Knowledge, Attitude and Practice of Herbal Remedies in A Group of Infertile Couples

  • Ladan Kashani Infertility Ward, Arash Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Elmira Hassanzadeh Infertility Ward, Arash Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Arefeh Mirzabeighi Infertility Ward, Arash Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Shahin Akhondzadeh Mail Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Attitude, Herbal Remedies, Infertility, Knowledge, Practice


The aim of this study was to evaluate knowledge, attitude and practice of herbal remedies (HRs) in infertile patients. This was a cross sectional study in a referral infertility care center. Three hundred and six outpatients, both women and men, presenting for the first time with complaint of infertility at Arash hospital, were recruited. Verbal consent for participation was received. A self administered questionnaire was used. Main outcome measure was knowledge, attitude and practice of patients toward herbal medications. 47.3% of participants were knowledgeable of HRs with female gender and lower educational background being the associated factors in knowledge. 43.4% of patients with significant female dominancy had positive attitude toward HRs. 31% of participants were using HRs. Only 3.2% of those using HRs informed their physician. The most common health condition promoting herbal use was psychological (33.3%) and gastrointestinal (30.8%) disorders. 3.5% of participants used HRs as fertility treatment which was significantly observed in women and those with lower levels of formal education. A considerable proportion of our population had used HRs without sufficient knowledge and had positive attitude toward HRs. More importantly, patients did not disclose their use of HRs to physicians. Therefore, physicians should inquire about the use of alternative remedies and provide patients with appropriate information.


Tindle HA, Davis RB, Phillips RS, Eisenberg DM. Trends in use of complementary and alternative medicine by US adults: 1997-2002. Altern Ther Health Med 2005;11(1):42-9.

National center for complementary and alternative medicine. The Use of Complementary and Alternative Medicine in the United States. Available at: External linkm tm. Accesse Dec 1, 2012.

3. Meeker WC. Public demand and the integration of complementary and alternative medicine in the US health care system. J Manipulative Physiol Ther 2000;23(3):123-6.

Onyiapat JL, Okoronkwo IL, Ogbonnaya NP. Complementary and alternative medicine use among adults in Enugu, Nigeria. BMC Complement Altern Med 2011;11:19.

World Health Organization. WHO traditional medicine strategy 2002-2005 .Available at: External link. Accessed Dec , 2012.

Yekta Z, Zamani AR, Mehdizade M, Farajzadegan Z. Pattern of Complementary and Alternative Medicine Use in Urban Population. J Res Health Sci 2007;7(1):24-31.

Tehrani Banihashemi SA, Asgharifard H, Haghdoost AA,Barghmadi M, Mohammadhosseini N. The use of Complementary/Alternative Medicine among the general population in Tehran, Iran (in Persian). Payesh 2008; 7: 355-62.

Astin JA. Why patients use alternative medicine: results of a national study. JAMA 1998;279(19):1548-53.

Moradi Lakeh M, Ramezani M, Ansari H. Factors influencing the use of herbal remedies/medicinal herbs among the general population in Tehran, Iran(in Persian). Payesh 2008; 7: 313-20.

Safarinejad MR. Infertility among couples in a populationbased study in Iran: prevalence and associated risk factors. Int J Androl 2008;31(3):303-14

Monga M, Alexandrescu B, Katz SE, Stein M, Ganiats T. Impact of infertility on quality of life, marital adjustment, and sexual function. Urology 2004;63(1):126-30.

Whiteford LM, Gonzalez L. Stigma: the hidden burden of infertility. Soc Sci Med 1995;40(1):27-36.

Domar AD, Broome A, Zuttermeister PC, Seibel M, Friedman R. The prevalence and predictability of depression in infertile women. Fertil Steril 1992;58(6):1158-63.

Cousineau TM, Domar AD. Psychological impact of infertility. Best Pract Res Clin Obstet Gynaecol 2007;21(2):293-308.

Dunkel-Schetter C, Lobel M. Psychological reactions to infertility. In: Stanton AL, Dunkel- Schetter C, Eds. Infertility: Perspectives from stress and coping research. New York: Plenum, 1991:29-57.

Abbasi-Shavazi MJ, Inhorn MC, Rezeghi-N asrabad HB, Toloo Gh. The “Iranian ART Revolution”: infertility, assisted reproductive technology, and third-party donation in the Islamic Republic of Iran. J Middle East Women's Studies 2008;4:1-28.

Rayner JA, Willis K, Burgess R. Women's use of complementary and alternative medicine for fertilityenhancement: a review of the literature. J Altern Complement Med 2011;17(8):685-90.

Vickers KA, Jolly KB, Greenfield SM. Herbal medicine: women's views, knowledge and interaction with doctors: a qualitative study. BMC Complement Altern Med 2006;6:40.

Sharples FM, van Haselen R, Fisher P. NHS patients'= perspective on complementary medicine: a survey. Complement Ther Med 2003;11(4):243-8.

Zini A, Fischer MA, Nam RK, Jarvi K. Use of alternative and hormonal therapies in male infertility. Urology 2004;63(1):141-3.

