protodioscin on the quantity and quality of sperms from males with
moderate idiopathic oligozoospermia
Medical Biology Division of Andrology, University of Sriwijaya,
Medika 22 (8): 614-618 (1996)
This study was conducted to assess the effectiveness of a certain
dosage and period of administration of Libilov (protodioscin) on
sperm quality and quantity in men with moderate idiopathic oligozoospermia.
This study also evaluated protodioscin's effect on libido, erection,
ejaculation and orgasm. Lastly, We also determined the length of
time that the beneficial effects of the treatment lasted after administration
of the preparation was stopped.
Our result showed that oral Libilov treatment with the dose of
3 x 2 tablets per day for 60 days could:
- increase sperm quantity and quality in men diagnosed with moderate
- restore and enhance libido, erection, ejaculation, and orgasm
of sexual intercourse, as compared to before the treatment. This
result was obtained in more than 80% of the treated patients.
A couple is defined as infertile if no conception results after
one year of normal sexual practice without contraception. The world
prevalence of infertile couples is between 5-20%, with 10-20% of
which is without medical basis or explanation. Etiologically, such
infertility could result from either the male partner, the female
partner, or both. Studies in Indonesia showed that the frequency
of infertility due to the male partner is between 34-60%.
This study was conducted to assess the effectiveness of a certain
dosage and period of administration of Libilov™(protodioscin)
on sperm quality and quantity of men with moderate idiopathic oligozoospermia.
This study also evaluated protodioscin's effect on libido, erection
, ejaculation and orgasm in males. Lastly, we also determined how
long the beneficial effect of the treatment lasted after the treatment
Our result showed that protodioscin treatment with the dose of
3 x 2 tablets / day per oral administration for 60 days could increase
the sperm quality and quantity in men diagnosed with moderate idiopathic
oligozoospermia, restore and enhance libido, erection, ejaculations
and orgasms of sexual intercourse, as compared to before the treatment.
These results were found in over 80% of the treated patients. Finally,
we suggest that a further, more detailed study be carried out to
assess the effect of protodioscin on oligozoospermia with other
etiological factors, as well as its effects on the male reproductive
A couple is diagnosed with infertility, if within one year of regular
sexual practice without the use of contraception, no successful
fertilization leads to pregnancy. If this constitutes the female's
first attempt to achieve pregnancy, this infertility can be classified
as primary infertility. On the other hand, if the female has been
pregnant before, leading either to normal birth or spontaneous abortion,
or if the female has had ectopic pregnancies, then the infertility
is classified as secondary infertility (1).
According to the National Survey of Family Growth (2) in 1982,
the prevalence of infertile couples that want to conceive reaches
14% in the United States, whereas world-wide this number ranges
from 5-20% (1,3). Approximately 10-20% of these infertility cases
have no known medical basis or etiology, and can be due to infertility
in the male partner, the female partner, or both.
Barten and Moningka (4) reported that based on a study conducted
in Northern Sulawesi, Indonesia, male infertility contributed up
to 34% of the infertility cases. Koesoemonegoro, however, suggested
that in couples diagnosed with primary infertility, infertile males
made up 74% of the cases, whereas 60% of secondary infertility cases
were attributable to the males (5). Previously, we determined that
in 246 infertile couples in Palembang, Indonesia, 48% of their infertilities
were due to the male partners (6).
Etiological studies of male infertility is mostly based on laboratory
analyses of semen. For example, oligozoospermia can be caused by
cryptorchidism, varicocele, hydrocele, medication side effects,
systemic infection, partial obstruction of the vas deferens, or
other idiopathic factors (Table I). In addition to semen analyses,
spermiogram and testes volume measurements are also often used to
diagnose male infertility.
|Testes Volume (ml)
| Severe oligozoospermia
Idopathic hypospermatogenesis Orchitism
accessory glands dis-
order, absence of dynein
Table I. Etiology of male infertility based on
spermiogram and testes volume analyses (Hudson et al., 1980)
The current treatments for oligozoospermia include medication by
clomifen citrate, tamoxifen, protodioscin, combination of HMG and
hCG, combination of FSH and hCG, and artificial insemination with
or without treated sperms (8, 9, 10).
Protodioscin is the dominant compound, present at no less than
45% of the total plant extract of Tribulus terrestris L. It has
been reported to increase spermatozoa concentration, mobility as
well as to improve libido in men and laboratory animals (10, 11,
12). As protodioscin is a non-hormonal and non-synthetic preparation
that differed from other treatment options for oligozoospermia,
we sought to determine its effectiveness on the sperm quantity and
quality in males diagnosed with moderate idiopathic oligozoospermia.
