Secondary Infertility in a Man of 35

Infertility is defined as the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. There are two kinds of infertility – primary and secondary.  Primary infertility is where the couple has never experienced a pregnancy, whereas secondary infertility means that the couple has experienced a pregnancy before and failed to conceive later.

Case details:

In this case of secondary infertility the patient walked into clinic with her reports done. She had a fibroid in her uterus. Her menses were regular and the couple had been planning for a second child for three years.  Lab work on her husband found oligospermia, so treatment was given for both of them through a constitutional approach.

Name: Mr. XYZ

Age: 35yrs

Sex: male

Religion: Hindu

Educational level: BA

Occupation : clerk

Marital status: married (since 6yrs)

DOC: 2/09/2016

CHIEF COMPLAINT:

The husband presented with the complaint of eructation, bloating of abdomen, aggravation with empty stomach in the morning

Aggravation by: fried foods

oligospermia  ( as per reports )

Premature ej-aculation (as reported by his wife )

Past history – (medical, surgical)

MEDICAL HISTORY: nothing significant

SURGICAL HISTORY:  He had undergone tonsillectomy at the age of 8 years.

PERSONAL HISTORY:

Diet:  vegetarian

Appetite and hunger: good

Thirst: thirsty

Aversion: Fruits

Thermals: chilly

Sleep: Good

LIFE SPACE INVESTIGATION:

• He always wanted to leave studies and help his mother in running the family, but his mother forced him to complete a degree and start working.
• Milestones: delayed walking, delayed speech. He did not speak till 4 age four. Now he chants all mantras so easily. (as stated by his mother)
• He always wanted his mother to accompany him while going to school (till 7^th standard), and wanted her to come with him to drop off him to school. He had been very shy child. He never participated in extra cultural activities or sports. He never even played with kids near home as they were bullying him.
• As a child he was introverted. Never used to mingled and his friends made make fun of him.
• His mother said he has respect for elders and never makes any sudden decisions. He can’t make simple decisions with asking for help. Now most of the household decisions are made by his wife. (ie. indecisive )
• His wife proposed to him twice and he said “Go and talk to my mother.”
• While taking the case he was silent; all the information was given either by his wife or mother.

His academic scores:

• He failed twice in 3^rd Standard
• 10^th standard(SSLC)– 49 %
• PUC (pre university course ) – 50 %
• BA (Bachelor of Arts) – it’s a 2 year course. He completed it in 5 years

VITALS:

Blood Pressure    – Lying Position-120/80 mm of hg

Pulse Rate           – 78bpm/ min

Weight                – 88 KGS

DIFFERENTIAL DIAGOSIS:

• Erectile dysfunction
• Premature ejaculation
• Klienfelter syndrome
• Hypogonadism
• Kartagener syndrome (Also known as immotile cilia syndrome. Ciliary dyskinesia affects the respiratory tract and spermatozoa. Patients may have a long history of sinusitis, recurrent ear infections, chronic bronchitis, or bronchiectasis.)

Final diagnosis:

• Oligospermia

CASE EVALUATION :

MIND :

• Indecisive, irresolute
• cowardice
• introverted
• Shy bashful
• Delusion: imagines he is laughed at
• Mind, talk, slow learning to

PHYSICAL GENERALS

Thermally – chilly

Aversion – fruits since childhood

CHARACTERISTIC – PARTICULAR

 Stomach eructation morning

The mind rubrics and physical rubrics were repertorized separately and both of them indicated the Baryta group. Considering his thermals and thirst the remedy selected was Baryta carbonica

PRESCRIPTION:

1. Baryta carbonica 200 2doses
2. Placebo 200 TID/15 days

FOLLOW UPS:

24/9/16- irritation in the eyes, feels cold easily, bloating has increased

Baryta carbonica 200 1 dose

9/10/16-  I explained to the couple about ovulation and the best times for conception.

Placebo 200

27/11/16- placebo was given

FINAL REPORT :

At the end of 3 months of constitutional treatment, the husband was sent for retesting. The report was normal as shown above (that is from oligospermia to normospermia). At about the same time, the couple conceived and it was a high risk pregnancy due to the wife’s age of 37. She was referred to a nearby obstetrician for further follow ups. She eventually delivered a healthy female baby by caesarian section.