Infertility from Herbs?
April 1999; Volume 1: 38-39
Abstract & Commentary
Source: Ondrizek RR, et al. An alternative medicine study of herbal effects on the penetration of zona-free hamster oocytes and the integrity of sperm deoxyribonucleic acid. Fertil Steril 1999;71:517-522.
Materials/Methods: In the first part of this two-part in vitro study, the effect of herbal solutions of St. John’s wort (Hypericum perforatum), ginkgo (Ginkgo biloba), saw palmetto (Serenoa repens), and echinacea (Echinacea purpurea) on fertilization was determined by human sperm penetration of zona-free hamster oocytes that had been incubated with the herbs for an hour.
The second part of the study tested the effect on the integrity of sperm incubated for seven days with the same herbs. Viability of sperm and the effect on DNA (specifically the BRCA1 exon 11 gene) was determined.
Results: Saw palmetto and low concentrations of echinacea (0.8 mg/mL), ginkgo (0.1 mg/mL), and St. John’s wort (0.06 mg/mL) had no effect on sperm penetration. High concentrations of echinacea (8 mg/mL) and ginkgo (1 mg/mL) reduced oocyte penetration and high concentrations of St. John’s wort (0.6 mg/mL) prevented oocyte penetration completely. Saw palmetto and ginkgo had no effect on sperm. Echinacea and St. John’s wort resulted in significant denaturation of DNA that occurred concomitantly with decreased sperm viability.
Funding: Not indicated.
COMMENT BY ADRIANE FUGH-BERMAN, MD
This interesting preliminary study leaves many questions unanswered. Of most concern is the finding that incubation of oocytes with high concentrations of echinacea, ginkgo, and St. John’s wort reduced or prevented oocyte penetration. It is unclear whether such high concentrations of any of these herbs would ever be achieved in tubal fluid.
This study raises but does not answer the question of whether St. John’s wort (and to a lesser extent echinacea) decreases sperm integrity and viability. Marinating sperm in herbs for a week is a poor surrogate for a clinical situation in which herbs are ingested, metabolized, and diffused differentially into various bodily fluids. A more clinically relevant study would have been a semen analysis of men who are using St. John’s wort.
It is maddening that so little information is given about the herbs when the most minute details are given about every other aspect of this experiment. The sum total information given on the source, formulation, and preparation of the herbs consists of the unfathomable sentence, "Concentrated herbal solutions consisting of each of the four herbs studied dissolved in modified HTF [human tubal fluid] and filtered through 0.8-mcm filters were added separately to each sperm suspension." What were the herbs’ sources? Was the starting material crude herb, a tincture, or a standardized extract? Did the researchers simply make a cold infusion by floating dried herbs in HEPES-buffered synthetic human tubal fluid?
There is scant information given on how concentrations were chosen. It is stated that the lower doses represent "one thousandth of the recommended daily dose dissolved in 1 mL of medium" for saw palmetto, ginkgo, and echinacea, and "one millionth of the recommended daily dose" for St. John’s wort. However, recommended doses for these herbs vary by formulation (and prescriber), and it is not clear how "low" and "high" concentrations of each herb were chosen. For example, if 0.06 mg represents one millionth of a daily dose for St. John’s wort, the dose would be 60,000 mg or 60 g, an astronomical dose for standardized extract or tincture, and a high dose even for dried herb used in infusion.
This report emphasizes the denaturation of sperm DNA and mutations of the BRCA1 exon 11 gene, but there is a crucial caveat, which is that "This occurred concomitant (sic) with decreases in sperm viability." In other words, these herbs were spermicidal. A week’s worth of St. John’s wort at high concentration (0.6 mg/mL) resulted in only 0.5% of sperm with intact DNA, but only 7.5% of the sperm were viable. A week’s worth of echinacea at high concentration (8 mg/mL) resulted in 29% of sperm with intact DNA, but only 8.5% of sperm were viable. Such a drastic reduction in viable sperm would render a semen analysis in the infertile range. Point mutations are beside the point in a non-viable gamete.
According to Gary Klinefelter, PhD, a reproductive biologist and toxicologist with the U.S. Environmental Protection Agency, PCR amplification/electrophoretic screening for mutations is a validated procedure, but lacks sensitivity. Also, there is no validation for using the BRCA1 exon 11 gene in this context.
In conclusion, this study seems to affirm the lack of effect of saw palmetto on gametes, and raises the question of whether St. John’s wort (and to a lesser extent ginkgo and echinacea) decreases fertility in women. Animal studies should be conducted to determine whether these herbs have contraceptive or mutagenic effects.
In general (with the exception of women being treated for infertility by a qualified herbalist), it is a good idea for a woman attempting pregnancy to avoid using any non-food medicinal herbs as there is a little known about the effect of such herbs on fertility and teratogenicity. It is possible that some herbs decrease male fertility as well. This study’s finding of effects on sperm lack clinical relevance; a study should be performed on the sperm of men who have ingested St. John’s wort.
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