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Oligozoospermia and Ayurveda – A Meta Analysis of Clinical Trials Conducted

at IPGT&RA, Jamnagar up to 2009.

Article · January 2010

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Oligozoospermia and Ayurveda – A Meta Analysis of Clinical Trials
Conducted at IPGT&RA, Jamnagar up to 2009.
Dr. M. S. Thirunavukkarasu*, Dr. Anup B Thakar**, Prof. M. S. Baghel***

*PhD Scholar, Department of Kayachikitsa, IPGT&RA, GAU, Jamnagar.

** Reader, Department of Panchakarma, IPGT&RA, GAU, Jamnagar.
*** Director, IPGT&RA, Gujarat Ayurveda University, Jamnagar.

Introduction:

Infertility is a problem of global proportions, affecting on average 8–12 percent of

couples worldwide1. Annual Incidence of Male infertility is at least 2 million cases
(based on The National Women's Health Information Center - NWHIC). Recent
studies have indicated that the prevalence of Oligozoospermia is extremely high in
metropolis as well as in smaller towns of India.2

Infertility is defined as the inability to achieve pregnancy after one year of

unprotected coitus3. Male infertility is considerably less complicated than Female
infertility but can account for 30 – 40% of infertility4. Except some physical defects,
low sperm count (Oligozoospermia) and poor sperm quality are responsible for male
infertility in more than 90% of cases. Out of these in about 30% to 40% the cause is
unexplained, and in the rest of the cases critical illness, malnutrition, genetic
abnormalities, pollution, side effects of some medicines, hormones and chemicals
play the major role5.

Vajikarana is one of the branches of Ayurveda that deals with the preservation and
amplification of sexual potency of a healthy man and conception of healthy progeny
as well as management of defective semen, disturbed sexual potency and
spermatogenesis along with treatment of seminal related disorders in man6.
Vajikarana promotes the sexual capacity and performance as well as improves the
physical, psychological and social health of an individual7.

On Vajikarana more than 120 works in PG / PhD level have been carried out in
various Ayurvedic Academic institutes in India, in which the researchers considered
various aspects of the problem like etiology, pathogenesis and complications of the
diseases related to reproductive system in both Ayurvedic and Modern parlance. Out
of 120 works more than 30 works have been carried out in Oligozoospermia. The
term Oligozoospermia was correlated in research works with Kshina Sukra (14
works); Alpa Sukra (1 work); Sukra dosa (2 works); Sukra Dusti (3 works); Sukra
Kshaya (6 works); Sukralpata (4 works); Kshina Retas (1 work); Bijopaghata (1
work) and Sukradhatu Vikara (3 works).8 Among these, Kshina Sukra is used in
majority of the research works with special reference to Oligozoospermia.
Oligozoospermia is the seminal disorder in which sperm count is below 20 million /
ml.9

In the Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat
Ayurved University, as part of M.D as well as Ph.D dissertations 12 research works
have been carried out on Oligozoospermia. Out of these, few works were conducted
to assess the clinical efficacy of single herbs (6 works), which are mentioned in
classics like Kapikacchu (Mucuna pruriens), Vidarigandha (Pueraria tuberosa),
Asvagandha (Withania somnifera), Kokilaksha (Asteracantha longifolia), Jatamamsi
(Nardostachys jatamansi), Swetamusli (Asparagus adscendens), Satavari (Asparagus
racemosus), Kshira Vidari (Ipomea digitata) etc. Some works established the efficacy
of the compound drugs (3 works) like Vajikarana Yoga, Satavaryadi Yoga,
Kokilikshadi Curna, Amalaki Rasayana, Bhallataka Phalamajjadi Avaleha,
Narasimha Curna etc., where as few works were done with Mineral formulations (3
works) like Svarnabhasma, etc. A few works were conducted to evaluate the efficacy
of Shodhana Karma (2 works) in Oligozoospermia and concluded that Basti is
effective in the management of the same.

