Clinical Context
Male infertility affects approximately 7% of men and contributes to up to 50% of couple infertility. In patients with type 2 diabetes, the prevalence is even higher due to multiple mechanisms: hyperglycemia-induced oxidative stress damages sperm DNA and membranes, diabetic neuropathy may impair ejaculation, and hormonal disturbances (reduced testosterone, elevated estradiol) compromise spermatogenesis. Asthenospermia—reduced sperm motility—is particularly common in diabetic men.
Conventional treatment for diabetic asthenospermia includes optimizing glycemic control, antioxidant supplementation (L-carnitine, CoQ10, vitamin E), and addressing comorbidities. However, results are often modest, and many couples still require assisted reproduction. Traditional Chinese Medicine (TCM) offers alternative approaches based on different theoretical frameworks.
In TCM, type 2 diabetes with asthenospermia is often classified as “qi-yin deficiency”—a pattern of depleted vital energy and body fluids that impairs kidney essence (the foundation of reproductive function in TCM theory). Wuziyuye Decoction is a classical formula designed to nourish kidney essence and replenish yin, potentially addressing the underlying pattern while improving sperm parameters.
PICO Summary
Population: Patients with type 2 diabetes mellitus and qi-yin deficiency pattern complicated by asthenospermia (reduced sperm motility).
Intervention: Wuziyuye Decoction, a traditional Chinese herbal formula, administered alongside standard glucose-lowering therapy.
Comparison: Conventional treatment with L-carnitine (a commonly used supplement for male infertility) plus standard glucose-lowering therapy.
Outcome: Wuziyuye Decoction significantly improved sperm progressive motility and sperm concentration compared to L-carnitine treatment. TCM syndrome scores also improved, indicating pattern-level therapeutic effects. No significant adverse effects were reported.
Clinical Pearls
1. Pattern-Based Selection: The intervention specifically targeted patients with qi-yin deficiency pattern as diagnosed by TCM criteria. This pattern-based selection is central to TCM practice—different formulas are prescribed for different patterns even within the same Western diagnosis. Results may not apply to patients with other TCM patterns.
2. Objective Outcome Improvement: The study measured objective outcomes (sperm motility, concentration) rather than only subjective or pattern-based assessments. This provides evidence interpretable within conventional medical frameworks, showing the formula produced measurable biological effects.
3. Active Comparator: Comparing to L-carnitine (rather than placebo) provides clinical relevance—L-carnitine is a commonly used intervention for male infertility with some evidence base. Superiority to an active treatment is more meaningful than superiority to placebo.
4. Integrative Approach: Both groups received standard glucose-lowering therapy, demonstrating an integrative model where TCM herbal medicine complements rather than replaces conventional diabetes management.
Practical Application
For patients with type 2 diabetes and asthenospermia interested in TCM approaches, referral to a qualified TCM practitioner for pattern diagnosis and individualized herbal prescription is appropriate. Wuziyuye Decoction may be considered for patients diagnosed with qi-yin deficiency pattern.
Continue optimizing glycemic control—hyperglycemia directly impairs spermatogenesis, and no herbal intervention substitutes for diabetes management. Address modifiable factors: smoking cessation, alcohol moderation, weight optimization, and treatment of varicocele if present.
Quality and standardization of herbal preparations vary significantly. Ensure products from reputable sources with quality testing for contaminants and accurate identification of botanical ingredients.
Broader Evidence Context
TCM for male infertility is widely practiced in Asia with growing interest globally. Systematic reviews suggest some Chinese herbal formulas may improve sperm parameters, though evidence quality is often limited by small studies and methodological issues. The specific formula Wuziyuye Decoction has traditional use for kidney deficiency patterns affecting reproduction.
Conventional antioxidants (carnitines, CoQ10, zinc, selenium) have modest evidence for improving sperm quality, though effects on pregnancy rates are less clear.
Study Limitations
Single-center Chinese study may limit generalizability. Sample size wasn’t specified in detail. Pregnancy outcomes—the ultimate measure of fertility intervention success—weren’t reported. TCM pattern diagnosis has inherent subjectivity. Blinding is difficult with herbal decoctions versus oral supplements.
Bottom Line
Wuziyuye Decoction significantly improves sperm motility and concentration in type 2 diabetes patients with qi-yin deficiency and asthenospermia compared to L-carnitine, without significant adverse effects. This TCM approach may benefit selected patients as part of integrative fertility management alongside conventional diabetes care.
Source: Yu Y, et al. “Wuziyuye Decoction for Type-II Diabetes Mellitus with Qi-Yin Deficiency Complicated by Asthenospermia: A Randomized Controlled Trial.” Read article
