Decrease Semen Amount Quantity Delhi India Treatment Causes Specialist Doctor Causes Doctor Specialist Hospital Centre Clinic Best Most Famous Experienced Senior Expert Guaranteed Cause Diagnosis Investigations East West North South Central Noida Ghaziabad Faridabad Gurgaon

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|| Small testis || Absent genital development || Small Genital & Genital enlargement ||
|| Less facial Hair || Hypogonadism || Testosterone deficiency || Andropause || Male Infertility ||
|| Breast enlargement in male || Male hormone Disorders || Less Body muscles and under weight ||

Male infertility

Male infertility i.e. difficulty in getting wife pregnancy due to defect in semen as decreased sperm count & low (Poor) motility or abnormal sperms occurs due to above causes. Treatment of low sperm count & motility are discussed below.
Low sperm count or Low (Poor) motility
Nil sperms (Azoospermia)

Low Sperm Motility (Ashtenospermia)

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

What is Low sperm motility: When sperm motility is less than normal i.e. less then 50% of sperms are actively motile is called Oligo-asthenia i.e. low sperm motility (when all the sperms are immotile are called astheno-spermia. This leads to difficulty in conceiving i.e. wife does not becomes pregnant. This is one of the common causes of male infertility. This is also one of the most common semen abnormalities.

What is Low sperm motility: When less than 50% sperms are motile then this condition is called oligoasthenia. When motility is less 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 genital 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 motility: The various causes of decreased motility 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, genital 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 opening 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 decreased sperm motility, 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 sperms & either make them less motile, totally immotile 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 decreased sperm motility. 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 genital chromosomes, of the man is abnormal. This causes abnormal development of the testicles, resulting in low sperm production or decreased sperm motility. 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 or motility 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 genital 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 & what ever are produced are less motile. 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 motility

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 motility. So we first try to find out cause. We take detailed history, thorough drug counseling, 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 motility & 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 motility are found then with in three months of treatment sperm motility & 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 as varicocele surgery, stopping of alcohol & smoking, stopping of offending drug. We also give following treatment for permanent cure of low sperm motility & 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 motility 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 sperm forming cells start dividing & produce multiple normally motile sperms.Thus in more than 90% cases sperm production can be normalized in three to four months time. Gonadotropin therapy is most successful of all the treatment available till now for sperm motility & motility enhancement. Gonadotropin therapy is indicated & effective all cases of hypogonadotropic Hypogonadism& almost all case of low sperm motility & motility. In many cases of low sperm motility when all other treatment has failed even in those cases gonadotropin therapy is effective.

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 motility.

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 motility 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 have elevated levels of prolactin.

14) Correction of thyroid hormone

15) Correction of congenital adrenal hyperplasia

16) Vitamins

17) Zinc

18) MethyPredinisolone

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 motility 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 genital problems. Addressing or premature ejaculation can improve fertility. Treatment for these problems often is with medication or behavioral approaches.

34) 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 motility to achieve pregnancy.

35) 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 motility 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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At these places all the facilities for investigation & treatments are available.