12 Clinical trials conducted in IPGT & RA, GAU, on Oligozoospermia are being
evaluated in this paper.

Dongarwar L.A. (1987):10 In PG level thesis work, Vajikarana Karma of Atmagupta,

Kokilaksa and Jatamansi was studied with special reference to their effect on
Sukravrddhi in selected 50 patients and he reported positive effect of Kokilaksa on
conditions like Daurbalya, Sperm count, sperm motility and duration of sexual act &
frequency of coitus. While Atmagupta were found effective on Daurbalya and anxiety
as well as libido. Jatamansi showed a good effect on anxiety, anorgasmia and
insomnia.

Bhat Kamlesh (1990):11 In patients of Sukradusti (Oligozoospermia) were

administered Satavari Curna in dose of 5 gm once daily with milk in ear1y morning
for 90 days (n=18) and in another group, Uttangan Curna was given in dose of 5 gm
once daily with milk for 90 days with milk in early morning (n=12). It was reported
after completion of therapy, in the group treated with both Satavari Curna and
Uttangan Curna sperm count, sperm motility and volume of semen improved
significantly.
12
Ahuja P C (1992): In this study, patients suffering from Sukradusti were treated
with three compound drugs. 14 patients with Musalyadi Curna (containing Sveta-
Musali, Asvagandha, Satavari in dose of 6 gm thrice daily with milk); 6 patients with
Bhallataka Phalamajjadi Avaleha (containing Bhallataka, Amalaki, Masa, Dugdha,
Sarkara, Ghrta in dose of 30 gm in divided dose / day with milk) and 6 patients with
Narasimha Curna (containing Satavari, Goksura, Varahi, Bhallataka, Citraka,
Trikatu, Tila, Sarkara, Madhu and Ghrta in dose of 18 gm in divided dose / day with
milk) for a duration of 60 days. He has observed that Musalyadi Curna provided
better relief to Phenila, Tanu, Ruksa, Vivarna, Puti, Piccila, and Avasadi types of
Sukradusti as well as Sighra Skhalana and lack of libido. It also increased total sperm
count (22.2 % ↑, p<0.001) and motility of spermatozoa (32.11 % ↑) significantly
better than other two groups. Bhallataka Phalamajjadi Avaleha showed better
improvement in Dhvaja-bhanga, Alpasukrata (sperm count - 39.99 % ↑, p<0.01) and
Sukraksaya Laksana, while Narasimha Curna provided better relief in duration of
sexual act and frequency of coitus.

P.K.Godatwar (1995): 13 Clinical and experimental study was conducted on the role
of Svarna Bhasma in normozoospermia. In the clinical trial, Svarna Bhasma was
administered orally in a dose of 4 mg twice daily for one month to 15 normal subjects
and Atmagupta Curna was given orally in a dose of 3 gm twice a day for one month
to 12 normal subjects.

In the clinical trial, significant improvement in the sperm concentration (34.1 % ↑,

p<0.05, n=4) was observed following treatment with Svarna Bhamsa, whereas
Atmagupta Curna failed to provide significant improvement (14.4 % ↑, n=8) in the
sperm concentration. RLP motility (5.21% ↑, n=4) and SLP motility (32.9 % ↑ at 1
month after study, n=8) were insignificantly improved with corresponding decrease in
NP (13.8 % ↓, n=4) and immotile sperm (20.6 % ↓) following the treatment by Svarna
Bhasma, whereas Atmagupta Curna improved the semen quality (i.e. sperm count,
motility, abnormal forms) insignificantly. Both Svarna Bhasma and Atmagupta
showed highly significant increase in body weight.

In the experimental study, it was found that concentration of spermatozoa in the cauda
epididymis of the rat and RLP motility increased significantly. The area of interstitial
tissue of the testis significantly increased. The diameter of the seminiferous tubules
per field in rat testes was reduced. The numbers of seminiferous tubules per field in
rat testes were increased after the treatment with Svarna Bhasma.

Rao Niranjan (1997): 14 In the clinical trial, First group of patients were administered
with a combination of A K Kvatha (n=11) [Amalakadi Curna (containing Amalaki,
Kapikaccu, Satavari) and Katphaladi Kvatha (containing Katphala, Sati and Khadira)
and the second group with Svarna Bhasma (n=6).

