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