Hindawi Publishing Corporation

Evidence-Based Complementary and Alternative Medicine

Volume 2015, Article ID 324369, 6 pages
http://dx.doi.org/10.1155/2015/324369

Research Article
Effect of Lepidium meyenii Walp. on Semen Parameters and
Serum Hormone Levels in Healthy Adult Men: A Double-Blind,
Randomized, Placebo-Controlled Pilot Study

Ingrid Melnikovova,1 Tomas Fait,2 Michaela Kolarova,3

Eloy C. Fernandez,1 and Luigi Milella4
1
Department of Crop Sciences and Agroforestry, Faculty of Tropical AgriSciences, Czech University of Life Sciences Prague,
Kamycka 129, 165 21 Prague 6, Czech Republic
2
Department of Gynecology and Obstetrics, 1st Medical Faculty, Charles University, Apolinarska 18, 128 51 Prague 2, Czech Republic
3
Department of Agroecology and Biometeorology, Faculty of Agrobiology, Food and Natural Resources,
Czech University of Life Sciences Prague, Kamycka 129, 165 21 Prague 6, Czech Republic
4
Department of Science, University of Basilicata, Viale dell’Ateneo Lucano 10, 85100 Potenza, Italy

Correspondence should be addressed to Eloy C. Fernandez; [email protected]

Received 4 May 2015; Revised 30 July 2015; Accepted 6 August 2015

Academic Editor: Cheorl-Ho Kim

Copyright © 2015 Ingrid Melnikovova et al. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
cited.

Background/Aims. Products of Lepidium meyenii Walp. (maca) are touted worldwide as an alimentary supplement to enhance
fertility and restore hormonal balance. Enhancing properties of maca on semen parameters in animals were previously reported
by various authors, but we present to the best of our knowledge the first double-blind, randomized, placebo-controlled pilot trial
in men. The aim of this study was to evaluate the effects of maca on semen parameters and serum hormone levels in healthy adult
men. Methods. A group of 20 volunteers aged 20–40 years was supplied by milled hypocotyl of maca or placebo (1.75 g/day) for
12 weeks. Negative controls of semen were compared to the samples after 6 and 12 weeks of maca administration; negative blood
controls were compared to the samples after 12 weeks of treatment. Results. Sperm concentration and motility showed rising trends
compared to placebo even though levels of hormones did not change significantly after 12 weeks of trial. Conclusion. Our results
indicate that maca possesses fertility enhancing properties in men. As long as men prefer to use alimentary supplement to enhance
fertility rather than prescribed medication or any medical intervention, it is worth continuing to assess its possible benefits.

1. Introduction inhabitants to boost overall vitality and treat infertility in

humans and domestic animals [9]. Even today, maca products
The infertility caused by impaired spermatogenesis and attract widespread interest for its claimed fertility enhancing
semen parameters is a public health problem which has properties in both male and female. In fact it was recently
become an issue of great concern. As long as current thera- demonstrated that maca root may alleviate SSRI-induced
peutic management is often associated with side effects and sexual dysfunction in postmenopausal women [8]. Maca was
no significant efficacy [1], need of an alternative treatment reported to enhance sexual desire [10, 11] and improved mild
arises. For this purpose, plants with an ethnopharmacological erectile dysfunction [12] in men. Its semen quality improving
reputation have been widely investigated for the identification properties have been reported by various studies in animals:
of their possible biological activities [2–5] or for the treatment mice [13], bulls [14], and rams [15]; but convincing scientific
of several ailments [6–8]. Lepidium meyenii Walp. from the evidence for its efficacy on semen in men is still lacking.
Brassicaceae family may be applied. This Andean bulbous According to the observed biological activities of its lipid
crop called maca has been used for centuries by native fraction [16], studies regarding maca have focused on a group
2 Evidence-Based Complementary and Alternative Medicine