Amalakadi Curna 6 gm thrice daily along with 30 ml of Katphaladi Kvatha once

daily were given for the First group where as Svarna Bhasma was administered 5 mg
twice daily with milk (30ml) in the second group. The duration of therapy in both the
group was of two months.

Svarna Bhasma provided significant improvement in motility (RLP, SLP, NP), sperm
count (73.8% ↑), Volume of semen (49.03% ↑), Semen viscosity, pH, debris,
amorphous matter, total abnormal forms and immobilization of the spermatozoa.
Body weight also increased significantly. A K Kvatha provided better effects in sperm
count (105 % ↑), RLP motility (42.6 %), liquefaction time, auto-agglutination,
immobilization and body weight. In experimental study, Svarna Bhasma showed
better improvement in RLP and SLP motility of spermatozoa in comparison to control
group.

Prasad B S (1998):15 Total of 92 patients of male infertility were treated in three

separate groups. Svarna Bhasma in dose of 4 mg (in capsule form) twice daily with
milk was administered in Group I (n=33), Musali Curna in the dose of 3 gm twice
daily with milk in the second (n=35) and Asvagandha in the dose of 3 gm twice daily
with milk in the third group (n=24). The duration was of 30 days.

The results of the study showed that Svarna Bhasma significantly improved both RLP
(335.9%) and SLP (72.1%) motility and caused corresponding decrease in the
immotile spermatozoal count (21.59%) and abnormal forms (16.2%) of spermatozoa.
A survey study was also conducted in goldmine areas and non-goldmine areas for the
further substantiation of the role of Gold in Spermatogenesis. In-vitro study with
Svarna Bhasma was also carried out to see its effect on sperm motility.

In survey study it was reported that the incidence of different pathological conditions
of semen especially Oligozoospermia and Oligoasthenozoospermia was very high in
non-goldmine areas in comparison to goldmine areas. In the gold estimation, seminal
plasma gold concentration was found high in non-goldmine areas in comparison to
goldmine areas. Semen volume, sperm count and motility were better in goldmine
areas in comparison to non-goldmine areas. This observation certainly indicates
towards some action of gold in spermatogenesis.

One-month treatment of 35 asthenozoospermia patients with Sveta-Musali caused

insignificant increase in sperm count ranging from 27.67 % to 57.46 %. It also
significantly increased RLP motility from 40.06 % to 91.31 % and SLP motility
ranging from 6.4 % to 16.72 % in fourth month of study.

Asvagandha insignificantly increased sperm count ranging from 16.53 % to 37.35 %

during first three months of study. It insignificantly improved RLP motility ranging
from 10.18 % to 113.78 % and SLP motility to ranging from 2.01% to 11.93%.

Comparison showed that Svarna Bhasma improved all types of sperm motility, which
was significantly better than other two groups.
16
Thakar A B (2000): Total 73 patients of Oligozoospermia were treated in three
groups: In Group I Svarna Bhamsa (n=10) was given in 10 mg twice daily dosage for
30 days with milk as Anupana; Group II Kokilaksa Bija Curna (n=25) was given in 5
gm thrice daily dosage for 30 days with milk as Anupana ; In Group-III, Asvagandha
Curna (n=33) was given in 3 gm twice daily for 30 days with milk as Anupana.

Svarna Bhasma was effective in increasing the sperm count (227 % ↑) and decreasing
the abnormal forms of spermatozoa (24%), Kokilaksa increased RLP motility (127 %
↑) and reduced viscosity (30%) and Asvagandha increased sexual desire (28%),
erection (23%) and ejaculation score (33%).
17
Acharya RN (1996): Male patients (n=30) of infertility and sexual dysfunction
were studied in four different groups. In group-I, five patients were treated with 1 gm
of Vidarikanda Curna; in group-II, ten patients were treated with 2 gm of
Vidarikanda Curna; in group-III, eight patients were treated with 500 mg of
Vidarikanda Curna and in group-IV, seven patients treated with 2 gm of Ksiravidari
Curna. All the patients were advised to take drug twice daily with honey for a period
of one month. Semen parameters such as count, motility including volume showed
remarkable decrease with administration of Vidarikanda irrespective of doses.

