Male Infertility Causes Diagnosis Delhi Treatment Male Infertility Fertility Causes Diagnosis Doctor Treatment India Specialist Expert Senior Best Therapy Hormone Experienced Difficulty Conceiving Becoming Pregnant Pregnancy Getting Gurgaon Ghaziabad Noida Fatridabad North west East Central Famous Clinic Centre Hospital

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Male Factor Infertility

Male factor infertility may result from low sperm count or low sperm motility, or decreased ability of the sperm to fertilize the egg or abnormal shape of sperms or lack of semen or inability of man to deposit the sperm into vagina due to erectile dysfunction or hypospadios. The leading cause of male infertility is low sperm count. Others may be low sperm motility, bad quality sperms, lack of semen. In general, most cases of male infertility are due to low sperm count. There are many biologic and environmental factors that can lead to low sperm count. Here is a list if conditions that may cause low sperm count in men. Please click the links for detail information about causes, investigations & treatment options.

Low Sperm Count
Nil Sperms
Low Sperm Motility
Pus in Semen
Anti-Sperm Antibody
Less Semen Formation
Absent Ejaculation
Dead Sperms
Abnormal Sperms
Immotile Sperms

Low Sperm Count (Oilgo-spermia)

What is Low sperm count
Causes of low count, motility
Investigations & Diagnosis
Treatment
Response of treatment

What is Low sperm count: When sperm count is less i.e. decreased in number or amount than normal is called oligospermia i.e. low sperm count. When ever there is less sperm count then chances of spontaneous pregnancy decreases (i.e. difficulty in conceiving i.e. wife does not becomes pregnant). This is one of the common causes of male factor infertility. This is also one of the most common semen abnormalities in men.

How sperms develop: When boy becomes of 14 years of age then L.H. & F.S.H. hormone secretion from pituitary increases. The rise in these hormones leads to proliferation of sperm forming cells (Germ Cells) in the testis. These germ cells start multiplying under the effect of above-mentioned pituitary sex hormones along with assistance of other hormones as testosterones, Growth hormones, Androstenidione, insulin like growth factor-I, Thyroids hormone, paracrine hormone & growth factors. Under the control of above-mentioned hormones germs cells divide & transformed into primary spermatocytes. Then further maturation of primary spermatocytes to spermatids & then finally into mature spermatozoa (i.e. normal sperms) occurs under the control of above-mentioned hormones. After few weeks of progressive maturation inside the testis these sperms become normally motile & develop the capacity to fertilize the ovum. This total sperm cycle from first stage to final stage of normal mature sperms is of three months. Any hindrance in the development of these spermatozoa will lead to less count of sperm & decreased motility, immotile or even dead sperms.

Causes of low sperm count: The various causes of low sperm count are as follows:

