Contributed by Dr.Saji
Male  aged 34 yrs Date : 14-12-11. with Infertility, one and a half yrs duration. It was a case of Oligospermia ( 17 million/ml, 50 % motility on 23-11-10 and 9 million/ml, 30% motility on 25-12-10 ) and Surgical treatment ( TVL) for varicocele ( Grade II, B/L-Manual ) was done in December 2010. After the surgery he developed Azoospermia. 
His FSH and LH levels were normal but Testosterone a bit high. Allopath advised MESA/TESE and ICSI. As those procedures are costly the patient decided to try Homoeopathy. The patient Has the habit of smoking.
lab report, treatment beforesecond, lab report



third lab report, azoospermiathird lab report , testosterone


 Investigations ( Before ) 
 1. Semen Analysis : 06/04/11 : Volume : 7.5 ml Azoospermia Fructose : 116 mg%. 
 2. Semen Analysis : 26/04/11 : Volume : 1 ml Azoospermia 
 3. Semen Analysis : 18/05/11 : Volume : 1.5 ml Azoospermia 
 4. Testosterone : 18/05/11 : 15.12 
Other syptoms on case taking were-Desires fish ;Sleep : Position, side, on right. ;Regionals : Heartburn after eating - 3-4 months duration;  Dandruff on scalp - many yrs;  Perspiration of palms and soles - many years.

Rubrics 
1.Generalities; food and drinks; fish; desires. 
2.Male, Infertility. ( 59 medicines-My Repertory ) 
3.Sleep; position; side, on; right. 
4.Head; dandruff. 
5.Extremities; perspiration; hands; palms. 
6.Stomach; heartburn; eating; after 
Repertorial Result : Phos Lyc 

 Remaining Symptoms : 
1.Extremities; perspiration; feet; soles 
2.Generalities; operations, after; deeper tissues : Phos, Lyc 
3.Generalities; contractions, stenoses; inflammation, after : Phos 
4.Toxicity, tobacco, desire for smoking (Murphy): Phos, Lyc. 
5.Emergency, wounds, chronic effects (Murphy): Phos 
The only rubric which is not covered by phos is perspiration soles. That rubric is not covered by the competing medicine ( Lyc ) too. Then look for the presence of these medicines under the concerned general rubric. ie Extremities; perspiration; feet : Phos, Lyc 
So the best choice will be Phosphorus.

But wait , Lets discuss it!      Prescription on 14/12/11 : ?
Before concluding this case let me remind you about the most important points in Azoospermia. Azoospermia in a patient with normal size testes and normal FSH suggest obstructive etiology. The sites of reproductive tract obstruction are epididymis, vas deferens and ejaculatory ducts. 
If the obstruction is at epididymis or vas deferens, the semen volume and fructose value will be normal. 
If the obstruction is at ejaculatory ducts, the semen volume and fructose value will be low. 

In this case, the patient is Azoospermic but FSH is normal - that means it is a case of Obstructive Azoospermia. In his semen analysis report, volume is almost normal and the fructose value is normal. - that means the obstruction is at the level of epididymis or vas deferens. 
The case was oligospermic before varicocele surgery and somehow or other bilateral vas deferens obstruction occured during the surgical procedure and the patient became azoospermic after surgery !! The obstruction of the vas deferens remained there as an obstruction to his recovery. As the cause was really mechanical,removal of that cause was supposed to bring him back to his pre-surgical condition. 
There are two ways for a homoeopath to remove that obstruction. 1. A physiologically acting medicine 2. A constitutional medicine. With the rubrics in the case, the repertorial choice I reached was Phosphorus. 
I decided to try the first one based on my clinical experience and was hoping to follow with the constitutional if he is oligospermic.  My prescription was Thyosinaminum 3x - 1 tab bd for 2 weeks.
I prescribed the medicine on 14/12/11 and advised him to retest after one month ( Semen Analysis ). But surprisingly he came up with a normal semen analysis !
In cases of Azoospermia, first investigation after medicine is done only after 75 days ( because, sperm formed today reaches the ejaculate only after 72-74 days. ) But, in cases of obstructive azoospermia, you can retest after 1 month because, the formed sperm will readily appear through the relieved obstruction. I semen analysis report one month after medicine ( 13/01/12 ) is given below


Investigation ( After Medicine) Semen Analysis : 13/01/12 Count : 50 million/ml Motility : 65 %


normal count, lab report , after treatment


Then again there is a question - Why varicocele is not considered ? We can predict the presence of varicocele in a patient by having a look into his semen analysis report. 'Moderate or normal count with low motility' is the usual presentation of varicocele related infertility. For a varicocele to interfere with spermatogenesis, it should be either Bilateral Grade II or Unilateral/Bilateral Grade III. In this case the count is low and motility is average in his oligospermic pre-operative stage. That means varicocele if suspected should be confirmed by colour doppler study. The concerned doctor made the diagnosis manually ( I had mentioned this in HPC ) and led the patient for a surgical procedure. As it is not confirmed and the semen analysis report is not corresponding, you can neglect that symptom. 
On the contrary if varicocele is considered as a rubric, Phos is not found under varicocele in any of the repertories except mine. I have added it as a clinically verified medicine ( 1 mark ) in my work.
This is a special case where vas deferens/epididymis obstruction is the only reason why he is azoospermic. The cause for the obstruction was purely a mechanical injury. Recovery of the patency of his tract did surely return him to his original condition.