Gynecomastia was observed in two patients in group-I and one patient in group-III.
Increased estrogen level by 20 times was estimated in a patient of gynecomastia. But
the drug Ksiravidari provided improvement in all parameters. In-vitro study with 50%
ethanol extract of both Vidarikanda and Ksiravidari did not show any spermatozoan
motility enhancing property when studied in the concentration of 0.1 to 0.4 mg per ml
of semen. Ksiravidari juice enhanced motility of spermatozoa when added to in-vitro
in the concentration of five mg per ml of semen.

Raja Reddy G (1999): 18 In Group I Erandamula Curna (N=28) was administered in

the dose of 3 gm twice daily with water and in Group II Kapikaccu Bija Curna (n=28)
was administered in the dose of 3 gm twice daily with water for a period of 30 days in
patients of Male Infertility and Male Sexual Dysfunction.

Erandamula registered 39.76 % improvement in total sperm count, 30.68 % increase

in RLP motility and 21.07 % reduction in semen viscosity; where as Kapikaccu
improved the total sperm count by 21.54 % (p<0.05), and RLP motility by 6.03 %
and reduced semen viscosity by 51.07 %. The scholar has concluded that Erandamula
was found better in improving seminal parameter, while Kapikaccu was proved better
effective on sexual parameters.

Girish KJ (2006): 19 In this study, total 65 patients of Oligozoospermia were treated

in two groups. In Ksiravidari group (n=35) tablets of Ksiravidari tuber was
administered in a dose of 6 gm per day in divided dose and in placebo group (n=30)
Bhrsta Godhuma Curna in capsule form [4 capsules / day (each 500 mg)] was
administered. In both the group, therapy was given for 45 days.

Ksiravidari increased sperm count (mil/ml) by 66.59 % (p<0.05). During follow-up

period, sperm count was further increased at the end of second month and third month
by 91.79 % (p>0.05) and 31.47 % (p>0.05) respectively.

RLP motility decreased by 18.62% (p>0.05), SLP motility was decreased by 33.09 %,
and NP motility was decreased by 4.38 % it was further decreased during follow up.
IMM spermatozoa were increased by 13.57 % (p< 0.05) and there was an increase in
total abnormal forms of sperm by 13.15 % (p<0.05), liquefaction time by 11.73%,
Viscosity of semen by 29.03%, Viability of sperm by 15.09%.

Volume of semen was increased by 12.07 % in Ksiravidari group (p>0.05). In follow-

up study, on 60th day, it was increased by 8.36 % (n=18) and which was decreased by
13.06 % by the end of third month (n=18) (p>0.05).

At the end of one and half month, there was significant increase in erectile function,
orgasmic function, sexual desire and intercourse satisfaction.

Overall effect of therapy was assessed on the basis of change in sperm count and
conception of female partners of the patients. In Ksiravidari group 8.57 % conception
was reported (3 patients). Complete remission i.e. improvement in sperm count by
>100%, was observed in 17.14 % in study group. Marked improvement i.e.
improvement in sperm count between 51-100% was recorded in 11.42 %.
Improvement i.e. improvement in percentage of sperm count was between 25-50%, in
25.71 % in study group. Unchanged i.e. improvement in percentage of sperm count
<25%, was found in 40%. Ksiravidari provided better improvement in conception and
sperm count in comparison to placebo therapy

Ayyagiri Raghuram (1998): 20 Total of 16 patients were studied in two groups. In

Group-I (n=6), Baladi Vrsya Basti that contains Bala, Atibala, Atmagupta, Apamarga,
Kalka Dravya, Ksira, Guda, Tila Taila and Saindhava] was given in the dose of 600
ml once a day for ten days and after a gap of one week same course was repeated. In
Group-II (n=10) Satavaryadi Yoga containing Satavari, Nagabala, Vidari, Goksura
and Amalaki was given in the dose of 6 gm twice daily with Anupana of Ghrta and
Ksira.

