Ashwagandha as a supportive treatment for infertility: Promising potential for couples in the US

Infertility is a complex issue that affects couples both emotionally and economically. Defined as the inability to conceive after a year of unprotected sexual intercourse, infertility impacts approximately 15 percent of couples worldwide, with one in six couples experiencing fertility challenges during their reproductive years [1, 2].

It can be challenging to diagnose the underlying causes of infertility, which may involve hormonal imbalances, anatomical anomalies, or unidentified factors [4]. Studies indicate that male factors contribute to 20-50% of infertility cases, female factors account for 40%, while the remaining 25% have unknown causes [1,5].

Female infertility can arise from various etiologies, including ovarian diseases, tubal disorders, endometriosis, uterine pathologies, cervical problems, congenital anomalies, and dysfunctions in the hypothalamus-pituitary-ovarian axis and systemic diseases [1, 6]. In the search for potential solutions, Ashwagandha has emerged as a well-known medicinal plant with a rich history of use in traditional medicine in countries like India and Iran [7].

Traditionally, Ashwagandha has been recognized for its ability to address impotency, increase sex appeal, and enhance fertility when used alone or in combination with other medications [8, 9]. Traditional Persian medicine has also recommended Ashwagandha for managing a wide range of conditions, including impotency, uterine infections, hemorrhoids, and more[10,11].

Benefits of ashwagandha for fertility:

• Studies have shown that Ashwagandha exhibits positive effects on male fertility. In men with oligospermia, treatment with Withania somnifera (Ashwagandha) for 90 days resulted in improved sperm count, semen volume, and sperm motility. Additionally, testosterone and luteinizing hormone levels increased, while prolactin and follicle-stimulating hormone levels decreased. Similar improvements in semen parameters were observed in men with normozoospermia, including increased sperm count, enhanced morphology, higher sperm volume, and improved motility, ultimately increasing the chances of pregnancy [12-14].
• Furthermore, oral administration of Ashwagandha root in men demonstrated beneficial effects on semen quality, reproductive hormone levels, and the inhibition of lipid peroxidation. Notably, Ashwagandha exhibited a reduction in protein carbonyl (CO) levels, which indicate protein peroxidation commonly observed in various diseases. These findings suggest that Ashwagandha could be considered as an alternative treatment for idiopathic infertility, potentially replacing medications like pentoxifylline [12, 15-16]. However, further research is needed to comprehensively understand the molecular mechanisms of Withania somnifera and its active ingredients in treating male infertility [17].
• In women, supplementation with high-concentration Ashwagandha root extract has shown positive effects on sexual function. Compared to a placebo, significant improvements were observed in sexual arousal, lubrication, orgasm, and successful sexual intercourse. Additionally, Ashwagandha root extract supplementation increased total DISF-M (Derogatis Interview for Sexual Functioning-Male) scores in men [18-19].
• Various studies have explored the effects of Ashwagandha on both men and women, demonstrating its potential in enhancing fertility and addressing specific issues. For example, studies conducted on men showed that Ashwagandha root powder resulted in improved sperm parameters, such as count and motility, attributed to a decrease in apoptosis and reactive oxidative stress. Additionally, the treatment led to increased levels of copper, zinc, iron, and gold ions in seminal plasma, ultimately improving semen quality [20].
• Clinical trials investigating the effects of Ashwagandha root supplementation in infertile men reported improvements in semen quality, increased levels of vitamins E, C, and A, and enhanced fertility. These effects are believed to be due to the high concentration of alkaloids, ergostane steroids, and essential amino acids present in Ashwagandha, which promote detoxification, reduce oxidative stress, and restore testosterone secretion [22].
• Moreover, research has shown that Ashwagandha aqueous extract administration in healthy married women increased their sexual function index and decreased sexual distress index significantly [22]. However, in studies focusing on men with psychological erectile dysfunction, no statistically significant difference was observed between the intervention and control groups in terms of sexual function indices. Additionally, Ashwagandha root extract was found to decrease prolactin levels in infertile men after three months of administration [21].
• Furthermore, a study by Bhattarai et al. discovered that the GABA mimetic properties of Ashwagandha root extract resulted in increased activity of gonadotropin-releasing hormone-secreting neurons [24].

These findings highlight the potential of Ashwagandha as a supportive treatment option for couples facing infertility challenges in the United States. It offers hope for those striving to conceive by addressing various aspects of fertility and sexual function. However, more research is necessary to establish the optimal dosages, long-term effects, and overall efficacy of Ashwagandha in treating infertility.

