AMH Revival and Beejotsarga: An Evidence-Based Evaluation of Rasayana Herbs (Shatavari, Ashwagandha, Gokshura) and Uttarbasti in Low Ovarian Reserve and Premature Ovarian Insufficiency- Narrative Review and Proposed Translational Research Framework
Section: Review Article
Affiliations
M.S. Ph.D, HOD & Professor, Dept. of Prasuti Tantra Evum Stree Roga, India
M.S. Ph.D (Scholar), Dept. of Prasuti Tantra Evum Stree Roga, India
B.H.M.S. (Homeopathic Medicine- Practitioner)- Pune, Maharashtra, India
Abstract
Background- Diminished ovarian reserve (DOR) and premature ovarian insufficiency (POI) affect a substantial proportion of reproductive-age women and remain difficult to reverse using conventional endocrine or assisted-reproduction protocols. Anti-Mullerian hormone (AMH), an indirect marker of the growing follicle pool, has become the central biomarker against which any restorative intervention is judged.
Objective- Ayurveda addresses this clinical picture under the framework of Artavakshaya (depletion of the ovarian/menstrual tissue) and Dhatukshaya (systemic tissue depletion), managed principally through Rasayana chikitsa (rejuvenation therapy) and Uttarbasti (intra-vaginal/uterine instillation of medicated oil). This paper undertakes an evidence-based evaluation of three widely used Rasayana herbs — Shatavari (Asparagus racemosus), Ashwagandha (Withania somnifera) and Gokshura (Tribulus terrestris) — and of Uttarbasti, in relation to AMH revival and beejotsarga (ovulation) restoration.
Methods- Randomized trials, case series, systematic reviews and mechanistic studies are synthesised alongside the biomedical literature on oxidative stress, dehydroepiandrosterone (DHEA) and adjuvant nutraceutical therapy in DOR/POI.
Result & Conclusion- A novel, biomarker-anchored integrative protocol and a phase-appropriate randomized trial design incorporating serial AMH/antral follicle count (AFC) measurement and follicular-fluid multi-omics are proposed, intended to test Ayurvedic rejuvenation therapy rigorously rather than anecdotally, while explicitly addressing herb-quality and heavy-metal safety concerns that have historically limited acceptance of Ayurvedic formulations in mainstream reproductive medicine.
Objective- Ayurveda addresses this clinical picture under the framework of Artavakshaya (depletion of the ovarian/menstrual tissue) and Dhatukshaya (systemic tissue depletion), managed principally through Rasayana chikitsa (rejuvenation therapy) and Uttarbasti (intra-vaginal/uterine instillation of medicated oil). This paper undertakes an evidence-based evaluation of three widely used Rasayana herbs — Shatavari (Asparagus racemosus), Ashwagandha (Withania somnifera) and Gokshura (Tribulus terrestris) — and of Uttarbasti, in relation to AMH revival and beejotsarga (ovulation) restoration.
Methods- Randomized trials, case series, systematic reviews and mechanistic studies are synthesised alongside the biomedical literature on oxidative stress, dehydroepiandrosterone (DHEA) and adjuvant nutraceutical therapy in DOR/POI.
Result & Conclusion- A novel, biomarker-anchored integrative protocol and a phase-appropriate randomized trial design incorporating serial AMH/antral follicle count (AFC) measurement and follicular-fluid multi-omics are proposed, intended to test Ayurvedic rejuvenation therapy rigorously rather than anecdotally, while explicitly addressing herb-quality and heavy-metal safety concerns that have historically limited acceptance of Ayurvedic formulations in mainstream reproductive medicine.
Keywords
Premature ovarian insufficiency; Diminished ovarian reserve; Anti-Mullerian hormone; Rasayana; Shatavari; Ashwagandha; Gokshura; Uttarbasti; Ayurveda; integrative reproductive medicine
References
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27. A comprehensive overview of Gokshura (Tribulus terrestris Linn.). J Ayurveda Integr Med Sci. 2019;4(6).
28. Effect of Gokshura (Tribulus terrestris L.) on gynecomastia and levels of sex hormone in chronic liver disease: a case report. 2022.
29. Ayurveda management protocol for primary infertility due to premature ovarian failure. J Ayurveda Case Rep. 2024.
30. Effect of Ayurvedic treatment protocol on diminishing ovarian reserve. 2020.
31. Uttarbasti in the management of infertility w.s.r. to anovulation — case series. 2016.
32. Infertility due to low ovarian reserve — treated by Matra basti: a case report. Indian J Ayurveda Integr Med KLEU. 2023;4(2).
33. Saper RB, Kales SN, Paquin J, et al. Heavy metal content of Ayurvedic herbal medicine products. JAMA. 2004;292(23):2868–2873.
34. Gogtay NJ, Bhatt HA, Dalvi SS, et al. The use and safety of non-allopathic Indian medicines. Drug Saf. 2002;25:1005–1019.
35. Heavy metal contamination in adaptogenic herbal dietary supplements: experimental, assessment and regulatory safety perspectives. 2025.
36. Chronic toxicity studies of Gandhaka rasayana — a herbo-mineral preparation used in Ayurvedic practice. J Ayurveda Integr Med. 2021.
2. Shi YQ, Zhu XT, Zhang SN, Ma YF, Han YH, Jiang Y, Zhang YH. Premature ovarian insufficiency: a review on the role of oxidative stress and the application of antioxidants. Front Endocrinol (Lausanne). 2023;14:1172481.
