Clinical Outcome of Virechana Followed by Ayurvedic Oral Medication in Idiopathic Oligozoospermia: A Prospective Case Series

Background: Infertility is an escalating global concern, impacting one-sixth of the reproductive-age population worldwide. Idiopathic oligozoospermia is a common cause of male infertility characterized by low sperm concentration without identifiable etiology in modern medicine. From an Ayurvedic perspective, it may correlate with Kshinashukra. Aim: This prospective interventional case series aims to evaluate the clinical effect of an Ayurvedic treatment protocol in improving semen parameters and FertiQoL scores in patients with Kshinashukra. Materials and Methods: Six cases of primary infertility associated with idiopathic oligozoospermia are reported. The treatment plan included Virechana (therapeutic purgation) followed by oral medication, administered for 33 days. The primary outcome was change in semen parameters, and the secondary outcome comprised change in FertiQoL (Fertility Quality of Life) score. Assessments were performed at baseline, post-treatment and during follow-up. Results: Marked improvement in the sperm concentration of all six patients was observed. The mean sperm concentration increased from 5.83 million/mL to 25.83 million/mL after treatment and was maintained at 27.67 million/mL during follow-up. All participants achieved sperm concentration above the WHO Laboratory Manual, 6th edition 2021 lower fifth percentile reference limit (16 million/mL) after treatment. The FertiQoL score improved from 38.83 ± 4.88 to 60.17 ± 3.54 (mean increase of 21.33 ± 3.98). The intervention was well tolerated, and no adverse events were observed. Conclusion: In this uncontrolled six-patient case series, Virechana followed by oral Ayurvedic medication was associated with increased sperm concentration and improved FertiQoL scores. The mean sperm concentration increased from 5.83 million/mL to 25.83 million/mL post-treatment (+20.00 million/mL) and was sustained at 27.67 million/mL during follow-up. The FertiQoL score improved from 38.83 ± 4.88 to 60.17 ± 3.54. These preliminary findings require confirmation in controlled clinical studies due to the small sample size, lack of a control group, and absence of pregnancy outcome data.