Ashwagandha and Male Fertility: Evidence Review
Based on current clinical guidelines, there is insufficient evidence to recommend ashwagandha for treating male infertility, despite some promising preliminary research showing improvements in semen parameters and testosterone levels. The most authoritative guidelines explicitly state that herbal therapies, including ashwagandha, lack the high-quality data needed to support their use in clinical practice 1, 2.
What the Guidelines Say
The 2021 AUA/ASRM guidelines are unequivocal: "Clinicians should counsel patients that the benefits of supplements (eg, antioxidants, vitamins) are of questionable clinical utility in treating male infertility" 2. More specifically, the 2017 WHO-supported analysis strongly recommends "based on very low quality of evidence that there are insufficient data to recommend the use of herbal therapies for the treatment of men with abnormal semen parameters and/or male infertility" 1.
The fundamental problem is methodological quality. While some herbal studies showed improvements in semen parameters (about two-thirds), only one of three studies (33.3%) reported positive effects on actual pregnancy rates 1. The guidelines emphasize that what matters clinically is live birth rates and time to pregnancy—not just laboratory improvements in sperm counts.
What the Research Shows
Despite guideline caution, recent research on ashwagandha specifically has shown more encouraging results:
Semen Parameter Improvements
A 2026 randomized controlled trial demonstrated substantial improvements after 8 weeks of standardized ashwagandha root extract (300 mg twice daily) 3:
- 36% increase in ejaculate volume
- 38% improvement in total sperm count
- 87% increase in total sperm motility
These effect sizes were described as "moderate to large" and "clinically meaningful" 3.
Hormonal Effects
Multiple studies show ashwagandha increases testosterone in men. A 2026 meta-analysis found testosterone increased by 57.43 ng/dL in men (though not in women, where the increase was only 5.09 ng/dL) 4. Individual trials confirmed significant testosterone elevation alongside improvements in sexual function 5.
The same meta-analysis demonstrated ashwagandha significantly reduces cortisol (SMD = -1.18) and increases serotonin (MD = 31.75 ng/mL) 4, suggesting stress reduction as a key mechanism.
Proposed Mechanisms of Action
Research suggests ashwagandha works through multiple pathways 6:
Direct Antioxidant Effects
- Inhibits lipid peroxidation in sperm cells
- Reduces oxidative stress markers in testicular tissue
- Increases antioxidant enzyme activity (SOD, catalase, GSH) 7
Hormonal Modulation
- Increases testosterone through effects on the hypothalamic-pituitary-gonadal axis 4
- Elevates LH and FSH levels in a dose-dependent manner 8
- Reduces stress hormones (cortisone, prolactin) that impair fertility 8
Neuroendocrine Pathway
- Acts through a GABA-mimetic pathway that improves hormonal balance via crosstalk between endocrine glands 6
- Modulates neurotransmitters (dopamine, serotonin) associated with sexual arousal 8
Erectile Function Enhancement
- Increases nitric oxide (NO) production via enhanced nNOS and eNOS expression
- Elevates cGMP levels while decreasing PDE5α expression (similar mechanism to sildenafil) 8
- Improves penile smooth muscle to collagen ratio 8
Critical Caveats
The disconnect between laboratory improvements and clinical pregnancy outcomes remains unresolved. The 2017 WHO analysis noted that while herbal therapies improved sperm DNA integrity in some studies, pregnancy rates were rarely reported, and when they were, results were inconsistent 1.
Safety concerns exist. One study cited in the guidelines reported "a large number of patients had adverse haematological reactions" with the herbal compound saffron 1. While ashwagandha-specific trials report no adverse events 3, 5, long-term safety data remain limited.
Standardization is problematic. The guidelines emphasize that "there are no high-quality data to support the use of a single antioxidant or a specific combination of antioxidants" and "it is not possible to recommend an effective treatment regimen" 1. Withanolide content varies significantly between preparations, potentially affecting efficacy 4.
Clinical Bottom Line
If a patient insists on trying ashwagandha, use a standardized root extract (300 mg twice daily) for 8 weeks, but counsel them that:
- Assisted reproductive technology (ART) has higher pregnancy rates and faster time to conception 2
- Laboratory improvements in sperm parameters do not guarantee pregnancy
- This is not FDA-approved for male infertility
- They should continue standard fertility evaluation and not delay proven treatments
The 2024 AUA/ASRM update maintains that supplements remain "of questionable clinical utility" 9, and the 2025 European guidelines do not mention ashwagandha or herbal therapies at all 10, suggesting continued lack of endorsement by major professional societies.
The most recent systematic review (2022) concluded that while ashwagandha shows "promising results," it requires "further study in a larger sample size" before clinical recommendations can be made 11. A 2025 review similarly noted ashwagandha "appears to be a promising natural adjunct" but emphasized "more study is needed to understand its long-term effects and dosing more fully" 12.