Freeman MP. Complementary and alternative medicine for perinatal depression. J Affect Disord 2009;112(1-3):1-10.

Rahman AA, Sulaiman SA, Ahmad Z, Salleh H, Daud WN, Hamid AM. Women's attitude and sociodemographic characteristics influencing usage ofherbal medicines during pregnancy in Tumpat District, Kelantan. Southeast Asian J Trop Med Public Health 2009;40:330-7.

Hussin AH. Adverse effects of herbs and drugherbal interactions. Malaysian J Pharm 2001; 1:39-44

Robinson A, McGrail MR. Disclosure of CAM use to medical practitioners: a review of qualitative and quantitative studies. Complement Ther Med 2004;12(2-3):90-8.

Chao MT, Wade C, Kronenberg F. Disclosure of complementary and alternative medicine to conventional medical providers: variation by race/ethnicity and type of CAM. J Natl Med Assoc 2008;100(11):1341-9.

Shannon J, El Saigh I, Tadrous R, Mocanu E, Loughrey J. Usage of herbal medications in patients undergoing IVF treatment in an Irish infertility treatment unit. Iranian J Med Sci 2010;179(1):63-5.

Stankiewicz M, Smith C, Alvino H, Norman R. The use of complementary medicine and therapies by patients attending a reproductive medicine unit in South Australia:a prospective survey. Aust N Z J Obstet Gynaecol 2007;47(2):145-9.

Boivin J, Schmidt L. Use of complementary and alternative medicines associated with a 30% lower ongoingpregnancy/live birth rate during 12months of fertilitytreatment. Hum Reprod 2009;24(7):1626-31.

Assisted Human Reproduction Canada. Complementary and Alternative Medicine and Infertility. Available at:External link cam-cma-eng.php.Accessed Dec 1, 2012.

Murphy PA, Kern SE, Stanczyk FZ, Westhoff CL. Interaction of St. John's Wort with oral contraceptives:effects on the pharmacokinetics of norethindrone and ethinyl estradiol, ovarian activity and breakthroughbleeding. Contraception 2005;71(6):402-8.

Izzo AA, Ernst E. Interactions between herbal medicines and prescribed drugs: an updated systematic review. Drugs 2009;69(3):1777-98.

Weiss DA, Harris CR, Smith JF. The use of complementary and alternative fertility treatments. Curr Opin Obstet Gynecol 2011;23(3):195-9.

Lee A, Chui PT, Aun CS, Lau AS, Gin T. Incidence and risk of adverse perioperative events among surgical patients taking traditional Chinese herbal medicines. Anesthesiology 2006;105(3):454-61.

Mabina MH, Moodley J, Pitsoe SB. The use of traditional herbal medication during pregnancy. Trop Doct 1997;27(2):84-6.

Practice Committee of the American Society for Reproductive Medicine. Definitions of infertility and recurrent pregnancy loss. Fertil Steril 2008;90(5 Supple):S60.

Tabatabaee M. Use of herbal medicine among pregnant women referring to Valiasr hospital in Kazeroon, Fars, South of Iran. J Medicinal Plants 2011;10:96-108.

Smith JF, Eisenberg ML, Millstein SG, Nachtigall RD, Shindel AW, Wing H, Cedars M, Pasch L, Katz PP. Infertility Outcomes Program Project Group. The use of complementary and alternative fertility treatment incouples seeking fertility care: data from a prospectivecohort in the United States. Fertil Steril 2010;93(7):2169-74.

Bamidele JO, Adebimpe WO, Oladele EA.Knowledge, attitude and use of alternative medical therapy amongst urban residents of Osun State, southwesternNigeria. Afr J Tradit Complement Altern Med 2009;6(3):281-8.

Edirne T, Arica SG, Gucuk S, Yildizhan R, Kolusari A, Adali E, Can M. Use of complementary and alternative medicines by a sample of Turkish women for infertility enhancement: a descriptive study. BMC Complement Altern Med 2010;10:11.

Coulson C, Jenkins J. Complementary and alternative medicine utilisation in NHS and private clinic settings: a United Kingdom survey of 400 infertility patients. J Exp Clin Assist Reprod 2005;2(1):5.

ROYAN institute. Available at: External link Accessed Dec 1, 2012.

Vayena E, Peterson HB, Adamson D, Nygren KG. Assisted reproductive technologies in developing countries: are we caring yet? Fertil Steril 2009;92(2):413-6.

Nachtigall RD. International disparities in access to infertility services. Fertil Steril 2006;85(4):871-5.

Lunenfeld B, Van Steirteghem A; Bertarelli Foundation. Infertility in the third millennium: implications for the individual, family and society: condensed meeting report from the Bertarelli Foundation's second global conference. Hum Reprod Update 2004;10(4):317-26.

How to Cite
Kashani L, Hassanzadeh E, Mirzabeighi A, Akhondzadeh S. Knowledge, Attitude and Practice of Herbal Remedies in A Group of Infertile Couples. Acta Med Iran. 51(3):189-194.