At our center / centre / clinic / clinics / hospital / hospitals doctors are dedicated for latest & scientific treatment of these diseases.
Routine Karyotyping (Giemsa banding) (G banding) (For numerical and structural chromosomal abnormalities) 3000, Blood 4800, Cord Blood 4800, Bone marrow 8000, Amniotic fluid 5000, Product of conception 6800 Chorionic Villi 6800, Placental biopsy 6800, Soft tissue, Routine Karyotyping (Q banding) (For numerical and structural chromosomal abnormalities), 4500 Blood, 4800 Cord Blood, 4800 Bone marrow, 8000 Amniotic fluid, 5000 Product of conception, 6800 Chorionic Villi, 6800 Placental biopsy, 6800 Soft tissue, 4800 Blood, 12500 Blood, 4500 Blood, 4500 Bone Marrow Cytogenetics for Fragile X 4800 Blood, Cytogenetics for AZFa, AZFb.AZFc 12500 Blood, Cytogenetics for Philadelphia Chromosome (For Chronic Myeloid Leukaemia - CML), 4500, 4500 Bone marrow, Cytogenetics (stress) for Fanconi’s Anaenri 4800 Blood, Cytogenetics for Beta thalassaemia (Analysis of complete set of 16 loci) 12500 Blood, Cytogenetics for muscular dystrophy (Detection of hot spot exon 25 nos for DMD) 12500 Blood, FISHfort(9;22)(Forbcr-abl translocation of Philadelphia Chromosome) 4500 Blood, 4500 Bone marrow, FISH fort (15; 17) (For promyelocytic leukaemia (PML/RARA/AML M3) 4500 Blood, 4500 Bone marrow, FISH fort (8; 21) (For Acute Myeloid Leukamia AMI M2) 4500 Blood, 4500 Bone, FISH for inv(16) (For Acute Myeloid Leukaemia AML M4) 4500 Blood, 4500 Bone, FISH for AML (M2,M3 and M4) {Includes 10800 Blood
t(15;17),t(8;21)andinv(16)} 1Q800 Bone marrow, FISH for del 13q (For multiple myeloma) 4500 Blood, 4500 Bone, FISH for Her2/Neu (Prognostic marker for 10000 Block CA breast) Smear Examination, Albert’s Stain for C.diphtheriae 120 Throat/Nasal swab, AFB-Acid fast bacilli by ZN stain AFB-Acid fast bacilli by 120, All specimens 150 All specimens, Flourescent Microscopy 120, Stool, Cyclospora, stool 120, Stool, Cryptosporidium, 100 All specimens stool, Gram’s staining 120, CSF, India Ink Preparation, CSF Isospora, stool KOH 140 Hair/Nail/Sputum, mount Leptospira, urine 220, Urine, Microsporidium, stool 120 Stool, Smear for Nocardia 120 Stool, Sputum/Tissue 1DU, etc.,

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.

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Azoospermia

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Some important information: low/ Low/ less/ decreased sperm count motility treatment therapy by hormone therapy is one of the very remarkable advancement in the last 5 years. low/ Low/ less/ decreased sperm count motility investigation, cause diagnosis & treatment facilities are availalable at very few centres in the delhi/ Delhi ( India / india).treatment of thousands patients has been successfully done at our centre. low/ Low/ less/ decreased sperm count motility treatment therapy by hormone therapy is very successful. low/ Low/ less/ decreased sperm count motility treatment therapy by hormone therapy after finding the correct cause of low/ Low/ less/ decreased sperm count motility. low/ Low/ less/ decreased sperm count motility treatment therapy by hormone therapy medical treatment results are very good. After low/ Low/ less/ decreased sperm count motility treatment therapy by hormone therapy patient becomes more satisfied. We have treatment for low/ Low/ less/ decreased sperm count motility treatment therapy by hormone therapy. Before starting treatment for low/ Low/ less/ decreased sperm count motility, our team of doctors decide how to treat low/ Low/ less/ decreased sperm count motility. At our Delhi (India) center, we have highly qualified expert doctor, who are well trained in diagnosis of cause of low/ Low/ less/ decreased sperm count motility. At our Delhi (India) centre, our doctors are experienced in low/ Low/ less/ decreased sperm count motility treatment (therapy) of low/ Low/ less/ decreased sperm count motility. low/ Low/ less/ decreased sperm count motility treated by drug (medical) treatment. low/ Low/ less/ decreased sperm count motility is one of the common cause of inferiority complex in many boys & men. low/ Low/ less/ decreased sperm count motility treatments is must. low/ Low/ less/ decreased sperm count motility therapy can be by oral hormone pills. low/ Low/ less/ decreased sperm count motility cause ( causes) are investigated at our hospital. low/ Low/ less/ decreased sperm count motility occurs due to various causes as mentioned above. Patient with low/ Low/ less/ decreased sperm count motility should go to qualified specialist. low/ Low/ less/ decreased sperm count motility patient should be investigated (various investigations / investigation ) before starting treatment. Our Hospital / centre is situated in east, East ,new,New, Delhi (India). It is closer to Central, central delhi, four kilometer from South, south delhi , North, north delhi, & West, west, delhi. Our Delhi centre is eight kilometer from Noida, Noida, Gaziabad, ghaziabad, Faridabad, faridabad & Gurgaon, gurgaon. Our hospital/ centre is one of the most famous decreased semen less Decreased quantity amount treatment center in Delhi & India.