1) Deficiency of central sperm producing hormones:
Hypothalamic � pituitary deficiency: Idiopathic GnRH deficiency, Kallman syndrome, Prader-Willi syndrome, Laurence-Moon-Biedl syndrome, Hypothalamic deficiency, pituitary hypoplasia, Trauma, post surgical, postiradiation, Tumour (Adenoma, craniopharyngioma, other), Vascular (pituitary infraction, carotid aneurysm), Infiltrative (Sarcoidosis, histiocytosis, hemochromatosis) Autoimmune hypophysitis, Drugs (drug-induced hyperprolactinemia, sex steroids use)
Untreated endocrinopathies, Glucocorticoid excess, Hypopituitarism, Isolated gonadotropin deficiency (non acquired): Pituitary, Hypothalamic, Associated with multiple pituitary hormone deficiencies: Idiopathic pan hypo pituitarism (hypothalamic defects), Pituitary dysgenesis, Space-occupying lesions (craniopharyngioma, Rathke pouch cysts, hypothalamic tumors, pituitary adenomas), , Laurence-Moon-Beidl syndrome Prader-Willi syndrome , Frohlich syndrome, Hypergonadotropic hypogonadism : Klinefelter syndrome, Noonan syndrome, Viral orchitis, Cytotxic drugs, Testicular irradiation.
2) Testicular disorders (primary leydig cell dysfunction i.e. Hypoganadism), Chromosomal (Klinefelter syndrome and variants, XX male gonadal dysgenesis), Defects in androgen biosynthesis, Orchitis (mumps, HIV, other viral, ),Myotonia dystrophica, Toxins (alcohol, opiates, fungicides, insecticides, heavy metals, cotton seed oil), Drugs (cytotoxic drugs, ketoconazole, cimetidine, spironolactone),
3) Partial obstruction in outflow tract from testis to penile pening in epididymis or of vas deferens (cystic fibrosis, diethlstibesterol exposure) also called obstructive oligospermia.
4) Varicocele: varicocele is dilatation of scrotal vein in the scrotum that leads to rise in temperature of testis and raise testicular temperature, resulting in less sperm production & death of whatever sperms are produced.
5) Drugs (e.g. spironolactone, ketoconazole, cyclophosphamide, estrogen administration, sulfasalazine)
6) Autoimmunity i.e. presence of Antisperm antibody. These Antisperm antibodies bind with spems & either make them less motile, totally imotile or even dead which is called necrospermia.
7) Undescended testicle (cryptorchidism). Undescended testis is a condition when one or both testicles fail to descend from the abdomen into the lower part of scrotum during fetal development. Undescended testicles can lead to less sperm production. Because the testicles temperature increase due to the higher internal body temperature compared to the temperature in the scrotum, sperm production may be affected.
8) Mosaic Klinefelter's syndrome. In this disorder of the sex chromosomes, of the man is abnormal. This causes abnormal development of the testicles, resulting in low sperm production. Testosterone production may be low or normal.
9) Viral orchits as mumps or other viral infections.
10) Infections as tuberculosis, sarcoidosis involving testis or surrounding structures as epididymis.
11) Chronic systemic diseases as Liver diseases, Renal failure, Sickle cell disease, Celiac disease
12) Neurological disease as myotonic dystrophy
13) Development and structural defects as mild degree of Germinal cell hypo-plasia
14) Partial Androgen resistance
15) Mycoplasmal infection
16) Partial Immotile cilia syndrome
17) Partial Spermatogenic arrest due to interruption of the complex process of germ cell diffrentation from spermatid level to the formation of mature spermatozoa results in decreased sperm count i.e. oligospermia. Its diagnosis is made by testicular biopsy. This is found in upto 30% of all cases of low sperm count patients.18) Heat Exposure to testis: as febrile illness or exposure to hot ambience induces a fall in sperm count which is usually reversible.
19) Infection � as bacterial epididimo-orchitis, even in prostatis spermatogenic defect have been noted.
20) Hyper-thermia due to cryptorchidism
21) Chromosomal abnormality: has been found in many cases of low sperm count
22) Alcohol use, Cocaine or heavy marijuana use or Tobacco smoking may lower sperm count
23) Anti-sperm antibodies. In some people there occurs development of some abnormal blood proteins called anti-sperm antibodies which binds with sperm and make them either immotile or dead or decrease their count.
24) Infections. Infection of urogenital tract may affect sperm production. Repeated bouts of infections are one of the common causes associated with male infertility.
25) Klinefelter's syndrome. In this disorder of the sex chromosomes, a man has two X chromosomes and one Y chromosome instead of one X and one Y. This causes abnormal development of the testicles, resulting in low or absent sperm production. Testosterone production also may be lower.
26) Trauma to testis
27) Environmental toxins: as Pesticides and other chemicals in food or as ayurvedic medicines.
28) Genetic Factors : as idiopathic partial hypo-gonadotropic hypogonadism

Diagnosis of Cause of Low Sperm Count

For correct diagnosis of cause of low sperm count, we need detail history & physical examinations then certain relevant investigations are required.

History & Physical Examinations: First step in proper treatment is accurate diagnosis of cause of low sperm count. So we first try to find out cause. We take detailed history, thorough drug history and general physical examination, examination of testis, epididymis, testicular veins & sperm carrying duct examinations. These examinations give idea about whether testis is normally developed or not & how is its function. After that depending on likelihood of particular, cause relevant tests are done. All testing facilities are available at our centre. Thus you may consult us at our centre & at same time you may get all tests done. The time taken in getting all the reports ready is 36 hours. So if you are from out of Delhi, you may come here for two days.

