Infertility and gonadal dysfunction with chronic rheumatic disorder are multifactorial (Østensen, 2004{Østensen, 2004 #54}and Silva and Brunner, 2007). The unhealthy conditions, as malnutrition, bad drug use, alcohol, obesity, tobacco, in addition to female and male genital illness (Balen and Rutherford, 2007) may decrease fertility (Østensen, 2004{Østensen, 2004 #54}and Silva and Brunner, 2007). In addition, hypothalamic–pituitary–adrenal axis dysfunction (Suehiro et al., 2008 and Medeiros et al., 2009); autoimmune disorders with release of anti-endometrial, anti–corpus luteum (Silva and Brunner, 2007), or anti-sperm antibodies (Soares et al., 2007and Suehiro et al., 2008), high activity of disease or chronic renal disorder and immunosuppressive medications (Latta et al., 2001 and Østensen et al., 2006) can initiate reduction of fertility in patients with rheumatic sicknesses. In the healthy people, the reproductive ability also decreases with age in both sexes (Balen and Rutherford, 2007).
Rheumatoid arthritis (RA) is a systemic disorder characterized by joint swelling with pain function loss, joint damage and permanent deformity if left without treatment (Tripathy et al., 2009). The spread of RA is reliable globally influencing about 0.5-1.0% of the population. It commonly occurs in individuals between 25 and 55 years of age (Meera et al., 2008). Although the exact cause is unknown but various hypotheses suggested that it is caused by the integration of genetic tendency and exposure to environmental factors like viruses (Babushetty and Sultanpur, 2012). The RA has several adverse effects on the body systems including heart and blood vessels, lungs, kidneys, liver and skin.
Tumor necrosis factor α (TNF α) is a crucial cytokine in acute inflammation and play a vital role in the reproductive physiology of men (Sharkey, 1998 and Harada, 2001). TNF α showed a wide diversity of biologic actions which may impair the reproductive functions, like stimulation of the immune-cascade and chemotaxis of neutrophils, cytolytic and cytostatic effect on tumor cells, initiation of fibroblastic progression, prostaglandin and collagenase synthesis, and possible efficacy on sperm movement and function (Hill et al., 1989).
Apoptosis is considered one of the vital cell death mechanisms with necrosis. Apoptosis is controlled by different genes and molecules that all play a pivotal role in stimulation of apoptosis such as Bax proteins. Induction of Bax proteins stimulate the secretion of cytochrome c and other apoptogenic factors leading to apoptosome formation, which then triggers caspase-9 with caspase-3 and 7 (Aitken et al., 2011). Sperm DNA damage activated by apoptosis has been demonstrated in different mammals (Dogan et al., 2012). The balance between germ cells and sertoli cells in the testes during spermatogenesis is achieved by apoptosis and an imbalance in this process was denoted to cause infertility in males (Aitken et al., 2011). Bax proteins have been founded in RA (Sioud and Mellbye, 1998 and Kobayashi et al., 2000). These Bax proteins can form hetero and homodimers, in addition the relative plenty of pro-apoptotic and anti-apoptotic molecules are vital in adjustment of apoptosis and cell cycle in RA (Hilbers et al., 2003).
Deceased fertility is not uncommon amongst patients with rheumatic disorder (Gupta et al., 2010 and Clowse et al., 2012). Drug treatments may considered the major cause for gonadal impairment (Freire et al., 2006). The reproductive possibility of male patients is declined by the disease directly in the testis or by immunosuppressive drugs. The assessment of male patients must depend on perfect case history, semen analysis, full physical checkup, and sex hormone examination (Tiseo et al., 2016).
Researchers are looking for the traditional medicine for finding extended acting anti-inflammatory medications having little side effects (Ekambaram et al., 2010 and Patil et al., 2010). Plant-derived drugs still a vital resource, especially in developing countries, for severe diseases therapy. It has been recorded that 60-90% of RA patients who already utilized alternative and complementary therapy; the majority used traditional Chinese medication (Zhao et al., 2013). In India, there are more than 2500 plants species which are used nowadays as herbal medicine (Sudha and Mathanghi, 2012).
Costus speciosus Koen. (Keu, Crape ginger), is considered an Indian ornamental herb, has been utilized in traditional therapy for a long period. This herb of Costaceae (Zingiberaceae) family is well-known as keukand (Hindi) and diversified Crepe Ginger (English) (Srivastava et al., 2011). The plant have anti-inflammatory, laxative, anti-arthritic and anti-fungal actions. It also utilized in bronchial asthma and gout rheumatism (Khare, 2007). Costus have a useful anti-arthritic efficacy as it shows a good results in monitoring inflammation in adjuvant induced arthritic rats. The medication is a hopeful anti-arthritic drug from plant extract in the medication of inflammation (Srivastava et al., 2012).
The current study directed to explore the effect of costus as anti-arthritic treatment on male rat fertility assessed by sex organs weight, sperm count, sperm abnormalities as well as viability. Also testicular androgen receptors, TNF α and Bax protein were assessed in the present study by immunohistochemistry.