function values, Disseminated intravascular coagulation, pregnancy, Distal tubal damage, infertility, Disulfiram, effects endocrine function values, Disuse, regional osteoporosis due , Diuresis, kinins , Diuretic(s) abuse , differential diagnosis , depletion body iodine, hypovolemia caused by, insulin secretion, loop effects endocrine function values, hypercalcemia, hypercalciuria, renal magnesium loss, mineralocorticoids, interactions , osmotic, effects endocrine function values, potassium secretion, potassium-sparing Barter syndrome, hypoaldosteronism caused by, renin release, therapy with Cushing syndrome, hypoosmolar states, hyporeninemic hypoaldosteronism, thiazide. Thiazide diuretics Diuretic / posature test drug effects , expected response , method , physiologic factors affecting, special considerations / interpretation , substance measured , Diurnal rhythm(s). Circadian rhythm(s); Endocrine rhythms endocrine test results, study , methods , testosterone, hypogonadism, Divergence paralysis, Diverticulitis, glucagon therapy , DKA. Dibetic ketoacidosis DNA (deoxyribonucleic acid), Complementary DNA (cDNA) amplification , by PCR, blotting. Southern blotting chemical or enzymatic cleavage , denaturation , PCR, denaturing gradient gel electrophoresis , elongation , PCR, fingerprinting, forensic analysis , genetic linkage map , methylation genetic imprinting,, X-inactive speicfic transcript (Xist), mitochondrial, mitochondrial, mutations , polymorphisms, sequences , changes , screening , sequencing , direct, single-strand conformation analysis , synthesis , PCR, DNA analysis prenatal diagnosis congenital adrenal hyperplasia, types , DNA-array chip design, DNA-based vacination, DNA-calcium phosphate, transfection promoter-reporter DNAs using, DNA-DEAE dextran, transfection promoter reporter DNAs using, DNA diagnosis endocrine disease, practical considerations , by service laboratories, situations appropriate , postmortem, preimplantation, prenatal, presymptomatic, DNA-lipid-protein (liposomes), transfection promoter-reporter DNAs using, DNA methyltransferase, DNA polymerase, from Thermophilus aquaticus, DNA-protein interaction assays, DNA-RNA hybrid molecule(s), chemical or enzymatic cleavage , DNase I, DNES. Diffuse neuroendocrine system Dobutamine congestive heart failure, dosage administration , effects endocrine function values, indications , receptor affinities , vasodilatory effects , Docking protein, PTH biosynthesis, Docasahexaenoic acid (DHA), Docusate. Laxatives Doherty, Gerard M., Dolichostenomelia homocystinuria, inherited disorders amino-acid metabolism, Dolly (sheep), Dominant inheritance, Domperidone (Motilium) adverse effects side effects , diabetic gastroparesis, effects endocrine function values, mechanism action , TSH secretion, Donepezil, effects endocrine function values, DOPA. Dihydroxyphenylalanine L-Dopa eating disorders, TSH secretion, DOPAC. Dihydroxyphenylacetic acid DOPA decarboxylase. L-Aromatic amino-acid decarboxylase L-Dopa decarboxylase, palsma / serum level , medullary thyroid cancer, Dopamine actions , adverse effects side effects , critical illness, aldosterone secretion, anterior pituitary function, appetite regulation, assays , chemistry , cirrhosis, critical illness, deficiency , polycystic ovary syndrome , diffuse neuroendocrine system, effects endocrine function values, fetal, gonadal axis, critical illness, gonadotropin-releasing hormone secretion, growth hormone secretion, chronic stress, hCG synthesis, high-dose, hypogonadotropic hypogonadism critical illness, hypothalamic, hyperprolactinemia , polycystic ovary syndrome , hypothalamic activity, low-dose, natriuretic effects , neurons containing, hypothalamus, norepinephrine release, pituitary tumorigenesis, as prolactin-inhibiting factor, prolactin secretion, critical illness, chronic phase, pulmonary, receptor