FORTEGE IN MALE INFERTILITY DUE TO OLIGOSPERMIA*
(Trial with a Non-hormonal Ayurvedic Drug in Infertile Couples)
JAGADISAN, M.s., M.ch. (Urology),
Professor of Surgery and Urology, Head of the Dept. of Urology,
M. SATYANARAYAN, M:s., M.ch. (Urology),
SIVAJI, M.B., B.S., Post-graduate
VIJAYAN, M.B., B.S., AND SHAMALA, M.38., B.S., D G.O.,
{ Dept. of Urology, Stanley Medical Collge & Hospital, Madras. }
The Antiseptic vol 78 No 12, Dec 1981
INTRODUCTION:— Male infertility is one of the main contributory factors for sterile marriages. This fact is now receiving its due recognition and greater attention. As such, it has become a routine practice now to examine and investigate both the partners in a barren marriage.
Oligospermia should be more appropriately termed as ‘oligo-zoospermia due to unknown origin’. It is accepted that certain etiological factors like (1) Chromosomal aberrations, (2) Diabetes,(3) Virus diseases like mumps causing orchitis especially at young age, and (4) certain conditions like varicocele, hydrocele, surgery for inguinal hernia are responsible for oligospermia. Above all, deficiencies of certain hormones, like folicule stimulating hormone (FSH) and luteinizing hormone (LH) may be responsible for oligospermia though fortunately the incidence is extremely rare. Treatment of Oligospermia with hormones is empirical and has met with poor response, besides the possibility of adverse effects of these hormones
Fortege
Each tablet of fortege contains
| Jeevanti (Leptadenia reticulata) .. | 56.5 mg |
| Kamboji (Breynia patens) .. | 56.0 mg |
| Kavncha beej (Mucuna pruriens) .. | 30.0 mg |
| Sudha Kachura (Curcuma zedoaria) … | 30.0 mg |
| Samudra Sosh beej_ .. | 15.0 mg |
| Vardhara bee] (Argyria speciosa) .. | 15.0 mg |
| Asan (Withania somnifera) .. | 15.0 mg |
| Vardhara mool (Argyria speciosa) =… | 15.0 mg |
| Laving (Myrtus Caryophyllus arcmaticvs) | 7.5 mg |
| Piper (Piper longum) | 7.5 mg |
| Vacha (Acorus calamus) | 7.5 mg |
| Mari (Piper nigrum) – | 7.5 mg |
| Sunth (Zinviber Officinale) .. | 7.5 mg |
| Chini kabab (Cubebs Officinalis) — | 7.5 mg |
| Akalakara (Anocycutus pyrethrum) …. | 7.5 mg |
| Sukhad ver (Santalum album) | 7.5 mg |
| Jaifal (Myristica fragrans) . | 4.5 mg |
| Javantri (Arillus surrounding the seeds of Myristica fragrans) | 3.0 mg |
In the present clinical study, we have chosen Fortege* (a non-hormonal ayurvedic drug) to treat cases of oligospermia in couple infertility
It is claimed that Fortege is capable of toning up the genito-urinary and neuroglandular systems. It is supposed to overcome fatigue, (nervous, muscular and sexual) lt is mentioned that Fortege increases the quality and quantity of semen, correct sperm defects if any, and improves sexual performance for better and proper insemination. Unlike hormonal drugs, no adverse effects have been observed.
Material and methods.—This study was conducted at theGovernment Stanley Hospital, Madras during the period 1979-81. Semen analysis was done in all infertile couples; those cases where semen analysis was normal, were left out of the study. Cases of oligospermia and azoospermia were recorded. Finally, only those cases of oligospermia with normal motility and with low motility, were taken up for treatment with Fortege. Cases of oligospermia waving varicocele, hydrocele, lympangiocele, and those suffering
“rom systemic diseases such as tuberculosis, diabetes, were excluded from the trial.
Fortege was given regularly to the male partner for six months and at the end of this period repeat semen analysis was done and results were analyzed. Another repeat semen analysis was made
after three months of observation, as a follow-up to see if there was any significant deviation in the results obtained through Fortege treatment had been stopped.
Age groups:—Tne age groups of the men in the infertile couples under investigation ranged from 30 yrs.—40 yrs.
Duration of Burren married life:—The duration of barren married life in these infertile couples ranged from 6 years to 14 years.
Semen analysis:—Semen analysis was done in all-male partners of the infertile couples. Semen collection was done at the pathological Laboratory of Stanley Hospital and was examined within one hour of collection. Abstinence from sex for three days or to the semen collection and examination was advised. This procedure was also followed for repeat semen examinations.