We also sought to determine how long the beneficial effects lasted
after treatment was stopped. Lastly, we also determined protodioscin's
effects on the male sex drive, penile erection, ejaculation and
This study was conducted in six months, and involved 15 men diagnosed
with moderate idiopathic oligozoospermia (7) of ages 25 to 40 years.
We determined the following variables before and after treatment:
- FSH, LH and testosterone levels
- hematological analyses
- blood chemistry analyses
- testes volume by orchidometer
- sex drive, erection, ejaculation and orgasm qualities
Each patients received protodioscin (Libilov) at a dose of 3 x
2 tablets / day orally for 60 days. Semen analyses were performed
twice before treatment (day 1), once after treatment is concluded
day 60) and once 30 days post-treatment (day 90). Changes in sex
drive or libido, erection, ejaculation and orgasm qualities during
sexual intercourse were measured by patient interviews at mid-treatment
(day 30) and after treatment (day 60). Data gathered were subjected
to statistical analyses (t-pair test), and was presented as means
± standard deviation.
RESULT AND DISCUSSION
As seen in Table II, spermatozoa concentration increased in all
patients, to approximately 160% after treatment was over (day 60).
This continued to increase to 200% when tested 30 days after the
last day of administration of protodioscin (day 90). Our result
agreed with that previously published by Moeloek et al. (10) and
by Viktorof et al. (12). Moeloek reported that treatment of male
patients diagnosed with oligozoospermia with protodioscin at 3 x
2 tablets / day dosage for 9 weeks resulted in increased sperm concentration.
| Sperm concentration (million/ml)
|| 9.89 ± 3.58
|| 15.73 ± 3.41
|| 18.40 ± 3.69
| Mobility (a+b) (%)
|| 24.33 ± 7.03
|| 36.00 ± 6.32
|| 40.67 ± 6.51
| Normal morphology (%)
|| 35.93 ± 4.03
|| 43.87 ± 4.12
|| 46.80 ± 5.18
Table II. Sperm concentration, mobility (a+b),
and with normal morphology before, after, and without Libilov (protodioscin)
In addition to the increase in sperm concentration, we also discovered
that the percent mobility (grade a+b) and percentage of sperm with
normal morphology were also increased. This was different than that
reported by Moeloek et al. (10), which stated that although sperm
morphology was improved, there was no significant change in sperm
The increase in sperm concentration, mobility and morphology after
treatment in this study is statistically significant (p < 0.05).
Even so, these improvements are still not yet within the bounds
of normal parameters as determined by the World Health Organization
in 1992 (13), i.e. > 20 million sperms / ml and percent mobility
(a+b) > 50%.
Coupled with hormonal analyses (Table III), the increase in sperm
mobility and morphology appeared to be linked to the increased level
of testosterone. Testosterone is involved in sperm maturation in
the epididymis (7, 14, 15). These findings agree with the hypothesized
mechanism of protodioscin, i.e. to increase the efficiency of spermatogenesis
and the increase in sperm production by stimulation of the Sertoli
and germinal cells. Protodioscin increases the level of conversion
of testosterone to dihydrotestosterone, which stimulates the epididymal
maturation of spermatozoa into fertile sperms (7, 11, 15).
| FSH (IU/l)
|| 2.52 ±
|| 2.16 ±
|| 1.77 ±
|| 1 - 12
| LH (IU/l)
|| 6.86 ± 0.80
|| 9.90 ± 2.10
|| 7.10 ± 1.28
|| 2 - 12
| Testosterone (nmol/l)
|| 283.4 ± 24.7
|| 328.4 ± 16.7
|| 379.0 ± 89.7
|| 270 - 1070
Table III. Serum level of FSH (IU/l), LH (IU/l),
and testosterone (nmol/l) before and after 30 & 60 days of Libilov
We concluded that the level of FSH was not increased by protodioscin
treatment (Table III). The level of LH and testosterone, however,
were increased to level still accepted as normal. This result was
internally consistent, as the increased level of LH was responsible
for the activation of Leydig cells to increase testosterone secretion,
thus resulting in increased testosterone level in the bloodstream.
This agreed with the previously described effect of protodioscin
on these hormones (11).
