Abarikwu SO, Onuah CL, Singh SK. Plants in the management of male infertility. Andrologia. April 2020;52(3):e13509. doi: 10.1111/and.13509.
Male infertility is estimated to account for approximately 60% of all infertility cases. Deficient sperm production is reported as a major reason for male infertility. Various plants have demonstrated aphrodisiac and testicular effects, which could enhance male fertility. The purpose of this review was to examine medicinal plants that may be candidates for improving male fertility.
The databases Google Scholar, Wiley Online Library, PubMed, and Scopus were searched from 1996 to 2019. The following search terms were used: male infertility; plant extracts and sperm quality; plant extracts and testosterone; medicinal plants and androgens; plant extracts and male infertility; and medicinal plants and incidence of male infertility. Based on their literature search, the authors identified medicinal plants that might form a pool for future studies to determine butterbur their mechanisms of action on the testes. The following herbs were reviewed: maca (Lepidium meyenii, Brassicaceae); bokbunja (Korean blackberry; Rubus coreanus, Rosaceae); puncturevine (Tribulus terrestris, Zygophyllaceae); Asian ginseng (Panax ginseng, Araliaceae); Japanese butterbur (Petasites japonicus, Asteraceae) celery (Apium graveolens, Apiaceae); Tongkat Ali (Eurycoma longifolia, Simaroubaceae); bara gokhru (Pedalium murex, Pedaliaceae); bahu phali (Corchorus depressus, Tiliaceae); velvet bean (Mucuna pruriens, Fabaceae); astragalus (Astragalus membranaceus, Fabaceae); nigella (Nigella sativa, Ranunculaceae); hawthorn (Crataegus monogyna, Rosaceae); uziza (Fagara tessmannii, Rutaceae); mahkota dewa (Phaleria macrocarpa, Thymelaeaceae); pellitory (Mount Atlas daisy; Anacyclus pyrethrum, Asteraceae); suo yang (Cynomorium songaricum, Cynomoriaceae); and Indian mulberry (Morinda officinalis, Rubiaceae). Unless otherwise noted, the plant parts of these herbs were not noted.
Maca (Lepidium meyenii, Brassicaceae). Clinical trials have shown that maca increases the number and motility of spermatozoa and increases sexual function. Macamides and macaenes, a group of secondary metabolites in maca, are thought to exert these effects through their antioxidant properties.
Bokbunja (Korean blackberry; Rubus coreanus, Rosaceae). Bokbunja is commonly used for the treatment of erectile dysfunction. The unripe fruit of bokbunja has been demonstrated in the testes of rats to enhance spermatogenesis and sperm quality through the modulation of cyclic adenosine monophosphate-responsive element-binding protein. The fruit has also been shown to relax the smooth muscle of white rabbit corpus cavernosum in vitro.
Puncturevine (Tribulus terrestris, Zygophyllaceae). Puncturevine leaves are used in Chinese medicine for the treatment of male reproductive disorders. Puncturevine fruit extracts have been shown to increase mice testes weight and sperm count. Protodioscin is the most abundant saponin in puncturevine and has demonstrated androgenic properties in humans.
Asian ginseng (Panax ginseng, Araliaceae). Asian ginseng root has been shown to improve spermatogenesis and restore Leydig and Sertoli cell numbers in aged rats. These effects were thought to occur through an increase in testicular antioxidant concentrations.
Japanese Butterbur (Petasites japonicus, Asteraceae). Japanese butterbur contains sesquiterpenes, which have been shown to stimulate spermatogonial stem cell proliferation in mice through their antioxidant effects.
Celery (Apium graveolens, Apiaceae). The aqueous leaf extract of celery has been shown in rats to increase the diameter of the seminiferous tubules and number of spermatocytes, spermatogonia, and spermatozoids. Celery oil has also been shown in rats to increase testes weight and sperm motility. Celery leaves and seeds are rich in phytochemicals and phytoestrogens, which are thought to exert these effects.