A sperm count to 30 million/ ml and over was taken as normal. Motility of 60% and over was taken normal motility. Abnormal forms of sperm up to 20% and the quantity of 2-3 ml of ejaculate were taken as normals. Semen analysis was done in 416 couples. Out of this semen, the report was normal in 251 men (60.3%) and the report of 165 men (39.7%) showed that they had oligospermia (28.2%) or azoospermia (11.5%)
TABLE I
Showing Semen Analysis
| Semen | No of Cases | % |
| Normal Semen (30 million/ml & over, motility 60%& over | 251 | 60.3% |
| Oligospermia (less than 30 millions/ml) | 117 | 28.02% |
| Azzospermia | 48 | 11.5% |
Testicular “biopsy, oligospermia and azoospermia:—Testicular biopsy was done in cases of azoospermia. A biopsy was done on one testis only and it was diagnostic. Among 165 cases of abnormal semen report, there were 48 cases of azoospermia. Out of these cases, 12 cases (7:3%) had obstructive pathology and 36 cases (21:8%) had non-obstructive azoospermia due to germinal cell aplasia.
Cases of azoospermia with obstructive pathology were advised surgical measures. However, all cases of azoospermia were excluded from the Fortege trial. Semen examination was not repeated in these cases.
There were [17 -cases of oligospermia. Of these, 66 cases (40%) had oligospermia (less than 30 million/ml.), but motility was normal (60% and over). 12 cases (7:3%) had oligospermia wit motility less than normal and 39 cases (23.6%), had oligospermia associated with conditions like- varicocele, hydrocele, lymphangiocele, or a systemic disease like tuberculosis, diabetes, etc. All these cases were excluded from the Fortege trial. Fortege trial could finally ba conducted only on 78 cases of oligospermia. (Table II).
TABLE II
Showing the causes of oligospermia and Azoospermia N = 165
| Semen Report | Cases include in Fortege Trial | % | Cases excluded from Fortege Trial | % |
| Oligospermia with normal motility | 66 | 40.0% | – | – |
| Oligospermia with low motility | 12 | 7.3% | – | – |
| Oligospermia associated with varicocele hydrocele,lymphangiocele, etc and TB, Diabetes, etc | – | – | 39 | 23.6% |
| Azoospermia (Non-Obstructive) | – | – | 36 | 21.8% |
| Azoospermia (Obstructive) | – | – | 12 | 7.3% |
The dose of Fortege:—Fortege was given in a dose of two tablets thrice a day, for a period of six months after the first semen examination. Results were analyzed regarding the response to Fortege after a repeat semen examination.
Results of fortege treatment in cases of oligospermia: —Assessment of response to Fortege in cases of oligospermia was made after six months of treatment and repeat semen examination. Among 66 cases of oligospermia with normal motility, the semen count increased to 50-60 million/ml. in 55 cases (83 3%), and there was no appreciable improvement in 11 cases, (16.7%).
Of 12 cases of oligospermia with low motility, in 9 Cases 75.0%) the sperm count increased to 50-60 million/ml. and the motility to 50-60%; the improvement was not appreciable in 3 cases 25.0%.
The overall response to Fortege therapy in 78 cases of oligospermia: Improvement in 64 cases (82:1%) and no improvement in 14 cases (17.9%). For the purpose of improvement with Fortege treatment, a minimum of 50-60 million/ml. of sperm count and 50-60% of motile sperms were taken as the criteria.
TABLE III
Showing the results of fortege therapy in oligospermia N = 78
| Oligospermia | No of cases | Improved | % | Not Improved | % |
| Oligospermia with normal motility | 66 | 55 | 83.0% | 11 | 16.7% |
| Oligospermia with low motility | 12 | 9 | 75.0% | 3 | 25.0% |
| Total | 78 | 64 | 82.1% | 14 | 17.9% |
Conclusions.—In male infertility, the major factors are a low sperm count and a large number of sperms of low motility. Treatment with Fortege improved both these conditions in the majority of cases.
As a follow-up, after three months of observation, a second repeat semen examination was done to find out if there was any deviation from the improvement already shown. This repeat semen examination showed that the improvement was sustained, both as to sperm count and motility.
Male infertility is almost as common as female sterility in barren marriages. Use of Fortege in cases of low motility (even with normal sperm count) and in oligospermia will be beneficial. Fortege improves sex performance for proper insemination, improves general health and gives a sense of well being.
Side effects:—No side effects were observed with the use of Fortege.
Acknowledgment – I am thankful to the Director of Medical Education Tamil Nadu, for obtaining necessary Government permission to conduct this trial, and to the Dean, Stanley Medical College and Hospital for affording necessary laboratory facilities.
I am also thankful to Alarsin Pharmaceutical, Bombay and to Mr. Thirugnanamurthy of that firm for their co-operation.
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