Although there was an increase in the concentration of spermatozoa
by protodioscin treatment, we found no increase in the testes volume
of treated patients (Table IV). This could be due to our orchidometer,
which had a set volume measurement of 1, 2, 3, 4, 5, 6, 8, 10, 12,
15, 20, 25, and 30 ml. An increase of 1, 2 or 3 ml could not be
measured in testes of more than 10 ml volumes. Moreover, it was
known that protodioscin does not increase the density of Leydig
cells. Instead, it increased the density of the Sertoli cells, and
increased the amount of spermatogonias, spermatocytes and spermatids
without changing in the diameter of the seminiferous tubules. In
this study, the testes volumes of the treated patients were categorized
as either borderline (12-15 ml) or normal (15-30 ml), according
to the criteria set forth by Hudson et al. (7).
Table IV. Testes volume (ml) before and after
In Table V and Graph I, we showed that the protodioscin treatment
resulted in significant increase in sex drive by 33% after 30 day
of treatment, and continued to 80% after 60 days. Erection increased
by 53% in 30 days, and by 87% in 60 days. Ejaculation quality improved
by 47% and 67% after 30 and 60 days of treatment, respectively.
Importantly, orgasm quality improved significantly by 40% and 87%
after 30, and 60 days of treatment.
||Remained the same
| Day 30 Day
|| Day 30 Day
|| Day 30 Day
|| 5(33%) 12(80%)
|| 10(67%) 3(20%)
|| 0 0
|| 8(53%) 13(87%)
|| 7(47%) 2(13%)
|| 0 0
|| 7(47%) 10(67%)
|| 8(53%) 5(33%)
|| 0 0
|| 6(40%) 13(87%)
|| 9(60%) 2(13%)
|| 0 0
Table V. Parameter of sexual fitness (sex drive,
erection, ejaculation and quality of orgasm or pleasure) before,
after 30-, and 60-days of Libilov treatment.
Graph I. Sexual fitness after 30- and 60-days
of Libilov treatment
These result agreed partially with a previous study (16), which
reported improvement in libido, although not a significant increases
in the qualities of penis erection, ejaculation and orgasm. As with
all previous studies, no patients reported any unwanted side-effects
in this trial.
To determine whether protodioscin treatment affected the normal
heart and liver function, we conducted a laboratory analyses to
determine the Hb, hematocrit, thrombocyte and lipid serum levels,
as well as heart functions (Table VI). We concluded that there were
no abnormal or significant changes in these parameters. This suggested
that the administration of protodioscin for 60 days at 3 x 2 tablets
/ day was medically safe. The increase in the Hb level seemed to
be due to the increased conversion of to dihydrotestosterone. Dihydrotestosterone,
a potent androgen, stimulated erythropoesis and muscle developments.
This contributed to a general feeling of well-being and health reported
by some patients, as increased red blood cells level improved oxygen
transport and circulation in the body. These, in turn, would also
contribute to the improvement in sexual functions of the patients,
in all part of the sexual response phases (17).
|| Day 30
|| Day 60
13.3 ± 0.5
40.4 ± 1.2
201.2 ± 50.5
13.6 ± 0.5
41.8 ± 1.8
198.8 ± 41.6
14.7 ± 0.7
42.5 ± 1.5
247.1 ± 47.0
12 - 18
45 - 62
150 - 300
Gamma GT (IU/l)
Alkaline phosphatase (IU/l)
Total cholesterol (mg/100ml)
22.1 ± 11.7
20.2 ± 9.7
21.5 ± 3.6
44.2 ± 7.1
183.5 ± 12.8
35.8 ± 14.1
126.4 ± 18.8
114.7 ± 34.4
10.6 ± 6.2
14.8 ± 4.0
10.6 ± 4.9
86.1 ± 7.2
178.8 ± 24.3
35.3 ± 7.8
110.6 ± 24.9
108.8 ± 16.2
24.0 ± 4.9
20.6 ± 4.0
11.5 ± 3.8
78.6 ± 3.0
175.1 ± 30.3
41.1 ± 9.5
119.1 ± 26.1
93.0 ± 29.9
10 - 40
6.3 - 22
6 - 26
36 - 92
130 - 270
30 - 60
70 - 190
72 - 174
Table VI. Hb, hematocrit, thrombocyte and lipid
serum levels; and heart functions
SUMMARY AND SUGGESTION
Based on our study, we concluded that protodioscin treatment for
60 days at the dose of 3 x 2 tablets per day could create improvements
in the quality and quantity of sperms, in sex drive, erection, ejaculation
and orgasm qualities in treated males. Significantly, improvements
in sex drive were experienced by 80% of males. A more detailed further
study, however is warranted to determine the efficiency of protodioscin
treatment on other forms of oilgozoospermia, and to determine in
detail its effect on the male reproductive system.
We wish to thank PT Teguhsindo Lestaritama for providing protodioscin
(Libilov™) for this study.
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