of unique nonpolar, long-chain fatty acid n-benzylamides the methodology previously described [18, 19]. A placebo
called macamides, which are considered as chemotaxonomic was selected on the basis of color and taste similarity to
markers used to assess its quality [17]. Nevertheless, the maca powder; milled apple fiber (Country Life) and sucrose
mechanism of its enhancing properties has not yet been fully (Cukrovar Vrbatky a.s.) were used in the ratio 3 : 2.
discovered.
Twenty apparently healthy men were treated with maca 2.3. Design of Experiment. To evaluate the effect of maca,
or placebo for 12 weeks in order to evaluate its effect on this pilot study was designed as a 12-week, double-blind,
semen parameters and serum hormone levels. In particular placebo-controlled, randomized, parallel trial in which active
we have monitored five reproductive hormones (luteinizing treatment by gelatinized maca was compared to a placebo.
hormone, follicle-stimulating hormone, prolactin, estradiol, Twenty men were randomly divided as previously described.
and testosterone), two thyroid hormones (free thyroxin and Powder was dosed into the gelatin enterosolvent capsules,
thyroid-stimulating hormone), and semen parameters (total each of which contained 350 mg; the daily dose was five
sperm count, sperm concentration, morphology, and motile capsules, equal to 1.75 g. Semen samples were collected before,
sperm count) to evidence the effects of maca supplement in the 6th and in the 12th week of the treatment. Samples of
on the mentioned parameters. As recommended by previous blood were collected before and after the trial.
studies [17–19] macamides content was quantified by High-
Pressure Liquid Chromatography with UV Detector (HPLC- 2.4. Assessment of Semen Parameters. The samples of semen
UV). were obtained by masturbation after 3 days of sexual absti-
nence and evaluated in the Assisted Reproduction Center
2. Material and Methods Apolinar, Department of Obstetrics and Gynecology, 1st
Faculty of Medicine, Charles University, and General Faculty
2.1. Subjects. Twenty healthy men of 20–40 years were Hospital in Prague. Seminal analysis was performed accord-
included in the study. They were nonsmokers and at least ing to the guidelines of the World Health Organization [21].
3 months before and during the study did not use hor-
monal treatment, anabolics, or any medical substances which 2.5. Hormone Assay. Blood samples were collected on the
could change their serum hormone levels. All the partici- same day as the semen samples. Five reproductive hor-
pants signed agreements to be involved in the study after mones (luteinizing hormone, follicle-stimulating hormone,
being informed of its purpose, possible benefits, and risks prolactin, estradiol, and testosterone) and two thyroid hor-
and approval from an independent Ethics Committee was mones (free thyroxin and thyroid-stimulating hormone) were
obtained. measured by routine immune-analytical methods in the
Using a prospective, randomized, placebo-controlled, Central Laboratory of General Faculty Hospital, 1st Faculty
double-blind design [20], 20 patients were randomly assigned of Medicine, Charles University in Prague.
into the trial group (11 patients) and the control group (9
patients). Group assignment for all subjects was determined 2.6. Statistical Analysis. All the data were analyzed using
using a random table prior to initiation of the study. The Statistica 10 software. As homogeneity of variance assump-
sequence of assignments was unknown to any of the inves- tions were not satisfied in all cases, a nonparametric Mann-
tigators. Each assignment was kept in a sealed envelope, and Whitney U test was used to analyze intergroup differences
the order in numeric number was shown on the outside of the and a Kruskal-Wallis H test was performed for analyzing data
envelope. Thus, the orders could not be changed. Envelopes of more than two groups. A 𝑃 value is based on the Chi-square
were arranged in order. The principal investigator generated distribution and a 𝑃 value of less than 0.05 was considered
this random selection a few months before recruiting the first statistically significant.
subject. No significant differences in age, physical condition,
and clinical stage of disease between the two groups were 3. Results
found.
From 20 volunteers, two men appeared to suffer from
2.2. Maca and Placebo. Gelatinized and powdered maca oligozoospermia; therefore, they had to be excluded from the
was provided by the Peruvian company Andean Roots SRL trial. Out of 18 remaining volunteers, 7 consumed placebo and
and delivered to the Czech Republic in 2012. The plant 11 maca.
material, yellow type of maca, was harvested in the Cerro de
Pasco region of the central Peruvian Andes at the altitude 3.1. Semen Parameters. Not any statistically significant dif-
between 4200 and 4500 meters above sea level. During the ferences between semen parameters in different collection
gelatinization, original dried hypocotyls of maca were rehy- dates as well as maca versus placebo groups were found. This
drated and exposed to short-term elevated pressure under could be due to higher within groups variation. We found,
moist conditions. This standard process of sample prepara- however, that all assessed quality parameters showed rising
tion decomposed the starch component and increased the trends in the maca group after 12 weeks of the trial (Table 1).
digestibility of the product; after gelatinization the sample Total sperm count increased by 20%, sperm concentration by
was dried again to less than 7% humidity. The content of the 14%, motile sperm count by 14%, progressively motile sperm
six most abundant macamides, the quality markers of maca, count by 18%, semen volume by 9%, and normal morphology
was analyzed in gelatinized sample by HPLC-UV following of sperms by 21% (Figures 1 and 2). In the placebo group, total
Evidence-Based Complementary and Alternative Medicine 3