affinities , renal effects , secretion , cytokines , structure , catechol estrogens, synthesis , therapy with adverse effects side effects , indications , thyroid function parameters, thyroid hormone regulation, thyroid-stimulating hormone secretion, thyrotropin-releasing hormone release, transporter , urinary, neonates, Dopamine agonist(s), acromegaly, results , dysfunction, hyperprolactinemia, nonfunctional pituitary adenomas, ovulation induction with, prolactinoma, somatostatin analogs, combined, Dopamine anta gonist(s), vasopressin secretion, Dopamine Vita-hydroxylase activity , deficiency , ocular effects , plasma / serum level , thyroid disorders, release , sympathetic nervous system, Dopamine receptor(s) DA1, DA2, L-Dopa test drug effects , expected response , method , physiologic factors affecting, special considerations/ interpretation , substance measured , Dopexamine cardiac effects , dosage administration , receptor affinities , vasodilatory effects , Doppler ultrasound cervical lymphadenopathy, color flow, thyroid, dysfunction evaluation, goiter, renovascular hypertension, Dorsal longitudinal fasciculus, Dorsocervical fat pad. Cervicodorsal fat pad Dorsomedial nucleus, appetite regulation, functional significance , Dostinex. Cabergoline Double elevator palsy, Double transgenic mice, Double vision. Diplopia Dowager's hump, Down-regulation. specific hormone definition , Down syndrome characteristic facies , children with, growth standards , cryptorchidism , familial, glucose intolerance , hCG levels , male infertility, micropennis , Doxapram, effects endocrine function values, Doxazosin. alfa-Adrenergic receptor antagonist(s) effects endocrine function values, Doxazosin mesylate (Cardura), benign prostatic hyperplasia, Doxepin. Tricycil antidepressants Doxorubicin chemoembolization using, metastatic gut endocrine tumors, effects endocrine function values, male infertility, therapy with anaplastic thyroid cancer, gastrinoma, , endocrinologic side effects , insulinomas, medullary thyroid cancer, Doxycycline. Tetracycline spermatogenesis, DPD. Deoxypyridinoline DR. Diabetic retinopathy Drash, Allan L., Drezner, Marc K., Drinking behaviour, endocrine brain , "Dripping-candle-wax" appearance, DRIs. Dietary reference intakes Drisdol. Ergocalciferol, therapy with (Calciferol, Drisdol) Droloxifene, Dronabinol effects endocrine function values, therapy with, , DRS. Diabetic Retinopathy Study Drug(s). Medication(s) autoimmune disease, catecholamine disease, catecholamine levels, diabetogenic, effects endocrine function values, thyroid function tests, endocrine-related, compendium , dysfunction, goitrogenic, gynecomastia, hypothalamic-pituitary-thyroid axis, iodide-containing, labeling , lactic ac idosis caused by, male infertility, metabolism , hypothyroidism, pregnancy categories , renal magnesium loss, systemic inflammatory response syndrome, weight gain, weight loss, Drug certification procefure, Drug Facts Comparisons, Drug Information, DRVS. Diabetic Retinopathy Vitrectomy Study Dry eye causes , menopause, Dry mouth. Xerostomia DSIP. Delta sleep-inducing peptide Dual-energy x-ray absorptiometry (DEXA), HIV-associated fat redistribution (HAFR), peripheral, Dubrow, Alan, Duchenne muscular dystrophy children with, growth standards , preimplantation diagnosis , Ductal development, errors , Ductuli efferentes, Ductus arteriosus closure , eicosanoids , patency , Ductus deferens, hormonal carcinogenesis , animal models , Dufour, D. Robert, Dumping syndrome, kinins , Dunningan variety, lipodystrophy, Duodenal ulcer(s), somatostatin , Duodenum, functional obstruction , hyperthyroidism, Dupuytren contractrue alcoholism, diabetes, Durabolin. Nandrolone phenpropionate oil Duralone. Methylprednisolone acetate Duratest 100 / 200. Testosterone cypionate oil. Durothate-200. Testosterone enanthate oil Durschlag, Roberta