Investigation & Diagnosis: For completes diagnosis of causes of decreased sperm count & one or more of the following tests may be required as

1) Complete male hormone profile: This profile includes all the male hormone tests which control testicular development, functions including normal sperm Productions. The tests include L.H., F.S.H., Testosterones, prolactins, thyroids test, & other relevant hormone tests depending on history & examinations.
2) Antisperm antibody
3) USG or Doppler study of scrotum & testis
4) Semen culture sensitivity
5) Semen fructose
6) Immunobead test
7) Sperm Function Tests
8) Human Sperm-Zona Pellucida Binding Ratio
9) Human Sperm-Zona Pellucida Pentration test
10) Genetic Studies
11) FNAC Testis
12) Egg penetration test
13) Molecular genetic studies done in some special cases
14) Chromosome analysis i.e. Karyotype
15) Assessment of androgen receptor
16) Combined Pituitary hormone tests is performed when needed
17) MRI head if pituitary hormone defect suspected
18) Hemogram test for systemic diseases.
19) Sperm Function Tests
The hamster egg penetration assay (HEPA) and the hemizona assay (HZA) are sperm function tests which can help assess the ability of sperm to penetrate the egg. These tests will not definitively tell whether a pregnancy will occur, but an abnormal test result helps predict reduced fertilizing capability. These tests are performed only rarely today.
20) Semen Fructose

At our center facility for all the above tests are available.

Treatment: Once the cause of low sperm count are found then with in three months of treatment sperm count & motility becomes normal in more than 90% cases.

The various treatments are as follows:

Correction of the Cause: First of all we try to find out the primary cause of infertility by above mentioned investigations. Then we correct the basic defect i.e. correction of hormone disorder & other defects. We also give following treatment for permanent cure of low sperm count & motility disorder.

1) Correction of Hormone deficiencies: Once the hormone disorder is found then it is corrected by any of the below medicines. Usually sperm count normalizes in three month time with proper hormone treatment.

2) Gonadotropin Therapy: Gonadotropins are most potent natural stimulators of sperm production in the testis. Once we start gonadotropin therapy, these gonadotropins stimulates the sperm producing cells in testis. Under the stimulating influence of gonadotropins dormant sperm forming cells which were not producing any sperms, they start dividing & produce multiple immature sperm cells with in three to four weeks. These are further matured in next two to three month into mature sperms under the influence of gonadotropin treatment. Thus in more than 90% cases sperm production can be normalized in three to four months time if it is started in properly selected cases of low sperm count. Gonadotropin therapy is most successful of all the available treatment for low sperm count till now. In many cases of low sperm count, when all other treatment has failed even in those cases gonadotropin therapy is effective. Thus treatment of low sperm count with gonadotropin therapy results in pregnancy soon.

3) Repronex.

4) Bravelle

5) Ovidrel

6) Gonadotropin-releasing hormone (Gn-RH) analogs

7) Growth hormone therapy in many cases where somatrop deficiency is found.

8) Growth Factor, Mineral & Micronutrient Therapy

9) Free Radial Scavangers: These are drug to reduce the free damaging oxidative radical in the testis. For your information every minute lot of oxidant radicals are generated inside the testis which damages sperm forming cells. These special antioxidant drugs scavange these damaging oxidative free radicals thus leading to production of normal sperms by the testis. In many study these free radical scavengers have been found to be very-very effective in normalizing sperm count.

10) Coenzyme ubique: These drugs improve the nutritional status of the testis. Thus testis as well as sperm forming cells get enough nutrient which helps in fast generation of sperms in good number with good motility & fertilizing capacity.

11) carnititine supplimentation increases the production of sperm, with normalization of sperm count in three months.

12) Fertyl: This drug is taken orally and it causes the pituitary gland to release more FSH and LH, which then stimulates the testis to produce more sperms.