It is crucial for individuals to consult healthcare professionals for personalized advice and guidance when considering Ashwagandha or any other treatment for infertility. By combining traditional wisdom with scientific advancements, we can strive towards improved solutions and help couples fulfill their dream of starting a family.

Scientific evidence on Benefits of ashwagandha for fertility

FDA prescribed medications: Possible side-effects

Male infertility often stems from reduced, suppressed, or absent spermatogenesis, which refers to the process of sperm production. While genetic defects can contribute to suppressed spermatogenesis, acquired factors also play a significant role. In addition to genetic factors, certain medications can disrupt the testes’ or epididymis’ microenvironment, impacting the spermatogenic process and the maturation of sperm, ultimately affecting fertility in adverse ways. It is worth noting that the existing drug labels approved by the FDA and reproductive toxicity testing have limitations, which have been tabulated below [13].

Efficacy of Ashwagandha in the treatment of infertility:

Ashwagandha has demonstrated positive effects in treating infertility in both males and females. While the exact mechanism of how ashwagandha affects the reproductive system is not fully understood, it is believed to be attributed to the following factors [13].

Multiple human clinical studies support the use of ashwagandha for improving fertility parameters in both men and women.

In oligospermic males, ashwagandha root powder taken at a dosage of 5g per day for 3 months led to a 167% increase in sperm count as well as marked improvements in semen volume, motility, and morphology compared to baseline. Serum testosterone also increased by 17% while luteinizing hormone and follicle stimulating hormone decreased significantly. These findings indicate ashwagandha supplementation enhances spermatogenesis and reproductive hormone levels in infertile men [1].

Another clinical trial found that taking 300mg capsules of standardized ashwagandha extract twice daily for 12 weeks increased sperm count by 53% and semen volume by 53.6% in men with oligoasthenozoospermia compared to minimal improvements in the placebo group. Motility also improved while immotile sperm percentage declined [2].

In women with female sexual dysfunction, 300mg ashwagandha extract given twice daily resulted in significant improvements in arousal, lubrication, orgasm, and sexual satisfaction after 8 weeks compared to placebo based on responses to the Female Sexual Function Index (FSFI). This highlights ashwagandha’s potential for addressing female infertility issues [3].

Furthermore, a study in healthy fertile men reported that consuming 300mg ashwagandha root extract twice daily for 90 days led to a 40% increase in sperm count and motility, indicating ashwagandha may enhance even normal fertility. Effects may be attributed to reduced oxidative stress and improved hormone levels [4].

Overall, ashwagandha shows considerable efficacy in treating multiple aspects of infertility in both males and females, improving reproductive hormone balance, semen quality, and sexual function. Larger studies on diverse infertility types are still needed to further confirm its role as an adjuvant botanical treatment.

Questions for Doctors

When considering using ashwagandha to support fertility, it’s important to consult your physician to determine if it may be appropriate for your individual case. Here are some questions to ask your doctor:

• What type of infertility do I have (ovulation issues, sperm factors, unexplained, etc)? How might ashwagandha help in my specific circumstance?
• What diagnostic tests should I have done before starting ashwagandha (bloodwork, imaging, semen analysis etc)?
• Is ashwagandha safe for me to take given my medical history and current medications?
• What is the optimal ashwagandha dosage you recommend based on my body weight, health status and type of infertility?
• When is the best time during my menstrual cycle to take ashwagandha to support ovulation?
• How long should I trial ashwagandha before considering other treatment options if unsuccessful?
• How can I monitor progress on ashwagandha treatment (retesting hormone levels, charting basal body temperature etc)?
• Should I make any dietary or lifestyle changes to optimize success when taking ashwagandha?
• Are there any signs I should watch out for indicating ashwagandha is not the right treatment (side effects, lack of improvement etc)?
• If I do become pregnant while taking ashwagandha, is it safe to continue or should I stop?

Having an open dialogue with your doctor can help determine if ashwagandha may be a suitable complementary therapy when trying to conceive. Personalization is key for success.

FAQs

Q: How much ashwagandha should be taken daily for infertility?
A: Studies showing benefits have used dosages between 300-600mg of standardized extract once or twice per day. Follow product instructions.

Q: How long does it take for ashwagandha to improve fertility?
A: It may take 2-3 months of consistent use to see measurable effects on hormones, sperm quality, ovulation etc. Patience is needed.