Table 1: Mean semen parameter values during maca and placebo treatment (mean ± standard error; Kruskal-Wallis 𝐻 test).

Progressively
Normal sperm Sperm Motile sperm Semen
𝑛 motile sperm Total sperm
morphology concentration count volume
count count (×106 )
(%) (×106 mL−1 ) (×106 mL−1 ) (mL)
(×106 mL−1 )
0 weeks 11 18.18 ± 1.68 77.27 ± 6.79 47.72 ± 4.33 58.00 ± 5.40 277.90 ± 31.18 3.66 ± 0.31
6 weeks 11 22.22 ± 2.22 86.11 ± 7.48 51.66 ± 2.88 63.22 ± 3.47 241.11 ± 25.54 2.92 ± 0.33
Maca 12 weeks 11 22.00 ± 2.00 87.80 ± 9.86 56.20 ± 7.19 66.30 ± 8.36 332.31 ± 58.98 3.99 ± 0.31
P value 0.29 0.52 0.28 0.39 0.42 0.11
H 3.25 1.31 2.56 1.89 1.75 4.46
0 weeks 7 20.71 ± 1.70 106.71 ± 15.59 70.00 ± 12.53 83.42 ± 13.73 295.56 ± 69.580 2.77 ± 0.53
6 weeks 7 23.33 ± 2.10 100.00 ± 10.24 60.00 ± 8.560 71.66 ± 8.620 395.16 ± 152.57 3.57 ± 1.01
Placebo 12 weeks 7 17.85 ± 3.75 100.28 ± 12.04 65.71 ± 11.09 74.85 ± 11.43 355.28 ± 96.940 3.44 ± 0.64
P value 0.44 0.83 0.89 0.72 0.87 0.73
H 0.23 0.38 0.23 0.67 0.27 0.63

Table 2: Baseline and posttreatment serum level of hormones in maca and placebo-treated subjects (mean ± standard error; Mann-Whitney
𝑈 test).

LH∗ FSH∗∗ Estradiol Testosterone fT4∗∗∗ TSH∗∗∗∗

𝑛
(IU L−1 ) (IU L−1 ) (nmol L−1 ) (nmol L−1 ) (pmol L−1 ) (mIU L−1 )
0 weeks 11 4.03 ± 0.50 4.40 ± 0.37 0.10 ± 0.01 19.92 ± 1.75 16.31 ± 0.29 2.35 ± 0.30
Maca 12 weeks 11 2.90 ± 0.33 3.75 ± 0.37 0.10 ± 0.01 20.10 ± 2.24 16.91 ± 0.62 1.58 ± 0.23
P value 0.09 0.23 0.76 0.88 0.95 0.07
0 weeks 7 3.82 ± 0.50 4.46 ± 0.50 0.09 ± 0.01 19.43 ± 2.25 14.02 ± 0.68 2.92 ± 1.63
Placebo 12 weeks 7 2.99 ± 0.57 3.55 ± 0.64 0.11 ± 0.01 18.63 ± 2.15 15.28 ± 0.72 2.63 ± 1.38
P value 0.23 0.23 0.17 1.00 0.23 1.00
∗
Luteinizing hormone; ∗∗ follicle-stimulating hormone; ∗∗∗ free thyroxin; ∗∗∗∗ thyroid-stimulating hormone.