P., Dwarfism with basal encephalocele, deprivational, familial GHRH-resistant, genetics , growth hormone deficiency, growth hormone-deficient, IGF-I abnormalities , Jansen metaphyseal chondrodysplasia, Laron, IGF-I abnormalities , long-limbed camptomelic, panhypopituitary, glucose intolerance , pathophysiology , pituitary, congenital, dental / orofacial abnormalities , psychosocial, with PTH-independent hypercalcemia, short-limbed, metaphyseal dysplasia, Dymelor. Acetohexamide Dynamic endocrine procedures. Endocrine test(s), dynamic Dynorphin(s) central nervous system effects , chemistry , diffuse neuroendocrine system, DYN A, precursor , structure , DYN B precursor , structure , gene , gut, hypothalamo-neurohypophysial system, pain perception, pars nervosa pituitary, precursor , gene , posttranslational processing , processing , preprohormone , structure , Dysautonomia(s) classification , familial , Riley-Day syndrome osteoporosis , Dysbetalipoproteinemia, familial, Dysesthesia(s) definition , diabetic neuropathy, Dysgerminoma, suprasellar clinical presentation , imaging , ophthalmopathy with, 45 X / 46, XY genotype, Dysgeusia, diabetes, Dyslipidemia(s) diabetes, drug therapy , treatment goals , rationale , diabetic nephropathy, familial, preexisting, pregnancy, pregnancy, syndrome, X, type 1 diabetes, type 2 diabetes, Dyslipoproteinemia(s). Hyperlipoproteinemia(s) children, therapeutic approach , type III, Dysmenorrhea, eicosanoids , with endometriosis, estrogen-progestin pill , oral contraceptives , Dysostoses, Dysostosis multiplex, lysosomal storage diseases with, Dyspareunia, with endometriosis, GnRH agonist , menopause , Dysphagia diabetes, with goiter, magnesium deficiency, thyrotoxic myopathy, with thyrotoxicosis, Dysrhythmia(s), cardiac. Arrhythmia(s) Dysthymia, Early Treatment Diabetic Retinopathy Study (ETDRS), Eastman, Richard C., Eating disorder(s), Anorexia nervosa; Bulimia clinical characteristics , delayed puberty, diabetic adolescent, epidemiology , hematologic abnormalities , hypothalamic dysfunction , neuroendocrine abnormalities , neuromuscular manifestations , Eaton-Lambert syndrome. EBV. Epstein-Barr virus E-cadherin, preimplantation embryo, EC cells. ERnterochromaffin cells Eccrine gland(s), ECE. Endothelin-converting enzyme ECF. Extracllular fluid ECG. Electrocardiography ECGF. Endothelial cell growth factor Echinococcal infection pituitary involvement by, thyroid, Echothiophate iodide (ophthalmic solution), iodine content , Echovirus 6, epididymoorchitis caused by, Eclampsia ocular effects , platelet abnormalities , ECLIAs. Electrochemiluminesence immunoassays Ectoderm defects , definitive, embryonic, primitive, Ectopia lentis causes , inherited disorders amino-acid metabolism, isolated, Ectopic ACTH syndrome, clinical, manifestations , Crooke cells , differential diagnosis , localization lesion , treatment , tumors causing, Ectopic corticotropin-releasing hormone (CRH) syndrome clinical manifestations , hyperadrenocorticism (Cushing disease, Cushing syndrome), Ectopic peptide hormone syndromes. Peptide hormone(s), ectopic synthesis , pathogenesis , Ectropion, causes , congenital, endocrine causes , Eczema inherited disorders amino-acid metabolism, pregnancy, Eczematoid dermatitis, zinc , EDCF. Endothelium-derived contracting factor(s) Edema, anorexia nervosa, cerebral diabetic ketoacidosis, signs symptoms , conjuctival, oral contraceptives , cyclic, diabetic nephropathy, eyelid, endocrine causes , Graves disease, oral contraceptives , Graves ophthalmopathy, hereditary angioneurotic, androgen replacement therapy , idiopathic, insulin treatment, macular, causes , cystoid, treatment , oral contraceptives , tamoxifen-induced, massive, natriuretic peptide levels, optic disc, diabetic retinopathy, hypertension, periorbital causes , treatment , pretibial Cushing disease, with thyroid