13) Bromocriptine. This medication is for men who has elevated levels of prolactin, then this hormone rise decreases the sperm production

14) Correction of thyroid hormone

15) Correction of congenital adrenal hyperplasia

16) Vitamins

17) Zinc

18) Methy-Predinisolone

19) Antibiotics

20) Antiestrogens

21) Tamoxifen

22) Clomiphene

23) Hgh

24) Antimicrobials

25) Anti-inflammatory

26) AIH

27) ART

28) Certain Newer Drugs has been found very effective

29) Treatment of antisperm antibody is achieved by steroid therapy, intrauterine insemination intra-cytoplasmic sperm injection (ICSI)

30) Surgery: Depending on the cause, surgery may be a treatment option for low sperm count due to partial blockade of the tract from testis to the tip of pennis. Surgery is also the treatment of choice for significant varicocele. Similarly surgery may be one of the treatment options for many endocrine tumours.

31) Intra-uterine insemination: In certain patients motile sperms are selected by various methods & then transferred directly in uterine cavity leading to improved pregnancy rate.

32) Test tube baby is also delivered with our efforts by use of intra-cytoplasmic sperm injection (ICSI), then transfer of embryo to uterus of mother.

33) Treatment of general sexual problems. Addressing imppotence or premature ejaculation can improve fertility. Treatment for these problems often is with medication or behavioral approaches.

33) Semen Bank: Facility for good quality sperm is semen bank in also available. At our center we have facility for all the testing & treatment facility required for low sperm count to achieve pregnancy.

34) Assisted reproductive technology (ART)
ART has revolutionized the treatment of infertility. Each year thousands of babies are born in India as a result of ART. Medical advances have enabled many couples to have their own biological child.

The most common forms of ART include:

a) In vitro fertilization (IVF). This is the very effective ART technique. IVF involves retrieving mature eggs from a woman, fertilizing them with a man's sperm in a dish in a laboratory and implanting the embryos in the uterus three to five days after fertilization. IVF often is recommended as a first-line therapy. It's also widely used for unexplained infertility, male factor infertility.

b) Electroejaculation. Electric stimulus brings about ejaculation to obtain semen.

c) Surgical sperm aspiration. This technique involves removing sperm from part of the male reproductive tract such as the epididymis, vas deferens or testicle. This allows retrieval of sperm if blockage is present.

d) Intracytoplasmic sperm injection (ICSI). This technique consists of a microscopic technique (micromanipulation) in which a single sperm is injected directly into an egg to achieve fertilization in conjunction with the standard IVF procedure. ICSI has been especially helpful in couples who have previously failed to achieve conception with standard techniques. For men with low sperm concentrations, ICSI dramatically improves the likelihood of fertilization.

35) Varicocele ligation

A varicocele is an abnormal tortuosity and dilation of veins of within the scrotum. It can be surgically treated - which might help fertility in some cases.

Response of treatment: When we start treatment, maturation of spermatocyte to mature spermatozoa start occurring in three to 4 weeks time and achievement of normal sperm count in three months. Thus cure rate is achieved in more than 95% of patients in three months time.

Side effects: This treatment is harmless because we prescribe well proven drugs which are prescribed in scientific literature. These medicines have to be purchased from medical store by patient himself.

