[Treatment of asthenoteratozoospermia with Jujing Decoction by improving the structure and function of sperm mitochondria via antioxidant stress based on the theory of "Yang-Qi transformation and Yin morphologization"].

Objective: To observe the clinical efficacy and action mechanism of Jujing Decoction (JJD) in the treatment of asthenoteratozoospermia (ATZ) by comparing JJD with combined administration of the antioxidant stress drug and sperm energy metabolism agent.

Methods: According to the inclusion criteria, we enrolled 67 male patients with ATZ in this randomized controlled clinical study and treated them by oral administration of JJD (the JJD group, n = 34) or natural vitamin E combined with L-carnitine solution (the positive control group, n = 33), both for 12 weeks. We collected the semen parameters, sperm DNA fragmentation index (DFI), sperm mitochondrial membrane potential (MMP), seminal plasma reactive oxygen species (ROS) and superoxide dismutase (SOD) levels from the patients, observed the ultrastructure of sperm mitochondria under the transmission electron microscope (TEM) before and after treatment, and analyzed the clinical efficacy and action mechanism of JJD by comparing the data obtained between the two groups.

Results: Treatment and follow-up were completed in 60 of the cases, 30 in the JJD and 30 in the positive control group. The total rate of clinical effectiveness was significantly higher in the JJD than in the positive control group (76.8% vs 43.3%, P< 0.05). Compared with the baseline, the percentages of progressively motile sperm (PMS) and morphologically normal sperm (MNS), DFI and MMP were significantly improved (P< 0.05), the level of seminal plasma ROS decreased (P> 0.05), and that of SOD remarkably increased (P< 0.05) after treatment with JJD; PMS, MNS, DFI and MMP were also improved (P> 0.05), seminal plasma ROS decreased (P> 0.05) and SOD increased (P< 0.05) in the positive controls after medication. In comparison with the positive controls, the patients treated with JJD showed even more significant improvement in PMS (［29.37 ± 14.56］% vs ［42.68 ± 15.86］%, P< 0.05), MNS (［1.84 ± 1.32］% vs ［3.66 ± 1.72%］%, P< 0.05), DFI (［32.66 ± 5.23］% vs ［16.61 ± 4.20］%, P< 0.05) and MMP (［46.47 ± 9.48］% vs ［61.79 ± 8.61］%, P< 0.05), ROS (［7.08 ± 0.51］ vs ［5.06 ± 0.52］ μmol/L, P> 0.05), and SOD (［100.65 ± 10.59］ vs ［139.05 ± 14.71］ U/ml, P< 0.05). TEM revealed significantly improved ultrastructure of sperm mitochondria after treatment with JJD. No serious adverse reactions were observed in either group during follow-up.

Conclusion: JJD, superior to natural vitamin E and L-carnitine oral solution, can safely and effectively increase the percentages of PMS and MNS, MMP and the level of seminal plasma SOD, reduce sperm DFI and seminal plasma ROS, and improve the ultrastructure of sperm mitochondria in patients with ATZ. The underlying mechanism of action may be related to its ability of improving the structure and function of sperm mitochondria via antioxidant stress.