Efficacy of Ginseng Extract on Patients with Oligospermia

Lee, Hee Yong; Paick, Jae Seung; Lee, Seung Won

Abstract

Infertility is a world wide problem affecting up to 15% of married couples. Although it is well known that male factor is the important cause of the infertility in 40-50% of the cases, the appropriate drugs for treating this condition have not yet been established. With certain exceptions, the etiology of many cases of male infertility is unknown. For such cases, various drugs including both hormonal and non-hormonal agents are sometime prescribed, but there have been no entirely satisfactory results. The present investigation would assess the effectiveness of Korean Ginseng, herbal medicine in the treatment of male infertility during the period from September to December, 1988, at the Andrology Clinic of the Department of Urology, Seoul National University Hospital. This herbal medicine was selected because its ingredients accelerate the metabolism of lipids and synthesis of DNA, RNA and proteins. This medicine contains ingredients which build resistance against stress since many of male infertility are under stress and also is to control immunological disorders. Ginseng has steroid-like, anti-allergic and anti-inflammatory actions, and accommodates the blood-testis barrier, improve digestive functions and peripheral blood flow. Accordingly, Ginseng has been used as an agent restoring healthy conditions to maintain homeostasis or to keep physical and mental balance. Extensive chemical investigation on Ginseng has revealed that Ginseng contains characteristic dammarane-type triterpenoid saponins as the main principles. These saponins are called ginsenosides and represent the principal pharmacological actions of Ginseng. The ginsenosides react at the hypothalamus-pituitary-gonadal axis. The decreases of sexual drive and disorders of fecundity under challenge of stress are prevented by oral administration of ginsenosides. To assess the efficacy of treatment with Ginseng which is alleged to improve spermatogenesis in idiopathic infertile selected patients. Participants in this study are men with primary idiopathic oligospermia and asthenospermia. The inclusion criteria would be as follows : a) men aged 20-40 years, whose female partners are entirely normal. b) men having vaginal intercourse with one partner and without psycho-sexual problems. c) men willing to enter this clinical trial and relying only on the drug administered throughout the study. d) no history of serious chronic physical or psychological diseases. e) men whose female partners are not using any method of birth control. f) men with no history of drugs to treat sperm disorders within 3 months. A total of 12 patients with sperm counts of less than 20 x 10 6/ml (oligospermia group), and 5 patients with sperm motility of less than 20% (asthenospermia group) are selected as the study subjects. Parameters to be assessed are as follows : Before and after Ginseng administration, history taking, physical examination with testis size measurement, laboratory works including urinalysis, CBC, seminal fructose, semen analyses (pH, volume, density, motility, activity grade, morphology, fertility unit, and WBC), plasma hormonal assays (FSH, LH, testosterone, estradiol, and prolactin). Before starting the treatment, 2 semen samples are obtained preteded by 3 days of abstinence. For follow-up, patients will have a semen sample taken every month while in treatment. After the treatment, more than 2 semen analyses will be undertaken for the final evaluation. Treatment scheme is as follows : The composition of the Ginseng extract used in this clinical trial consisted of the standardized highly concentrated Ginseng extract G115, 100mg : concentrated standardized lectithin, 95mg , alpha tocopherol, 10mg ; and excipients q.s.ad. This Ginseng extract named Ginsana capsule produced by Pharmaton-Korea Co., Ltd. Four capsules of Ginsana are given twice a day by mouth before meal for more than 90 days to be justified on the basis of general assumption that spermatogenesis cycle lasts approximately 74 days. The results of the clinical investigation are considered to be effective, if more than double of improvemant being noted on the count or more than 30% ot improvement being noted on motility beyond the pre-treatment levles. Clinical characteristics of a total of 17 patients are listed in the table 1. The outcomes of this trial are presented as follows : (tables 2 and 3). Coital frequency increased from 2.6/week before Ginsana exposure to 3.1/week after the treatment. General health such as stamina, body weight and spirits improved in 10 patients of the 17 after Ginsang treatment. Regarding hormonal partmeters (table 2), Plasma FSH and LH were not changed much before and after Ginsana administration. Patients with low FSH and LH levels before the treatment and patients with high range of prolactin levels before the treatment have a tendency to improve more in semen parameters after the treatment. Hyperestrogenemia was decreased and plasma testosterone levels increased after Ginsana treatment. Subsequently, T/E2 ratio resulted in normal to help spermatogenesis. Regarding the semen parameters (table 3), sperm counts increased in 58% of the patients in oligosperrnia group after oligospermia group. Sperm motility improved in 33% of the patients rn oligospermia group after the treatment. Mean motility increased from 34% to 45% after the treatment in oligospermia group. Activity grade and fertility unit were also improved in oligospermia group after the treatment Other parameters such as volume, normal morphology, pH and seminal fructose were not changed significantly before and after Ginstna treatment. Only one case showed an improvement in sperm counts and motility of a total of 5 patients with asthenospermia. Pregnancy resulted in 2 patients of improved cases and 1 patient of not improved cases in oligopsermia group after Ginsana administration. So that, pregnancy rate was 25 % of the oligospermia group. The study results of some imvestigators are summarized in the table 4. From these results, Ginsana appears mainly act on testis directly, restore the steroidogenesis, resulting in the stimulation of spermatogenesis. in conclusion, the authors clinical experience confirmed that Ginsana, a traditional Chinese medicine, appears to be of value particularly in the trettment of idiopethic oligospermia without any noticeabel adverse side effects.