sperm count increased also by 20%, but sperm concentration Table 3: Content of the six most abundant macamides in maca
did not change and motile sperm count and normal sperm powder (mg/g DW).
morphology decreased by 10% and 14%, respectively.
Macamide Mean ± SE
Methoxy-n-benzyl-(9Z.12Z.15Z)-octadecatrienamide 0.12 ± 0.05
3.2. Serum Hormone Levels. Statistically significant differ-
n-Benzyl-(9Z.12Z.15Z)-octadecatrienamide 1.02 ± 0.17
ence in level of prolactin between the baseline of maca
and placebo group was found; therefore, prolactin was not Methoxy-n-benzyl-(9Z.12Z)-octadecadienamide 0.10 ± 0.01
included in the hormonal analysis. No substantial changes of n-Benzyl-(9Z.12Z)-octadecadienamide 1.02 ± 0.16
other hormone levels were observed in the blood serum after n-Benzylhexadecanamide 1.68 ± 0.29
12 weeks of maca or placebo administration (Table 2). n-Benzyl-(9Z)-octadecanamide 0.41 ± 0.08

3.3. Macamides Content. The content of six main abundant

macamides in maca powder is shown in Table 3. Among This pilot study appears to extend the knowledge of maca’s
them n-benzylhexadecanamide, n-benzyl-(9Z.12Z)-octade- properties and supports several findings of previous studies.
cadienamide, and n-benzyl-(9Z.12Z.15Z)-octadecatrienam- Our results showed rising trends of semen parameters after
ide were the most abundant; the content has been found to be 12 weeks of maca administration and correlate with two
1.68 ± 0.29, 1.02 ± 0.17, and 1.02 ± 0.16 mg/g of dried weight previously conducted studies in men, which lacked any
of plant material (mg/g DW), respectively. control group [22, 23]. Subjects consumed 3 g of powdered
maca in both above mentioned studies. Gonzales et al. [22]
4. Discussion reported in nine healthy volunteers a statistically significant
increase of sperm concentration by 35%, total sperm count
We wish to evaluate maca’s semen quality enhancing prop- by 84%, and count of motile sperm even by 109% after 16
erties by, to the best of our knowledge, the first double- weeks of treatment. Tancara et al. [23] studied ten patients
blind, randomized, placebo-controlled trial in healthy men with clinically diagnosed infertility. Authors did not find
and to contribute to the current scientific evidence of this any improvement in sperm concentration or total sperm
crop with a pronounced ethnopharmacological reputation. count but reported a statistically significant increase of motile
4 Evidence-Based Complementary and Alternative Medicine

180 black maca are the varieties responsible to increase sperm

count and sperm motility whereas red maca had no effect.
160 Rubio et al. [24] indicated that maca also reversed lead
acetate induced damage of spermatogenesis in male rats.
140 These findings suggest that maca improves sperm formation.
Sperm concentration (×106 mL)

This is in line with an increased motile sperm count and count

120
of sperms with normal morphology in our and the above
100
named studies in men.
In order to demonstrate whether maca influences fertility
80 on a hormonal basis, levels of selected hormones in blood
serum were measured. We did not find any substantial
60 changes in comparison to the baseline or a control group.
These results reinforce previous studies in rats [25] and
40 humans [26] and in vitro [27], which did not show an
influence of maca consumption on hormone levels. On
20 the contrary, Oshima et al. [28] reported increased level
0 6 12 of progesterone in female and testosterone in male mice
Weeks of treatment and Uchiyama et al. [21] described significant elevation of
Median
luteinizing hormones in female mice with a daily dose of 3–
25%–75% 30 g maca powder per kg. However, maca forms part of native
Min-max Andean inhabitants’ diet; daily doses used in animal models
seem to be unfeasible for humans.
Figure 1: Influence of maca treatment on sperm concentration. The mechanism of the fertility enhancing properties of
maca remains unconfirmed, but some aphrodisiac activities
have been related to its lipidic fraction [13], which contains
140 mainly fatty acids and macamides. Macamides are used to
assess the quality of maca products; therefore, we quantified
120 the most abundant of them. Their content was comparable to
Motile sperm concentration (×106 mL−1 )