3. Amrita School of Ayurveda and Amrita Institute of Medical Sciences. An exploratory single arm study to evaluate the role of an Ayurvedic treatment protocol as a prerequisite for in vitro fertilization in women with diminished ovarian reserve incorporating multi-omics approaches: study protocol. Front Med (Lausanne). 2025.
4. Efficacy of dehydroepiandrosterone to improve ovarian response in women with diminished ovarian reserve: a meta-analysis. Reprod Biol Endocrinol. 2013.
5. The effect of dehydroepiandrosterone (DHEA) supplementation on women with diminished ovarian reserve (DOR) in IVF cycle: evidence from a meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2016.
6. DHEA use to improve likelihood of IVF/ICSI success in patients with diminished ovarian reserve: a systematic review and meta-analysis. 2018.
7. Dehydroepiandrosterone supplementation improves the outcomes of in vitro fertilization cycles in older patients with diminished ovarian reserve. Front Endocrinol (Lausanne). 2019.
8. The effect of dehydroepiandrosterone supplementation on ovarian response is associated with androgen receptor in diminished ovarian reserve women. 2017.
9. The auxiliary effect of oral nutritional supplements on fertility in women with diminished ovarian reserve: a systematic review and meta-analysis. 2025.
10. Nutritional therapies for enhancing reproductive tissues (Shukra and Artava Dhatu). 2026.
11. Management of infertility w.s.r. to PCOS through Ayurvedic herbal approach. J Ayurveda Integr Med Sci.
12. Critical evaluation of Ayurvedic plants for stimulating intrinsic antioxidant response. 2012.
13. Beyond reverse pharmacology: mechanism-based screening of Ayurvedic drugs. 2011.
14. Evaluation of free-radical quenching properties of standard Ayurvedic formulation Vayasthapana Rasayana. 2011.
15. SheVari4®, a proprietary root extract from Asparagus racemosus, ameliorates menopausal health: insights from a randomized, double-blind, placebo controlled clinical trial. 2025.
16. Clinical assessment of CL22209, a standardized proprietary extract of Asparagus racemosus, for mitigating vasomotor and menstrual symptoms in perimenopausal women: a randomized, double-blind, placebo-controlled study. Funct Foods Health Dis. 2025 Jul.
17. A standardized Asparagus racemosus root extract improves hormonal balance and menstrual health and reduces vasomotor symptoms in perimenopausal women: a randomized, double-blind, placebo-controlled study. J Am Nutr Assoc. 2025;44(8).
18. Ademola J, Ajgaonkar A, Debnath T, Debnath K, Langade J. Efficacy and safety of Shatavari root extract (Asparagus racemosus) for menopausal symptoms: a randomized, double-blind, three-arm, placebo-controlled study. Front Reprod Health. 2025.
19. Shatavari (Asparagus racemosus): a promising ally for fertility. 2025.
20. Effects of Ashwagandha on reproductive health: a systematic review of sex-specific hormonal and fertility outcomes. Phytother Res. 2025.
21. Effect of ashwagandha (Withania somnifera) on endocrine and reproductive traits in Awassi sheep. 2025.
22. Ajgaonkar A, Jain M, Debnath K. Efficacy and safety of Ashwagandha (Withania somnifera) root extract for improvement of sexual health in healthy women: a prospective, randomized, placebo-controlled study. Cureus. 2022.
23. Reproductive and developmental safety assessment of Ashwagandha (Withania somnifera) root extract in Wistar rats. 2025.
24. Effects of Withania somnifera on reproductive system: a systematic review of the available evidence. 2018.
25. Withania somnifera in women's hormonal modulation: a narrative review with implications for polycystic ovary syndrome and premenstrual syndrome. 2025.
26. Tribulus terrestris and female reproductive system health: a comprehensive review. Phytomedicine. 2021.
27. A comprehensive overview of Gokshura (Tribulus terrestris Linn.). J Ayurveda Integr Med Sci. 2019;4(6).
28. Effect of Gokshura (Tribulus terrestris L.) on gynecomastia and levels of sex hormone in chronic liver disease: a case report. 2022.
29. Ayurveda management protocol for primary infertility due to premature ovarian failure. J Ayurveda Case Rep. 2024.
30. Effect of Ayurvedic treatment protocol on diminishing ovarian reserve. 2020.
31. Uttarbasti in the management of infertility w.s.r. to anovulation — case series. 2016.
32. Infertility due to low ovarian reserve — treated by Matra basti: a case report. Indian J Ayurveda Integr Med KLEU. 2023;4(2).
33. Saper RB, Kales SN, Paquin J, et al. Heavy metal content of Ayurvedic herbal medicine products. JAMA. 2004;292(23):2868–2873.
34. Gogtay NJ, Bhatt HA, Dalvi SS, et al. The use and safety of non-allopathic Indian medicines. Drug Saf. 2002;25:1005–1019.
35. Heavy metal contamination in adaptogenic herbal dietary supplements: experimental, assessment and regulatory safety perspectives. 2025.
36. Chronic toxicity studies of Gandhaka rasayana — a herbo-mineral preparation used in Ayurvedic practice. J Ayurveda Integr Med. 2021.
Corresponding Author
Shrikant Atmaram Dighe (digheshreekant@gmail.com)