Research progress on active ingredients of traditional Chinese medicine in the treatment of asthenozoospermia

Asthenozoospermia, a main cause of male infertility, is characterized by diminished sperm motility and increased morphological abnormalities, presenting a major barrier to natural conception. While current treatments provide limited benefit, their effectiveness is often variable, invasive, and costly. In contrast, Traditional Chinese Medicine (TCM), guided by holistic principles and syndrome differentiation, offers a distinct therapeutic approach. Through multi-component, multi-target, and multi-pathway actions, TCM herbal compounds demonstrate considerable potential to improve sperm quality and address core pathological mechanisms of asthenozoospermia. This review systematically summarizes the therapeutic potential of four major classes of TCM active ingredients—flavonoids, polysaccharides, saponins, and phenols—in the management of asthenozoospermia. We elucidate their underlying molecular mechanisms, particularly focusing on the modulation of oxidative stress and inflammatory pathways. Furthermore, this review discusses current limitations of TCM in this area, addresses a knowledge gap regarding TCM active components for asthenozoospermia, and offers a reference for future research.