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We get patients from all major cities in India & Abroad . In the following cities all the facilities for investigation & treatments including medicines are available as Delhi (North, South, East, Central, West, New Delhi). To Different Communities like Hindustani, Hindustan, Hindu, Christian, Muslim, Sikh, Parsee.The other cities are Ghaziabad, Faridabad, Noida, Gurgaon, Meerut,, Rewari, Pataudi, Rohtak, Bahadurgarh,Bombay, Bhiwani, Karnal, Panipat , Ambala, Ludhiana, Amritsar, Batala, Gurdaspur, Jalandhar, Patiala, Chandigarh, Calcutta, Ferozepur Simla, Manali, Jammu, Udhampur, Poonch, Rajouri, Srinagar, Kargil, Aligarh, Mathura, Etawah, Lucknow, Kanpur, Allahabad, Varanasi, Kashi, Faizabad, Bareilly, Moradabad, Rampur., Dehradun, Uttarkashi, Meerut, Sitapur, Mathura, Madras, Pilibhit, Nainital, Almora, Agra, Ferozabad, Jhansi, Alwar, Jaipur, Dausa, Ajmer, Beawar, Pali, Bhilwara, Chittorgarh, Kota, Dholpur, Churu, Ratangarh, Sikar, Bikaner, Jodhpur, Jalore, Rajkot, Porbandar, Jamnagar, Dwarka, Junagadh, Surendranagar, Bhav Nagar, Ambala, Ahmedabad, Gandhi Nagar, Godhra, Vadodara, Surat, Bilmora, Navasari, Mumbai, Sonapur, Kalbadevi, Girgaon, Dadar, Mahim, Dharavi, Juhu, Andheri, Kurla, Sahar, Pune, Thane, Palghar, Panaji, Panvel, Solapur, Pandharpur, Ahmednagar, Satara, Kolhapur, Ichalkaranji, Kalyan, Nasik, Dhule, Bhir, Nagpur, Bhandara, Amraoti, Khandwa, Indore, Ujjain, Ratlam, Mandsaur, Bhopal, Vidisha, Sagar, Guna, Shivpuri, Gwalior, Jabalpur, Bhilai, Raipur, Hyderabad, Zahirabad, Suryapet, Guntakal, Chittoor, Tirupati, Tirumala, Nandyal Vijayawada, Guntur, Goa, Tenali, Nellore, Visakhapatnam, Vellore, Bangalore, Banglore, Ulsoor, Mysore, Srirangapatna, Hassan, Mangalore, Udupi, Manipal, Davanagere, Shimoga, Dharwad, Hubli, Bellary, Hospet, Bijapur, Belgaum, Chennai, Chengalpattu, Pondicherry, Tiruvannamalai, Kumbakonam, Thanjavur, Tiruchirappalli, Palani, Madurai, Sivakasi, Tirunelveli, Ambasamudram, Tenkasi, Nagercoil, Kanchipuram, Salem, Erode, Tirupur, Coimbatore, Pollachi, Kanyakumari, Ernakulam, Trivandrum, Calicut, Kottayam, Calcutta, Howrah, Purulia, Darjeeling, Siliguri, Gangtok, Bhubaneswar, Puri, Rourkela, Guwahati, Shillong, Imphal, Kohima, Agartala, Patna, Gaya, Bokaro, Jamshedpur, Ranchi, Madhubani.

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At our center / centre / clinic / clinics / hospital / hospitals doctors are dedicated for latest & scientific treatment of these diseases.

Cyclosporin, blood, Cysticercus - IgG antibodies, Cytogenetics (stress) for Fanconi�s Anaemia, Cytogenetics for AZFa, AZFb, AZFc, Cytogenetics for Beta thalassemia (Analysis of complete set of 16 loci), Cytogenetics for Fragile X, Cytogenetics for muscular distrophy (Detection of hot spot exon 25 nos for DMD), Cytogenetics for Philadelphia Chromosome (For Chronic Myeloid Leukaemia - CML), Cytology, Cytology with cell block, Cytology with cell block, D-Dimer Quantification, plasma, Dengue-lgG antibodies, Dengue-lgG antibodies, Dcsmin by Immunohistochemistry

