Vol. 22, Issue 1, / January-March 2021
(Letter to Editor, pages 73-74)
PMID: 33680889 (PubMed) - PMCID: PMC7903667

Mehdi Pasalar
1- Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
2- Essence of Parsiyan Wisdom Institute, Traditional Medicine and Medicinal Plant Incubator, Shiraz University of Medical Sciences, Shiraz, Iran
Maryam Mosaffa-Jahromi
- Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
Sedigheh Amooee
- Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Babak Daneshfard Corresponding Author
- Traditional Medicine Clinical Trial Research Center, Shahed University, Tehran, Iran

Received: 6/24/2020 Accepted: 11/29/2020 - Publisher : Avicenna Research Institute

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Dear Editor,
We read enthusiastically the paper written by Bond et al. (1). In this retrospective cohort study, the efficacy of metabolic global approach has been evaluated in 127 obese (BMI ≥30 kg/m2) women. This investigation showed that lower BMI significantly improves the rate of pregnancy in obese women. Another recent study not only revealed that higher levels of physical activity are associated with reduced risk of fertility problems in women but also, once again, emphasized the negative impact of higher body mass index (BMI) on fertility (2). In this survey, which included 6130 women participated in The Australian Longitudinal Study on Women’s Health (ALSWH), those who were overweight had the hazard ratios (HR) of 1.18 (95% CI: 0.99-1.39) while this index was 1.36 (95% CI 1.14-1.63) in obese women.
It is worth mentioning that about a millennium ago, Avicenna (980-1037 AD) has pointed out such associations in his feat, "The Canon of Medicine". In the third volume of his book, this Iranian physician addresses the causes of infertility in both sexes in details in "sexuality weakness" section. Avicenna mentions that the decrease in the quantity and quality of sperm/ovule which could happen due to various causes plays a crucial role in the male/female fertility (3).
According to the Persian medicine which is one of the oldest comprehensive medical schools relying on humoral medicine and theory of temperaments (4), the process of reproductive cell production requires a normal temperament of the body organs (Especially vital organs, i.e., brain, heart, liver, and gonads). When there is excessive wet humor or wetness increase (The situation which is associated with increased BMI), the quantity and quality of sperm/ovule are negatively affected. Consequently, assisted reproduction techniques could be virtually ineffective, too (5, 6). In addition, this increase in wet humor negatively affects the digestive system of the patient, impairs the normal production of reproductive cells, and ultimately disrupts the sperm production in the testicles and the same happens in the female reproductive system (7-9).
On the other hand, it should be kept in mind that the increase in wet humor or BMI could have a harmful effect on the vital body organs including heart which is also involved in blood and nutrients supply of the reproductive process (10, 11).
Considering the holistic experiences in use of complementary and alternative medicines, applying Persian medicine as an integrative evidence-based approach could provide new promising horizons in the treatment of infertility.

Conflict of Interest
Authors declare no conflict of interest.


  1. Bond RT, Nachef A, Adam C, Couturier M, Kadoch IJ, Lapensée L, Bleau G, Godbout A. Obesity and Infertility: A Metabolic Assessment Strategy to Improve Pregnancy Rate. J Reprod Infertil. 2020;21(1):34-41.   [PubMed]
  2. Mena GP, Mielke GI, Brown WJ. Do physical activity, sitting time and body mass index affect fertility over a 15-year period in women? Data from a large population-based cohort study. Hum Reprod. 2020;35(3):676-83.   [PubMed]
  3. Avicenna. Al-Qanun fi al-Tibb (The Canon of Med-icine). 3rd ed. Tehran, Iran: Soroush Press; 2005. p. 228-35.
  4. Atarzadeh F, Daneshfard B, Dastgheib L, Jaladat AM, Amin G. Early Description of Diet-Induced Blistering Skin Diseases in Medieval Persia: Avicenna's Point of View. Skinmed. 2016;14(5):367-70.   [PubMed]
  5. Parvizi MM, Salehi A, Nimroozi M, Hajimonfarednejad M, Amini F, Parvizi Z. The Relationship between Body Mass Index and Temperament, Based on the Knowledge of Traditional Persian Medicine. Iran J Med Sci. 2016;41(3 Suppl):S14.   [PubMed]
  6. Sohrabvand F, Mahroozade S, Bioos S, Nazari SM, Dabaghian FH. Improvement in Sperm Parameters With Traditional Iranian Remedy: A Case Report. J Evid Based Complementary Altern Med. 2017;22(2):223-6.   [PubMed]
  7. Daneshfard B, Jaladat AM. Male infertility and diet: a perspective of traditional persian medicine. Galen Med J. 2016;5(2):103-4.
  8. Pasalar M, Nimrouzi M, Choopani R, Mosaddegh M, Kamalinejad M, Mohagheghzadeh A, Bagheri Lankarani K. Functional dyspepsia: A new approach from traditional Persian medicine. Avicenna J Phytomed. 2016;6(2):165-74.   [PubMed]
  9. Tahvilzadeh M, Hajimahmoodi M, Toliyat T, Karimi M, Rahimi R. An evidence-based approach to medicinal plants for the treatment of sperm abnormalities in traditional Persian medicine. Andrologia. 2016;48(8):860-79.   [PubMed]
  10. Daneshfard B, Jaladat AM, Sanaye MR, Dalfardi B. Cardiac Infertility in Persian Medicine: Avicenna’s View. Galen Med J. 2017;6(4):356-7.
  11. Zohalinezhad ME, Zarshenas MM. Cardiovascular aspects of erectile dysfunction as outlined by Avicenna. Int J Cardiol. 2014;175(2):e33-4.   [PubMed]


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