An extract of pomegranate fruit and galangal rhizome increases the numbers of motile sperm: a prospective, randomised, controlled, double-blinded trial

Abstract

Pomegranate fruit (Punica granatum) and galangal (Alpinia galanga) have separately been shown to stimulate spermatogenesis and to increase sperm counts and motility in rodents. Within traditional medicine, pomegranate fruit has long been used to increase fertility, however studies on the effect on spermatogenesis in humans have never been published. With this study we investigated whether oral intake of tablets containing standardised amounts of extract of pomegranate fruit and powder of greater galangal rhizome (Punalpin) would increase the total number of motile spermatozoa. The study was designed as a prospective, randomized, controlled, double-blinded trial. Enrolment was based on the mean total number of motile spermatozoa of two ejaculates. The participants delivered an ejaculate after 4-8 days of tablet intake and two ejaculates just before they stopped taking the tablets. Seventy adult men with a semen quality not meeting the standards for commercial application at Nordic Cryobank, but without azoospermia, were included in the study. Participants were randomized to take tablets containing extract of pomegranate fruit (standardised with respect to punicalagin A+B, punicalin and ellagic acid) and freeze-dried rhizome of greater galangal (standardised with respect to 1'S-1'-acetoxychavicol acetate) or placebo on a daily basis for three months. Sixty-six participants completed the intervention (active treatment: n = 34; placebo: n = 32). After the intervention the total number of motile spermatozoa was increased in participants treated with plant extracts compared with the placebo group (p = 0.026). After three months of active treatment, the average total number of motile sperm increased by 62% (from 23.4 to 37.8 millions), while for the placebo group, the number of motile sperm increased by 20%. Sperm morphology was not affected by the treatment. Our findings may help subfertile men to gain an improved amount of motile ejaculated sperm by taking tablets containing preparations of pomegranate fruit extract and rhizome of greater galangal.

Trial registration: ClinicalTrials.gov NCT01357044.

Conflict of interest statement

Competing Interests: Two of the authors (IG and HBJ) are commercializing the product; however, their company, Nerthus APS, has not contributed financially to the study. The full names of the two filed patent applications are: Dry preparation of Alpinia galanga or Alpinia conchigera with high content of 1′S-1′-acetoxychavicol acetate:(Application no. PCT/EP2014/061880); and Composition for enhancing semen quality in a male subject: (Application no. PCT/EP2014/061851). The product name of the food supplement: Punalpin®. There are no further patents, products in development, or marketed products to declare. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials, as detailed online in the guide for authors.

Figures

Figure 1. Flow diagram.

Consort diagram showing the flow of the study participants.

Figure 2. Differences in total motile sperm counts (TMSCs).

Plot of the differences in TMSCs from baseline to follow-up for each participant in the active treatment receiving the combination of P. granatum fruit extract and A. galanga rhizome powder and the placebo group. Follow-up – baseline (Y-axis) represents the calculated differences in TMSC between the follow-up TMSCs following 90 days of administration of either the dry preparation of A. galanga and the P. granatum extract or the placebo and the corresponding TMSCs prior to administration (baseline). Horizontal bars indicate mean.

Figure 3. ACA content in tablets.

Amount of 1′S-1′-acetoxychavicol acetate (ACA) in the A. galanga tablets within 21 months of production date.