Essa Bahauldeen Fadhil, Mohammed Mahmood Mohammed, Ula M Alkawaz
Journal: F1000Research 2024;12():1093
PMID: 38957201
Infertility affects around 15% of couples of reproductive age, and while some cases cannot be treated, new therapies are being explored. This study aimed to assess the effects of adding coenzyme Q10 (CoQ10), a substance that helps produce energy in cells and acts as an antioxidant, protecting cells from damage, to letrozole, a hormone-modulating medication used off-label in male infertility to lower oestrogen levels and raise testosterone, on sperm quality and hormone levels in men with low sperm count, poor sperm movement, and abnormal sperm shape. This randomised control trial recruited 67 adult men aged 18–60. As an open-label study, both participants and researchers were aware of which treatment was received. Group A (n=29) received letrozole 2.5 mg twice weekly, while Group B (n=38) received letrozole 2.5 mg twice weekly plus CoQ10 400 mg daily. Both groups were treated for three months.
The results showed that both groups experienced significant improvements across most sperm and hormone parameters after three months of treatment, including increased sperm concentration, normal morphology, total sperm count, motility, testosterone, and follicle-stimulating hormone levels, alongside a decrease in oestradiol. However, when the two groups were compared directly, Group B produced significantly greater improvements than Group A in sperm concentration, normal morphology, total sperm count, testosterone levels, oestradiol levels, and the testosterone-to-oestradiol ratio.
In conclusion, adding CoQ10 to letrozole therapy may help improve most sperm parameters and hormonal markers in Iraqi men with poor sperm quality. Healthcare professionals may find these results useful when considering adjuvant treatments for men with infertility.
None
• The aromatase inhibitor letrozole is used in the treatment of iOAT, which is characterised by low sperm count and motility, and a large number of dysmorphic spermatozoa.
• Addition of CoQ10, 400mg per day for 3 months, appears to further improve sperm parameters in men with high oestradiol and low testosterone levels, when used in conjunction with letrozole.
Introduction
• The aim of this study was to evaluate whether the addition of Coenzyme Q10 (CoQ10) to letrozole, a third-generation aromatase inhibitor used to increase low testosterone levels in men, offers additional benefit to men with Idiopathic oligoasthenoteratozoospermia (iOAT) which is characterised by low sperm count and motility, and a large number of dysmorphic spermatozoa.
Methods
• This open-label, randomised controlled trial which included 67 men aged 18-65 with iOAT was carried out in Iran.
• Participants received either letrozole, 2.5 mg twice per week, alone (group A, n=29) or with Co10, 200 mg twice a day (group B, n=38), for 3 months.
• Primary outcomes were seminal fluid analysis, secondary outcomes were sex hormones.
Results
• Although weight was not an eligibility criterion, most participants were obese with a mean BMI of 31.4 ± 5.1 (group A) and 32.7 ± 5.6 (group B, p = 0.313). Mean ages were 32.6 ± 7.5 (A) and 35.1 ± 8.3 (B).
• Sperm concentration, total sperm count, progressively motile sperm (%), non-progressively motile sperm (%), immotile sperm (%), and morphologically normal sperm (%) significantly improved in both groups (p=0.005 or p<0.001 from baseline to end of study). Significantly better improvements were seen at the end of the study with the addition of CoQ10 compared to control for sperm concentration (25.2 ± 16.5 vs 16.5 ± 11.9 Mil/ml, p = 0.020), total sperm count (80.1 ± 62.6 vs 52.9 ± 48.8 Million, p = 0.029) and normal morphology (5.5 ± 5.13 vs 3.7 ± 2.51 %, p = 0.040). There was no significant change in seminal fluid volume in either group at the end of the study.
• Testosterone, oestradiol, FSH and testosterone/oestradiol significantly improved in both groups at the end of the study (all p < 0.001). Better hormone levels were seen at the end of the study in the CoQ10 group for testosterone (7 ± 2 vs 6.8 ± 0.9 ng/ml, p = 0.032), oestradiol (26.1 ± 6.6 vs 31.4 ± 8.4 Pg/ml, 0 = 0.005) and testosterone/oestradiol ratio (28.9 ± 11.3 vs 23.5 ± 8.1, p = 0.032)
Conclusion
• The authors recommend the addition of CoQ10 to letrozole for patients with iOAT syndrome and with high oestradiol and low testosterone levels.
The addition of CoQ10 should be considered for patients with iOAT who have high oestradiol and low testosterone levels and are treated with letrozole.
• Longer term RCTs which not only investigate laboratory outcomes but also fertility outcomes (pregnancy, livebirths).
• RCTs investigating the use of CoQ10 on its own or in combination with other antioxidants and/or lifestyle interventions in patients with iOAT who do not wish to take letrozole or in whom letrozole is contraindicated.
Worldwide, infertility affects about 15% of reproductive-age couples. In many cases, infertility can't be treated, however new treatment options with promising value have been involved in recent clinical trials. The aim of this clinical trial was to evaluate the impacts of adding coenzyme Q10 (CoQ10) to letrozole on the results of spermiogram and sex hormone tests in men diagnosed with idiopathic oligoasthenoteratozoospermia (iOAT) syndrome, which is a type of male defective spermatogenesis of unknown etiology. This randomized, open-label, parallel two-arm interventional study included 67 adult male patients aged 18-60 years with a confirmed diagnosis of iOAT syndrome recruited from The High Institute for Infertility Diagnosis & Assisted Reproduction Technologies/Nahrain University. Patients were randomly separated into two groups, Group A included 29 patients treated with letrozole 2.5 mg tablet orally twice a week, Group B included 38 patients treated with a combination of letrozole 2.5 mg tablet orally twice a week plus CoQ10 400 mg per day. Both groups completed treatment for three months. Semen samples, serum follicle-stimulating hormone (FSH), estradiol (E ), and testosterone (T) were analyzed at day one, and at the end of month one, two and three. Both groups showed that sperm concentration, normal morphology, total sperm count and motility, serum testosterone and FSH levels, and T/E ratio were significantly increased, while estradiol levels significantly decreased after three months of treatment. Seminal fluid volume changed significantly in group A only. In comparing between the two groups, all measured parameters, apart from sperm motility and FSH level, demonstrated a significant difference after three months of treatment, while sperm volume reached significant value after only two months of therapy. CoQ10 as adjuvant treatment to letrozole effectively improved most of the tested sperm parameters in Iraqi men with iOAT. ClinicalTrials.gov ( NCT05847257, May 6, 2023).
Copyright: © 2024 Fadhil EB et al.
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