ORIGINAL ARTICLE P J M H S VOL.4 NO.4 OCT – DEC 2010 387 Effect of Oral Ambroxol HCl Treatment on Characteristics and Recovery of Spermatozoa from Abnormally High Viscous Semen in Infertile Men KHALID JAVED RABBANI, TANVEER MEHMOOD, FURQAN RABBANI ABSTRACT Objective: The objective of this study was to assess the impact of treating abnormally high viscous semen in infertile men with oral Ambroxol HCl by changing the qualitative and quantitative characteristics of spermatozoa recovered by SWIM UP methods to be use in assisted reproductive techniques (ART). Study Design: Controlled clinical study Material and Methods: Fifty sub fertile men producing abnormally high viscous semen participated in this study. The use of oral Ambroxol HCL for improving the liquefaction of semen in these patients leading to impact on the semen specimen produced by the patient was assessed. The spermatozoa recovered with swim up methods were used in ART to treat the sub fertile couple. The method of semen liquefaction used in this study was helpful in the recovery of greater numbers and higher quality spermatozoa (PiO.05) as compared to the conventional method. All the characteristics of spermatozoa were assessed both from quantitative and qualitative point of view in both, the conventional and the Ambroxol liquefied specimens. Conclusions: The liquefaction of abnormally high viscous semen with Oral Ambroxol was shown to be a treatment, which can help significantly in the handling and preparation of abnormally high viscous semen specimen. The oral use of Ambroxol HCL in sub fertile men with abnormally high viscous semen assisted in the recovery of qualitatively and quantitatively improved spermatozoa, which can be used, assisted reproductive techniques. Key words: Semen viscosity, coagulation, liquefaction, Ambroxol HCL INTRODUCTION The Assisted Reproduction Techniques (ART) by using isolated motile spermatozoa came into clinical practice for the management of infertility in human about three decades ago. Over the last many years, the indications to use ART have become more common in the management of male factor infertility and this urged the researchers to find better and more suited techniques to separate functional spermatozoa from immotile with poor morphology. The conventional swim up procedure is the most simple and cheapest of all available presently 1 . Fresh human semen is normally ejaculated in the viscous liquid state followed by immediate coagulation and it does not liquefy for at least 20-30 minutes 2-6,8 . So-called coagulation proteins which are derived from the seminal vesicle, promote the coagulation and liquefaction is caused by secretions from prostate gland 8 . Some times semen samples are rather viscous even after 30 to 45 minutes 4,5 . However, if ----------------------------------------------------------------------- Department of Urology, Lahore Medical & Dental College, Ghurki Trust Teaching Hospital, Lahore Correspondence to Prof. Khalid Javed Rabbani Email: kjranduro@yahoo.com liquefaction is not complete and the semen remains viscous, it is considered as an abnormality because of a lack of proteolytic enzyme present in the prostatic secretions 4,5 . The coagulation and subsequent liquefaction of semen and its physiological significance is not clear. Delayed or failure of liquefaction, and high viscosity (hyper viscosity) are conditions equated with infertility, since it is claimed that the spermatozoa are tangled in the fibrous or mucous mass in the semen and are prevented from migrating properly from the seminal plasma into the cervical track Fluids and ascending to the site of fertilization 3,9-11 . The viscosity of the liquefied semen different from coagulation is gauged by aspirating into a wide- bore 5-ml pipette and then allowing the semen to drop by gravity and observing the length of the thread. A normal sample leaves the pipette as small discrete drops. In cases of abnormal viscosity the drop will form a thread more than 2cm long. Alternatively, introducing a glass rod into the sample and observing the length of the thread that forms on withdrawal of the rod may evaluate the viscosity. Again, the thread should not exceed 2cm.