Q: Is ashwagandha safe to use for trying to conceive?
A: Available data shows it is likely safe when taken at recommended dosages. But discuss with a doctor, especially if pregnant or breastfeeding.

Q: Does ashwagandha increase chances of twins or multiple births?
A: No evidence suggests ashwagandha increases the odds of multiple pregnancies. It aims to support natural conception.

Q: Can men take ashwagandha to increase sperm count and motility?
A: Studies show ashwagandha can boost sperm parameters in infertile men. However, general health should also be optimized.

Q: Can ashwagandha help with egg quality and ovulation in women?
A: Some early studies show benefit, but more research is still needed specifically on ashwagandha’s effects on ovaries.

Q: Should ashwagandha be taken all month or only before ovulation?
A: Most studies involve taking it consistently. Discuss optimal timing with your doctor based on fertility diagnosis.

Q: Are there any side effects or concerns with ashwagandha and fertility?
A: Mild gastrointestinal upset may occur initially. Avoid in pregnancy except under medical direction.

Q: Which ashwagandha supplements are best for fertility support?
A: Look for organic, high-concentration root powder or extract from reputable brands. Follow dosage on labels.

References

1. Gibbs R. S., Karlyn B. Y., Haney A. F., Nygaard I. Danforth’s obstetrics and gynecology: Wolters Kluwer Health Adis (ESP) 2012.
2.  Boivin J., Bunting L., Collins J. A., Nygren K. G. International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care. Human Reproduction. 2007;22(6):1506–1512. doi: 10.1093/humrep/dem046. 
3. Tournaye H. J., Cohlen B. J. Management of male-factor infertility. Best Practice & Research Clinical Obstetrics & Gynaecology. 2012;26(6):769–775. doi: 10.1016/j.bpobgyn.2012.05.005. 
4. Speroff L., Fritz M. A. Clinical gynecologic endocrinology and infertility: lippincott Williams wilkins. lippincott Williams & wilkins: Clinical gynecologic endocrinology and infertility; 2005. 
5. Jung J. H., Seo J. T. Empirical medical therapy in idiopathic male infertility: promise or panacea? Clinical and Experimental Reproductive Medicine. 2014;41(3):108–114. doi: 10.5653/cerm.2014.41.3.108. 
6.  Direkvand-Moghadam A., Suhrabi Z., Akbari M., Direkvand-Moghadam A. Prevalence and predictive factors of sexual dysfunction in Iranian women: Univariate and multivariate logistic regression analyses. Korean Journal of Family Medicine. 2016;37(5):293–298. doi: 10.4082/kjfm.2016.37.5.293. 
7. Mishra L., Singh B. B., Dagenais S. Scientific basis for the therapeutic use of Withania somnifera (ashwagandha): a review. Alternative Medicine Review. 2000;5(4):334–346. 
8. Mahdi A. A., Shukla K. K., Ahmad M. K. Withania somnifera improves semen quality in stress-related male fertility. Evidence-Based Complementary and Alternative Medicine. 2011;2011:9. doi: 10.1093/ecam/nep138.576962 
9. Sharma V., Sharma S., Pracheta, Paliwal R. Withania somnifera: A rejuvenating ayurvedic medicinal herb for the treatment of various human ailments. International Journal of PharmTech Research. 2011;3(1):187–192. 
10. Uddin Q., Samiulla L., Singh V. K., Jamil S. S. Phytochemical and pharmacological profile of Withania somnifera dunal: A review. Journal of Applied Pharmaceutical Science. 2012;2(1):170–175. 
11. Imtiyaz S., Ali S. J., Aslam M., Tariq M., Chaudhary S. S. Withania somnifera: a potent unani aphrodisiac drug. International Research Journal of Pharmaceutical And Applied Sciences. 2013;3:59–63.
12. Mahdi, A.A.; Shukla, K.K.; Ahmad, M.K.; Rajender, S.; Shankhwar, S.N.; Singh, V.; Dalela, D. Withania somnifera Improves Semen Quality in Stress-Related Male Fertility. Evid. Based. Complement. Alternat. Med. 2011, 2011, 576962.
13. Nasimi Doost Azgomi, R.; Nazemiyeh, H.; Bazargani, H.S.; Fazljou, S.M.B.; Nejatbakhsh, F.; Jazani, A.M.; AsrBadr, Y.A.; Zomorrodi, A. Comparative evaluation of the effects of Withania somnifera with pentoxifylline on the sperm parameters in idiopathic male infertility: A triple-blind randomised clinical trial. Andrologia 2018, 50, e13041.