Baladi Vrsya Basti provided better improvement in all semen parameters in

comparison to Satavaryadi Yoga. It also caused better relief in sexual parameters.
Satavaryadi Yoga provided comparatively better improvement in sperm count and
improving SLP motility better than Basti.

Juneja M Yashwant (2009): 21 In total 12 male patients were studied in two groups.
In Group A patients were administered Basti by classical method i.e. by Classical
Basti Putak method and in Group B patients were administered Basti by Enema pot
method. Patients of both groups were administered Kala Basti (acc. to Ch.Si.1/47-48)
course as mentioned in classics. Varsha & Pravrit Ritu (Rainy season) was selected
for administration of Basti. Patients of both groups were administered 2 placebo
capsules each of 250 mg twice in a day with milk for 30 days (during follow up
period) to avoid drop out from the study.

Kala basti are sixteen in number. Out of sixteen, ten Anuvasana Basti contains 100 ml
of taila (Eranda Taila and Saindhava lavana) were administered in both the groups
and Six Asthapana basti 500ml of Baladi Yapan Basti were given in both the groups.
The patients were subjected for Abhyanga with Bala taila and Baspa Sveda prior to
the administration of the Basti in both the groups.

Basti given by Basti putak significantly increased the sperm count by 70.75%,
increased the motility by 18.14%, increased the RLP motility by 12.82%, reduced the
viscosity in abnormal specimens by 71.42%, increased the erectile function by 75%,
sexual desire by 73.33%, ejaculatory function by 72.22%, frequency of coitus by 60%
and duration of coitus by 35%. 84.61% of relief was observed in Daurbalya while
52.63% in Panduta, 69.23% in Bhrama and 76.47% in Shrama. Complete remission
was obtained in 16.67% patients, marked improvement in 66.67% and no
improvement in 16.67%. Where as, Basti given by Enema pot method significantly
increased the sperm count by 54.07%, increased the motility by 18.97%, increased the
RLP motility by 19.02%, reduced the viscosity in abnormal specimens by 50%,
increased the erectile function by 53.33%, sexual desire by 68.75%, ejaculatory
function 52.63%, frequency of coitus by 45.45% and duration of coitus by 25.64%.
66.66% of relief was observed in Daurbalya while 43.75% in Panduta, 70.58% in
Bhrama and 56.25% in Shrama. In Enema pot group 16.67% patients were able to
impregnate their wives, 66.67% patients reported marked improvement and 16.67%
patients reported Mild improvement.

Basti Putak method showed excellent result in sperm count and viscosity and in
sexual parameters such as sexual desire, erection etc. while in Enema pot group good
results were observed in RLP, SLP, NP, IMM and volume in seminal parameters of
patients.

Discussion and Conclusion

Oligozoospermia is one of the most prevalent reasons for male infertility in clinical
practice. In most of the cases, functional deformity in spermatogenesis is the major
reason for Oligozoospermia, which involves either defective mechanism of
testosterone, LH and FSH secretion, or excess production of reactive oxygen
specimen (ROS) or both.22

Acharya Susruta has included Kshina Sukra under Sukra dusti.23 Here, Vata dosha
along with pitta undergo vitiation and does disturbance in the normal qualities and
quantity of the sukra dhatu.24 As a result of this, sukravaha srotas undergoes dusti,
which debilitate one normal individual from impregnating his life partner, ending in
infertility.

The main line of treatment in Oligozoospermia is “Ksine Sukrakari Kriya”25 means

the dravyas, which increases Sukra i.e having Sukrakara properties26 like Madhura
rasa (Sweet Taste), Snigdha (unctuous) Guru (heavy quality), Jivana (promotes
quality of life) and Brmhana (nourishing property) dravyas should be given. Sukra
Dusti should be treated on the lines of involved Dosa i.e., in case of Oligozoospermia
(Ksinasukra) treatment has to be planned in line with Vataja Pittaja Sukradustihara
Yogas.27 Where as in Modern science, first step in the treatment of Oligozoospermia is
prevention; includes preventing sexually transmitted diseases, not smoking, not
drinking alcohol or caffeine excessively, not using recreational drugs etc. as well as
proper nutrition with vitamin supplements. Decreased follicle-stimulating hormone
levels may respond to vitamin B therapy; decreased LH levels, to human chorionic
gonadotropin (hCG) therapy. Normal or elevated LH level requires low dosages of
testosterone. Decreased testosterone levels, decreased semen motility, and volume
disturbances may respond to hCG and the medications like Clomiphene, Metformin,
Bromocriptine and Cabergoline. Intrauterine fertilization is also used in some cases.28