acropachy, retinal, causes , diabetic maculopathy , treatment , thiazolidinedione-related, Edex. Alprostadil EDF. Erythroid differentiation factor EDHF. Endothelium-derived hyperpolarizing factor EDRF. Endothelium-derived relaxing factor(s) Edrophonium chloride (Tensilon) test, EDTA, effects endocrine function values, Edward syndrome, cryptorchidism , Effector cell(s), definition , EGF. Epidermal growth factor Ehlers-Danlos syndrome, childhood osteopenia , classification , clinical features , mild mcderate forms , ocular manitestations , osteoporosis , Sack-Barabas type . Ehlers-Danlos syndrome, type IV (ecchymotic or arterial) type I (gravis), clinical features , genetics , ultrastructural findings , type II (mitis), clinical features , genetics , ultrastructural findings , type III (benign familial hypermobility), clinical features , genetics , ultrastructural findings ,INDEX-2337 type IV (ecchymotic or arterial), biochemical findings , clinical features , diagnosis , genetics , pregnancy complications , prenatal diagnosis , ultrastructural findings , type V (X-linked) clinical features , genetics , inheritance , type VI (ocular), biochemical finding , clinical features , diagnosis , genetics , inheritance , prenatal diagnosis , treatment , ultrastructural findings , type VII (arthrochalasis multiplex congenita), biochemical findings clinical features , genetics , inheritance , type VIIA, genetics , type VIIC (dermatosparaxis), type VIII (periodontal) clinical features , genetics , inheritance , type IX biochemical findings , clinical features , genetics , inheritance , type X (fibronectin platelet defect ) biochemical findings clinical features , genetics , inheritance , ultrastructural findings , EIA. Enzyme immunoassay Eicosanoid(s), Prostaglandin(s) assay , bone resorption, carbohydrate metabolism, catabolism , critical illness, dermal, diabetes, ductus arteriosus, hysmenorrhea, gastrointestinal effects , hepatic glucose production, hypercalcemia malignancy, inflammatory response, inhibitors , therapeutic applications , luteolysis, mechanism action , metabolites , therapeutic applications , pathophysiology , endocrine effects , nonendocrine systems, physiology endocrine effects , nonendocrine systems, platelets, pulmonary effects , renal effects , reproductive physiology, rheumatoid arthritis, skiin, pathophysiologic functions , synthesis , therapeutic applications , trophoblastic, uterine effects , vasoactive, renovascular hypertension, Eicosanoid receptor(s) cellular tissue distribution , mechanism action , nomenclature , Eicosapentaenoic acid (EPA), Eisenbarth, George S., Ejaculation age first, dysfunction, failure, definition , process , retrograde, diabetes, Ejaculatory failure, definition , Elaidic acid, ELAM. Endothelial-leukocyte adhesion molecule Elastase critical illness, prognostic significance , therapeutic potential , Elastin, IGF-I signaling pathway, Elderly activity level , risk osteoporotic fractures, adrenal androgenes , adrenal cortex , adynamic bone , aldosterone , androgen replacement therapy , assessment , bone loss , bone quality changes , calcium balance , carbohydrate metabolism , catecholamines , chondrocalcinosis , with hyperparathyroidism, congestive heart disease , cholesterol reduction , demographics , diabetes , asymptomatic, clinical presentation , complications , diagnostic criteria dietary therapy , epidemiology , exercise therapy , glycemic control , insulin therapy , management , oral hypoglycemic agents , pathogenesis , progression , factors , diabetes treatment , fracture risk , Graves disease , growth hormone therapy , hip fractures , smoking , hyperadrenocorticism , hypercalcemia , hypercalcemia malignancy , hypercholesterolemia , hyperthyroidism , gastrointestinal manifestations , hypoadrenocorticism , hypogonadism , adrogen use , hypothyroidism , immunologic responses , thymic hormones , impaired homeostasis , laboratory tests , male hypogonadism , treatment , medication use by, nodular thyroid disease , nonspecific atypical presentations , obesity , osteomalacia , osteoporosis , Paget disease bone , principles care , renin , reproductive system changes , thyroid hormone therapy , treatment , vitamin B12 deficiency , Electrocardiography adrenal insufficiency, diabetic ketoacidosis, hyperaldosteronism, hypermagnesemia, hyperthyroidism, hypocalcemia, hypothyroidism, magnesium deficiency, with pheochromocytoma, Electrochemiluminesence immunoassays, total testosterone measurement, Electrochemistry, Electodiagnosis, neuromuscular disorders, Electroencephalography, hypocalcemia, Electrolyte(s). specific electrolyte abnormalities acromegaly, adrenal insufficiency, Cushing syndrome, drug-induced, nutritional repletion, administration , nutritional repletion, alcohol , anorexia nervosa, critical illness, metabolism , , plasma / serum level diabetic ketoacidosis, measurement , replacement , diabetic ketoacidosis, requirements, infants children, therapy with, critical illness, Electromyography acromegaly, hypokalemic (subacute necrotizing) myopathy, hypothyroidism, Nelson syndrome, neuromuscular disroders, tetany, thyrotoxic myopathy, Electron microscopy, lysosomal storage disease, Electron transport flavoprotein (ETF) deficiency, Electron transport flavoprotein (ETF) : ubiquinone oxidoreductase deficiency, Electrophoresis, alkaline phosphatase isolenzyme, denaturing grandient gel, lipoprotein, protein, Electrophoretic mobility shift assay (EMSA), Ellectroporation, Eledoisin, central nervous system effects , structure , Elephantiasis verrucosa nostra, Eliopoulos, George M., ELISA. Enzyme-linked immunosorbent assay Ellis, William, J., Ellsworth-Howard test, Elsching spots, Eltroxin. Levothyroxine sodium Embryo bilateral symmetry , craniocaudal axis , development , genetic control , genome , activation , implantation , calcitonin , inner cell mass , oviduct transport , postimplantation development , Embryo (continued) preimplantation, cavitation , compaction , preimplantation development , Embryoblast. Embryo, inner cell mass Embryogenesis, emergency contraceptive use , Embryology, reproductive, Embryonal carcinoma, Embryonal tumor(s), laboratory findings with, sellar region, imaging , testicular, thyrotoxicosis wtih, Embryonic stem (ES) cells, human, adult brain, mouse, pluripotent, targeted homologous recombination , use , biological ethical questions concerning, Embryo transfer, Emcyt. Estramustine phosphate sodium Emergency contraceptive pills, Emesis. Nausea / vomiting EMG. Electromyography Emiocytosis, insulin secretion, EMIT. Enzyme-multiplied immunoassays Emotion anatomic substrate , cardiovascular response , hypothalamic modulation , hypothalamus , Emphysematous cholecystitis, diabetes, Empty sella imaging , partial, primary, children, Morsier syndrome primary hypothalamic / pituitary insufficiency , secondary, Empty sella syndrome, aging , brain-imaging techniques , clinical features , ophthalmopathy , primary, secondary, EMSA. Electrophoretic mobility shift assay Enalapril. Angiotensin-converting enzyme (ACE) inhibition / inhibitor diabetes, effects endocrine function values, hyperaldosteronism, Encainide, effects endocrine function values, Encephalitis bulimia, cytomegalovirus, , hypopituitarism caused by, Encephalocele(s) acquired, basal, evaluation , congenital, differential diagnosis , frontoethmoidal, imaging , sphenoethomidal, spheno-orbital, transethmoidal, transsphenoidal, Encephalopathy catabolic stress, with defects camitine metabolism, hyperosmolar, hyponatremic, metabolic, hypophosphatemia, protein administration , guidelines , thyrotoxic, ENDIT trail, Endobones, osteopetrosis, Endocervix, true hermaphorditism,

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