Tongkat Ali (Eurycoma longifolia, Simaroubaceae). In clinical trials, eurycomanone from Tongkat Ali has demonstrated improvements in serum testosterone and erectile dysfunction by inhibiting the conversion of testosterone to estrogen catalyzed by aromatase.
Bara Gokhru (Pedalium murex, Pedaliaceae). Bara gokhru has a long history of use in traditional Indian medicine as an aphrodisiac and testosterone booster. The plant contains the saponin diosgenin, which may modulate sex hormones in humans. Bara gokhru extracts have also demonstrated aphrodisiac and curative effects in infertile male rats.
Bahu phali (Corchorus depressus, Tiliaceae). Bahu phali has long been used in Indian systems of traditional medicine as an aphrodisiac. The saponin diosgenin obtained from a chloroform fraction of bahu phali has demonstrated androgenic and aphrodisiac properties in vitro and in vivo.
Velvet bean (Mucuna pruriens, Fabaceae). Velvet bean roots and seeds are rich in alkaloids, triterpenes, saponins, and sterols. In clinical trials, velvet bean seeds significantly improved semen quality in infertile men.
Astragalus (Astragalus membranaceus, Fabaceae). Astragalus is a tonifying adaptogenic herb that contains saponins, flavonoids, polysaccharides, and phytosterols. One study demonstrated a significant stimulatory effect on the spermatozoa of healthy donors in vitro using a water extract of the herb.
Nigella (Nigella sativa, Ranunculaceae). A trial in infertile men demonstrated that nigella oil given twice per day for eight weeks resulted in an increase in sperm count and quality. These favorable effects on sperm parameters are thought to be linked with the major bioactive component of nigella, thymoquinone, which has anti-inflammatory and antioxidant properties.
Hawthorn (Crataegus monogyna, Rosaceae). Hawthorn has various applications in folk medicine, including the treatment of infertility. Male rats who were treated with an aqueous extract of hawthorn fruit demonstrated an increase in concentrations of testosterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH). Hawthorn contains proanthocyanidins and flavonoids as well as other constituents, which may be responsible for these effects.
Uziza (Fagara tessmannii, Rutaceae). Uziza roots and aerial parts have been used in folk medicine to treat infertility and sexual weakness. Vanillic acid and other triterpenes present in uziza have been shown to enhance sperm quality and increase testosterone concentrations in rats.
Mahkota Dewa (Phaleria macrocarpa, Thymelaeaceae). Mahkota dewa has traditionally been used in Indonesia to improve fertility in males. The aqueous extract of the herb has been reported to increase the number of spermatogonial cells, testosterone level, and sperm viability of rats. The major chemical constituents in the different parts of mahkota dewa, include lignans, glucosides, xanthones, and other polyphenols, which might contribute to the positive effects on male gonads.
Pellitory (Anacyclus pyrethrum, Asteraceae). Pellitory dried roots are widely used in traditional Indian medicine for rejuvenation, vitality, and sexual desire. The petroleum extract of pellitory was shown to increase the penile erection index, sperm quality, and LH and FSH concentrations in rats. These effects were assumed to occur due to the high androgenic potential of the alkylamide-rich extract of the plant.
Suo yang (Cynomorium songaricum, Cynomoriaceae). Suo yang has been used to treat sexual dysfunction and impotence in traditional Korean medicine. An aqueous extract of suo yang has demonstrated spermatogenesis-enhancing properties in mice by inducing the expression of glial cell-derived neurotrophic factor in Sertoli cells.
Indian mulberry (Morinda officinalis, Rubiaceae). The aqueous extract of Indian mulberry has been shown to increase sperm count and germ cell numbers in the seminiferous tubules of rats. Bajijiasu, the active ingredient of Indian mulberry, has also been shown in mice to enhance sexual behavior, increase testosterone concentration and sperm quality, and protect the sperm DNA from oxidative damage.
Despite the many medicinal plants that may regulate the function of the testes to improve male fertility, the authors call for further evidence to support the plants' traditional claims. Additional studies in animal models on the efficacy and safety of these plants can pave the way for human trials.
The authors declare no conflicts of interest.
–Gavin Van De Walle, MS, RD