Dexamethasone Suppression test for ACTH, Overnight Suppression (Basal at 8-9am on day oral 1mg dexa given at night 11pm. Post dexa sample coiiectea at 8-9am next day.), L ow dose (Basal at 8-9am on day 1. Oral 0.5mg dexa given, every 6 hrs for 2 days. Post dexa sample collected at 8-9am on day-3, High dose (Basal at 8-9am on day 1. Oral 2 mg dexa given every 6 hrs for 2 days. Post dexa sample collected at 8-9am on day-3, Dexamethasone Suppression test for Cortisol: - Overnight Suppression (Basal at 8-9am on day 1. Oral 1mg, dexa given at night 11pm. Post dexa sample collected at 8-9am next day.), Low dose (Basal at 8-9am on day 1. Oral O.5mg dexa given every 6 hrs. for 2 days. Post dexa sample collected at 8-9am on day-3, High dose (Basal at 8-9am on day 1. Oral 2 mg dexa given every 6hours for 2 days. Post dexa sample collected at 8-9am on next day.), DHEAS-Dihydroepiandrosteindione Sulphate, serum, DHT-Di hydro testosterone, serum, Diabetes profile, Mini (FBS, PPBS, Cholesterol, HbA1c, Microalbumin), Diabetes profile.Maxi (CBC, FBS, PPBS, Cholesterol, Triglycerides, Creatinine, Electrolytes, Urine it, Insulin antibody, Microalbumin, Insulin, C-peptide, HbA1c), Dialysis panel (CBC, FBS, Electrolytes, Proteins, Alkaline phosphatase, Ca, P, Uric acid, Creatinine, BUN), Diazepam (Benzadiazepine), urine (Qualitative), Digoxin (Lanoxin), serum, Dilantin (Phenyntoin) (Eptoin), serum, DNA (Double Strand) Antibody, serum (Qualitative), Down�s Syndrome Screen-1 st trimester (Triple test) (Down�s syndrome screening through analysis of Free HCB-beta, PAPPa and statistical risk factor calculation), Down�s Syndrome Screen-2nd trimester (Triple test) (Down�s syndrome screening through analysis of HCB-beta, AFP, uE3 and statistical risk factor calculation), DPD-Deoxypyridinoline, urine, Drugs of abuse panel (Qualftative)(7 Drug panel) (Amphetamine, Coccaine, Barbiturates, Cannabinoids, Opiates, PCP and Benzodiazaplne), Drugs of abuse panel (QuantitativeXS Drug panel) (Amphetamine, Methamphetamine, Coccaine, Barbiturates, Cannabinoids, Opiates, PCP, Benzodiazapine and Methadone with creatinine correction), DVT-Deep Vein Thrombosis Panel (Activity of AntiThrombin-III, Protein C and Protein S, Lupus anticoagulant, Cardiolipin IgG and IgM), D-xylose test, E2 - Estradiol, serum, E3-Unconjugated Estriol, serum, EBV(VCA)-lgM antibodies, Echinococcus (Hydatid Cyst) - IgG, serum, ECG, Echovirus antibody-IgG, Echovirus antibody-IgM, EGF-Epidermal Growth Factor, Electrolytes, ENA(Extractable Nuclear Antigen) profile (Antibodies to SSA, SSB, Sm, RNP-Sm, Scl-70, Jo-1), Endocrine panel-Female (FSH, LH, Prolactin, E2 and TSH to be done on 2-5th day of cycle.)., Endocrine panel-Male (FSH, LH, Prolactin, Testosterone-total & free and TSH), Endothelial Markers Profile (Factor VIII, CD31, CD34), Endomysial Antibody, Epinephrine(Adrenaline), Epinephrine (Adrenaline),Epithelial Marker profile(Pan Keratin,CK10,EMA,CEA), , ithelial Membrane Ag(EMA)-lmmunohistochemistry, toin (Phenytoin). serum, ER-Estrogen receptor, Erythropoietin, serum (EPO), ESR (Automated), Estradiol (E2), serum, Ethanol,

