|Date: 12-15-2014||HC# 111421-510|
Fedder MD, Jakobsen HB, Giversen I, Christensen LP, Parner ET, Fedder J. An extract of pomegranate fruit and galangal rhizome increases the numbers of motile sperm: a prospective, randomised, controlled, double-blinded trial. PLoS One. October 2, 2014;9(10):e108532. doi: 10.1371/journal.pone.0108532.
Low sperm quality and quantity can result in delayed pregnancy. There is evidence that herbal supplements high in antioxidants can improve sperm characteristics in cases of infertility. Pomegranate (Punica granatum) has been shown to improve sperm count and reduce the number of abnormal sperm in rats, and galangal (Alpinia galanga) has been shown to have similar effects in mice. Pomegranate contains high concentrations of ellagitannins, specifically punicalagin A and B and punicalins, in the pericarp and aril, and high concentrations of anthocyanins in the aril. Galangal rhizome has been shown to be both an antioxidant and anti-inflammatant and contains high concentrations of 1'S-1'-acetoxychavicol acetate (ACA). The goal of this randomized, double-blind, controlled study was to measure the effect of pomegranate extract and galangal powder on total motile sperm count (TMSC) and sperm abnormalities in men with low TMSC.
Study subjects > 17 years of age were recruited from the Nordic Cryobank or from responses to newspaper ads in Copenhagen, Denmark between May 2011 and September 2012. Men from the Nordic Cryobank had been rejected as sperm donors due to low TMSC (> 200 mio). Men were excluded if they had azoospermia. Seventy men were enrolled, but 4 withdrew due to logistical complications. Subjects were randomly divided between a treatment and placebo group. The treatment consisted of tablets with pomegranate fruit extract (P40P™; PoliNat; Las Palmas, Spain) and tablets with freeze-dried, ground galangal rhizome. Two tablets of each were taken in the morning and in the evening for 90 days. Placebo tablets were matched to each of the treatment tablet types. Pomegranate extract tablets were screened with high-performance liquid chromatography to find those most representative of high-quality pomegranate juice. The product chosen delivered 106 mg/d of punicalagin A, 278 mg/d of punicalagin B, 4.7 mg/d punicalins, and 9.6 mg/d ellagic acid. A suitable source of commercially produced galangal was not found so galangal tablets were produced by the authors and resulted in consumption of 16 mg/d ACA. The placebo tablets contained microcrystalline cellulose. Coloring was added to the galangal treatment and placebo tablets so that their appearance was similar. Two ejaculate samples were collected before treatment began, 4-8 days after treatment began, and after treatment ended. The initial ejaculate was used to determine if men met the inclusion criteria. TMSC was measured on a minimum of 200 sperm, if present, within 1 hour of ejaculate delivery. Sperm morphology was measured on a minimum of 400 sperm, if present, using ethanol fixation and Papanicolaou staining. Subjects filled out a questionnaire about side effects they experienced. Data were compared before and after treatment with an unequal variance t-test. A linear regression with the variables body mass index (BMI) and age was run.
The average age of the treatment subjects (n = 32) was 30 ± 0.7, and that of the placebo group (n = 34) was 28 ± 0.6. In each group, there was 1 subject with only 1 testicle. The treatment group experienced a significantly larger increase (62%) in TMSC than did the placebo group (20%, P = 0.026). The concentration of motile sperm was also higher in the treatment group than in the placebo group (P = 0.03). TMSC was unchanged in the first week of supplementation in both the treatment and placebo groups. Sperm morphology was unaffected by the treatment. BMI and age did not significantly affect TMSC. Compliance, as measured by returned tablets, was relatively high. Eighty-five percent of the subjects consumed 80% of the tablets given to them. Thirty-eight subjects returned questionnaires about side effects. Of these, 1 subject from the treatment group experienced unwanted gastrointestinal side effects. When the tablets were analyzed for active compounds after 21 months, the ACA concentration in the galangal tablets had decreased by 50%. The bioactive compounds in the pomegranate tablets were unchanged.
Three months of pomegranate and galangal supplementation increased TMSC in subjects with low TMSC. No effect was seen in the first week of supplementation, leading the authors to conclude that the supplements affect spermatogenesis and not the environment of the epididymis. There are no similar studies conducted in humans, but a similar effect was seen in rats taking pomegranate juice supplements. This effect is thought to be the result of the high antioxidant concentrations found in both pomegranate and galangal. Both reactive oxygen species and free radicals can damage sperm, and antioxidants may provide a protective environment for sperm. This effect may be direct or indirect. The study is limited by the natural variation in TMSC among sperm samples, and the potential effect of a decrease in ACA within the galangal tablets over the course of the study. There would also be value in knowing if these changes in TMSC altered pregnancy rates.–Cheryl McCutchan, PhD