Study: Ashwagandha for male infertility

reference

Ambiye VR, Langade D, Dongre S, Aptikar P, Kulkarni M, Dongre A. Clinical evaluation of spermatogenic activity of root extract of Ashwagandha (Withania somnifera) in oligospermic men: a pilot study.Evid Based Complement Alternate Med. 2013;2013:571420.

design

Double-blind, randomized, placebo-controlled, parallel-group pilot study

Participant

68 healthy men aged 22 years–40-year-olds with male infertility were evaluated. Of these participants, 46 were included after being deemed eligible for inclusion. Male factor infertility was defined by a sperm concentration between 5 and 20 million/ml and a total motility of 10%.–30% with forward motility <15% and abnormal morphological forms >70%. All participants had had regular sexual intercourse with a female partner in the past. Participants were randomly assigned to one of two groups. Participants were excluded if they had a history of erectile dysfunction, congenital anomalies, uncontrolled diabetes, cryptorchidism, varicocele, genital tract surgery, or testicular hypertrophy.

Study medication and treatment protocol

Twenty-one men in the treatment group received 225 mg of encapsulated ashwagandha root orally three times daily for 12 weeks, while 25 men in the control group took a placebo capsule orally three times daily for 12 weeks. Participants were instructed not to take any other medications or supplements that could affect spermatogenesis during the study. Ashwagandha root, known as KSM-66, was extracted, concentrated and standardized to contain at least 5% withanolides by Ixoreal Biomed Private Ltd in Hyderabad, India.

Primary outcome measures

Semen analysis was performed to assess changes in sperm concentration, motility and morphology at baseline, after 30 days of treatment and again after 90 days of treatment. Serum testosterone and luteinizing hormone (LH) were measured at baseline and after 90 days of treatment.

When semen parameters were compared at baseline and after the 90-day treatment period, average sperm concentration increased, representing a 167% increase in sperm concentration in men treated with ashwagandha root.

Key findings

When comparing semen parameters at baseline and after the 90-day treatment period, the average sperm concentration increased from 9.6 + 4.4 x 106/ml to 25.6 + 8.6 x 106/ml, which corresponds to a value of 167% (P<0.0001) Increase in sperm concentration in men treated with ashwagandha root. Average semen volume increased from 1.74 + 0.58 ml to 2.76 + 0.60 ml, representing a 53% increase in semen volume in men treated with ashwagandha root for 90 days (P<0.0001). Average sperm motility increased from 18.6 + 6.1% to 29.2 + 6.3%, representing a 57% increase in sperm motility after 90 days of Ashwagandha root treatment. Compared to baseline, serum testosterone levels increased by 17% (P<0.01) and LH increased by 34% (P<0.02). No adverse events or side effects were reported by any of the participants.

Effects on practice

Infertility, which is diagnosed when a couple fails to conceive after 12 months of unprotected sex, affects 15% of all couples; 50% of these cases are attributed to male infertility. There is evidence that male fertility is declining, with one study estimating that mean sperm count is declining by about 2% per year.¹Male infertility is idiopathic in 30% of cases, meaning that standard clinical and laboratory tests do not reveal a cause.²Hormonal imbalances, endocrine disruptors, and poor lifestyle choices can all play a role in male infertility. Furthermore, oxidative stress mediated by reactive oxygen species (ROS) is increasingly recognized as a causative factor in male infertility.^3.4This is because mature sperm, surrounded by a polyunsaturated lipid membrane, are susceptible to the effects of ROS, which at high doses can impair spermatogenesis and reduce sperm quality, thereby affecting sperm motility and morphology.^5–7Sperm number and quality are also influenced by hormones from the hypothalamic-pituitary-gonadal (HPG) axis, with the hypothalamus producing gonadotropin-releasing hormone (GnRH), which stimulates the anterior pituitary to produce follicle-stimulating hormone (FSH) and luteinizing hormone to pay out (left). FSH and LH stimulate spermatogenesis and testosterone secretion by acting on Sertoli cells and Leydig cells, respectively.^8.9Spermatogenesis is regulated by a complex interaction between FSH, LH and intratesticular testosterone. Disturbances in the HPG axis have been shown to affect seed parameters.^10,11

Reproductive endocrinologists treat men with abnormal semen parameters with injectable medications such as recombinant FSH, human chorionic gonadotropin (hCG), the hormone human menopausal gonadotropin (hMG), or gonadotropin-releasing hormone (GnRH). Clomiphene citrate, an estrogen receptor antagonist, is an oral medication used to stimulate gonadotropin release from the pituitary gland. However, these options are expensive, not widely available, may take several months to provide benefit, and are not without risk.¹²Given these shortcomings, naturopathic physicians are well-positioned to offer their patients a more holistic approach to improving male reproductive health. Evidence-based natural medicines to improve male infertility due to oxidative stress have already been discussed inJournal of Natural Medicine Here And Here.

When doctors determine that HPG dysregulation contributes to male infertility, ashwagandha root may be recommended to improve semen parameters. Ashwagandha, a medicinal plant whose name means “horse smell” in Sanskrit,¹³has been used for thousands of years to treat hypogonadism, low libido and male infertility.^14.15In Ayurvedic medicine, it is used as a rasayana (or rejuvenating) tonic that restores internal strength. The results of this study are consistent with a previous study that showed ashwagandha improved sperm parameters in infertile men with hypogonadism.¹⁶While this study lacked long-term follow-up and assessment of pregnancy rates with ashwagandha treatment, consideration should be given to the statistically significant improvement in semen parameters, the absence of side effects and side effects, and the relative affordability compared to assisted reproductive techniques of ashwagandha root as part of a naturopathic approach to male treatment Infertility, especially if low testosterone or HPG dysregulation are contributing factors.