Systemic review of 12 clinical trials on Oligozoospermia carried out in the IPGT &
RA, Gujarat Ayurved University shows that Ayurvedic treatment would be more
helpful in the management of Oligozoospermia. Most of the drugs, which used in the
studies, have the properties like Madhura Rasa, Guru & Snigdha Guna and Sita Virya
along with Vatapittahara action. The Mineral drug Svarna has the qualities like
Snigdha guna, Madhura Vipaka, Sarva doshagnata along with Brmhana, Vrsya,
Medhya and Pushtikara properties.29 Svarna bhasma has the qualities like Ojodhatu
vivardhana and Balakara.30 The drugs possess Vrsya and Vajikarana properties also.
Madhura, Tikta Rasa, Guru & Snigdha Guna present in these herbs produce
Brmhana effect in the body; also these are the qualities opposite to that of vata and
pitta, by these qualities the drugs easily disintegrate the sampratpti of Kshinasukra
(Samprapti Vighatana chikitsa).

To explain the mode of action on modern scientific line, most of the drugs like
Asvagandha (Withania somnifera) effectively reduced oxidative stress as assessed by
decreased levels of various oxidants and improved level of diverse antioxidants.
Moreover, the levels of Testosterone, LH, FSH and PRL were increased which are
good indicators of semen quality.31

Kapikacchu (Mucuna pruriens) seeds are rich source of L-DOPA and its metabolites,
which include epinephrine and norepinephrine. Therefore, an increase in dopamine
level in the brain may not only induce the activation of sexual behavior but it may
also increase plasma testosterone level. It has been reported recently that L-DOPA
and its metabolite dopamine stimulate the hypothalamus and forebrain to secrete
gonadotropin-releasing hormone (GnRH). This, in turn, up regulates the anterior
pituitary gland to secrete follicle stimulating hormone (FSH) and luteinizing hormone
(LH) causing increased synthesis of testosterone by Leydig cells of the testis.
Furthermore, spermatogenesis is controlled by the hypothalamus and anterior
pituitary working together. Thus Mucuna pruriens significantly ameliorated
psychological stress and seminal plasma lipid peroxide levels along with improved
sperm count and motility as well as restored the levels of SOD, catalase, GSH and
ascorbic acid in seminal plasma of infertile men.32

Kokilaksha (Asteracantha longifolia) significantly increased the sperm count as well

as fructose levels of seminal vesicles was noted in the male albino rats.33

Svarna Bhasma induced activity of two major antioxidant enzymes - superoxide

dismutase (SOD) and catalase in rats34. They prevent increase in ROS concentration
in seminal plasma and thereby protect the sperm against damage and oxidative stress
caused by ROS. This maintains the sperm motility for a long time.35

Most of the Vajikarana Bastis are rich in amino acids, lipids, sugar and various
enzymes, which are very essential in the production of various steroidal hormones and
provide nourishment to the whole body. On the other hand, Basti stimulates the gut
hormones as well as send signals to Central and peripheral brain regions, including
the hypothalamus. 36

The drugs used in these studies act on the Hypothalamo Pituitary Gonadal axis, by
that it increase the quality and quantity of the semen as well as reduce stress.

All the 12 studies were lacking in the parameters like Testosterone, FSH, LH etc., and
one drug i.e Vidarigandha produced Gynecomastia in 3 patients as an adverse effect.

By all these facts, the further studies should include biomarkers and other latest
parameters for proper assessment of Ayurvedic management in Oligozoospermia.
Deepana, Pachana and Shodhana should be given systematically before the
administration of Vrsya drugs for a better outcome in the management of
Oligozoospermia.

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