the already published average values obtained by the analysis

100 of samples from different locations in Peru. The amount
of the most common macamide, n-benzylhexadecanamide,
80 was determined as 1.68 mg/g, while in previous studies
these values differed between 1.39–3.68 mg/g [19] and 0.49–
60 4.57 mg/g [29]. The content of macamides varies significantly;
therefore, we encourage the recommendations of previous
studies to determine their content before each experiment.
40
From the viewpoint of trial design, the daily doses and
the length of treatment would be expected to play a crucial
20
role. Values in spermiograms of our volunteers showed rising
trends between 6th week and 12th week of treatment. Thus,
0 the fact that Gonzales et al. [22] obtained more significant
0 6 12
Weeks of treatment
results after 16 weeks of trial supports the hypothesis that the
length of maca administration influences semen parameters
Median positively. On the other hand his team described no signifi-
25%–75% cant impact if the daily dose of maca was reduced from 3 to
Min-max 1.5 g.
Hirsh [30] declares that subfertility affects one in 20 men.
Figure 2: Influence of maca treatment on motile sperm concentra-
This correlates well with our results since two volunteers of
tion.
our group suffered from oligozoospermia. These results sup-
port evidence that subfertility affects a considerable amount
of young men. Nevertheless, sperm parameters achieved by
sperm count by 10% and of normal sperm morphology by 18 men in this study were higher than recent WHO reference
12% after 12 weeks of maca consumption; these findings are values for human semen characteristics [31].
consistent with ours. Maca is touted as a potent over-the-counter (OTC)
Maca’s semen enhancing properties have also been supplement. As long as men prefer to use OTC products
described in several scientifically rigorous studies in animals to enhance fertility rather than prescribed medication or
[13–15]. Gonzales et al. [13] reported increased stages of sper- any medical intervention, it is worth continuing to assess its
miation and mitosis of germ cells during the spermatogenic possible benefits [1]. Our results indicate that maca possesses
cycle in male rats, demonstrating also that yellow maca and some of its claimed properties. Hence, we decided to continue
Evidence-Based Complementary and Alternative Medicine 5

maca oriented research in order to evaluate its potential. with serum testosterone levels in adult healthy men,” Androlo-
A trial considering the effect of maca in patients suffering gia, vol. 34, no. 6, pp. 367–372, 2002.
oligozoospermia is currently being developed. [11] M. Stone, A. Ibarra, M. Roller, A. Zangara, and E. Stevenson,
“A pilot investigation into the effect of maca supplementation
on physical activity and sexual desire in sportsmen,” Journal of
Conflict of Interests Ethnopharmacology, vol. 126, no. 3, pp. 574–576, 2009.
The authors declare that there is no conflict of interests [12] T. Zenico, A. F. G. Cicero, L. Valmorri, M. Mercuriali, and
regarding the publication of this paper. E. Bercovich, “Subjective effects of Lepidium meyenii (Maca)
extract on well-being and sexual performances in patients with
mild erectile dysfunction: a randomised, double-blind clinical
Acknowledgments trial,” Andrologia, vol. 41, no. 2, pp. 95–99, 2009.
[13] G. F. Gonzales, C. Gonzales-Castañeda, and M. Gasco, “A
The authors thank Andean Roots SRL for providing maca mixture of extracts from Peruvian plants (black maca and
powder and the Assisted Reproduction Center Apolinar yacon) improves sperm count and reduced glycemia in mice
and Central Laboratory at Department of Obstetrics and with streptozotocin-induced diabetes,” Toxicology Mechanisms
Gynecology, 1st Faculty of Medicine, Charles University, and and Methods, vol. 23, no. 7, pp. 509–518, 2013.
General Faculty Hospital in Prague for seminal and hormonal [14] C. Clément, J. Kneubühler, A. Urwyler, U. Witschi, and M.
analysis. Kreuzer, “Effect of maca supplementation on bovine sperm
quantity and quality followed over two spermatogenic cycles,”
Theriogenology, vol. 74, no. 2, pp. 173–183, 2010.
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