Different Hospitals in india are: Moolchand Health Care, St. Stephen�s Hospital, Dr. Ram Manohar Lohia Hospital, G.B Pant Hospital, Lok Nayak Hospital, RG Stone Urological Reasarch Institue, Sir Ganga Ram Hospital, Jeevan Hospital, Deen Dayal Upadhyaya Hospital, Orthonova Hospital, Batra Hospital, Sahi Hospital, Indraprastha Apollo Hospitals, Holy Faimly Hospital, Jeevan Mala Hospital, Jaipur Golden Hospital, Lady Harding Hospital, Smt. Sucheta Kriplani Hospital, Mata Chanan Devi Hospital, Safdarjung Hospital, Mohindra Hospital, M.P Heart centre Hospital, Bara Hospital, Hindu Rao Hospital, Holy Angels Hospital, Shankar Hospital, Holy Family Hospital, Chopra Hospital, Escorts Hospital St. Stephen's Hospital, Vardaan Hospital, Visitech Eye Hospital, Vardhman Mahavir Medical College, Safdarjung Hospital, Lok Nayak Jai Prakash (LNJP) Hospital, Private Hospital, Guru Teg Bahadur Hospital, Kalra Hospital, Bangalore Baptist Hospital, Bowring Hospital, B W Lions Eye Hospital, Bangalore Hospital, Bangalore Children's Hospital, Genesis Hospital, Lakeside Hospital, M G A Hospital, Mallya Hospital, Manipal Hospital, Sindhi Charitable Hospital, Yellamma Dasappa Hospital, Sir Harkisandas Narottamdas Hospital, Prince Alikhan Hospital, Saifee Hospital, Breach Candy Hospital, Jaslok Hospital, Habib Ismail Hosptal, Kalajyot Hospital, Motiben Dalvi Hospital, Bombay Hospital, Corwest Jain Clinic Group of Hospitals, D.S. Kothari Hospital, Lotus Hospital, Elizabeth Hospital, Bhatia Hospital, The Bomanji Dinshaw Petit Parsee Hospital, Cumbala Hill Hospital, Noor Hospital, K.B. Haji Bachoali Charitable Ophthalmic & ENT Hospital, Bai Jerbai Wadia Hspital, Nawroji Wadia Maternity Hospital, Wadia Hospital, Yerla Medical Trust Hospital, Tarachand Bappa Hospital, Dhanwantari Hospital, Shri Samasta Parajiya Suvarna Hospital, Smt.B.C.J. General Hospital, Smt.B.C.J. General Hospital, Holi Spirit Hospital, Lilavati Hospital, The Bandra Holy Family Hospital, Raheja Hospital, Gurunanak Memorial Hospital, Ramakrishna Mission Hospital, Radhibai Watumull Global Hospital, BSES Hospital, Sushrut Hospital, LH Hiranandani Hospital, Maganlal Popatlal & Sarvoday Hospital, Rajawadi Municipal General Hospital, Shatabdi Hospital, KBB Hospital, V.N. Hospital, Dr.K.B. Babha Hospital, Cooper Hospital, Bhagwati Hospital, Sion Hospital, K.E.M. Hospital Nayar Hospital, Kama Hospital, G.T. Hospital, J.J. Hospital, Sr.George Hospital, Aliganj Hospital, Blue Cross Hospital, Getwell Hospital, Krishna Lok Hospital, Lucknow Hospital, Medwin Hospital and Health Centre, Vivekanand Hospital, G.M.Associate Hospital, Dufferin Hospital, Civil Hospital, Communicable/Infectious Diseases Hospital Lifeline Hospital and Heart Centre, Lucknow Hospital, Shalimar Hospital, Rajendranagar Hospital Tuberculosis Hospital, Lucknow Rajpoot Hospital, Nishat Hospital, Z A Chartable Hospital, Indira Gandhi Eye Hospital, Sitapur Eye Hospital, Awadh Hospital and Heart Centre, Balrampur Hospital, Cantonment General Hospital, Civil Hospital, Dr.Shyama Prasad Mukherjie Hospital, Fatima Hospital, G.M.Associate Hospital, K.K.Hospital, Veerangana Jhalkari Bai Female Hospital, Shekhar Hospital, Queen Mary Hospital, Osmania General Hospital, Gandhi Hospital, Government Maternity Hospital, Nilofar Hospital, Cancer Hospital, T.B. Hospital, Hospital for Mental Diseases, Sarojini Devi Hospital, Sundram Medical Foundation, Chennai. MIOT Hospital, Chennai. Apollo Hospital, Madras. Malar Hospital Limited, Gandhi Nagar Adyar, Chenni. Calcutta Medical College Hospital. N.R.S. Medical College & Hospital, Calcutta. R.G. Kar Medical College & Hospital, Calcutta. Calcutta National Medical College & Hospital, Instt. of Postgraduate Med. Education & Research, Calcutta Seth S.K.M. Hospital, Calcutta. Sambhu Nath Pandit Hospital, Calcutta. Lady Dufferinvictoria Hospital, Calcutta. Howrah General Hospital, Howrah, Hoogly Sadar Hospital, Hoogly, Chittaranjan Seva Sadan & Chittaranjan Cancer Hospital, Ramakrishna Mission Seva Pratishthan General Hospital, Calcutta.