DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20222369
Published: 2022-09-17

Coenzyme q10 and letrozole versus letrozole alone for ovulation induction in polycystic ovary syndrome

Ivy Nasrin, Shakeela Ishrat, Mumtahena Amir, Suravi Halder, Farzana Rahman, Mohammad Kamruzzaman

Abstract


Background: Polycystic ovary syndrome (PCOS) is the largest single cause of anovulatory infertility. PCOS is associated with oxidative stress. Coenzyme q10 (Coq10) is an antioxidant that protects the mitochondria from damage caused by either insulin resistance or oxidative free radicals. The objective of the study was to compare the effect of combined Coq10 and letrozole than of letrozole alone for ovulation induction in women with PCOS.

Methods: This open label parallel design randomized controlled trial study was conducted on 80 infertile women with PCOS selected for ovulation induction. Eligible women were randomized either to combined Coq10 and letrozole (40 patients, 83 cycles) or letrozole alone (38 patients, 91 cycles). The outcome measures were mature follicles, adequate endometrial thickness, ovulation and pregnancy.

Results: Mature follicles (≥18-25 mm) were significantly higher in women given Coq10 at 2nd (74.2% vs 31.3%) and 3rd cycles (83.3% vs 28.6%). Adequate endometrial thickness was significantly higher in women given Coq10 in second (90.3% vs 56.3%) and third cycle (94.4% vs 47.6%). When Coq10 was added to letrozole, ovulation rates were significantly higher (87.1% vs 53.1% in second cycle), (83.3% vs 38.1%, in third cycle). Cumulative pregnancy was 2.37 times (95% CI 1.03-5.48) higher in women having Coq10 in addition to letrozole for ovulation induction.

Conclusions: Coq10, as an adjuvant to ovulation induction with letrozole improves ovarian response, ovulation and pregnancy in PCOS women. Combination of Coq10 and letrozole can be tried successfully before a more complicated and expensive treatment such as gonadotrophins and laparoscopic ovarian drilling.


Keywords


PCOS, Coenzyme q10, Letrozole, Oxidative stress, Ovarian response

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References


Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moral L et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Hum Reprod. 2018;33(9):1602-18.

Rezvanfar MA, Rezvanfar MA, Ahmadi A, Saadi HS, Baeeri Mand Abdollahi M. Mechanistic links between oxidative/nitrosative stress and tumor necrosis factor alpha in letrozole-induced murine polycystic ovary: Biochemical and pathological evidences for beneficial effect of pioglitazone. Hum Exp Toxicol. 2012;31(9):887-97.

Imani B, Eijkemans MJ, teVelde ER, Habbema JD, Fauser BC. Predictors of patients remaining anovulatory during clomiphene citrate induction of ovulation in normogonadotropic oligoamenorrheic infertility. J Clin Endocrinol Metab. 1998;83(7):2361-65.

Ma L, Cai L, Hu M, Wang J, Xie J, Xing Y et al. Coenzyme q10 supplementation of human oocyte in vitro maturation reduces postmeiotic aneuploidies. Fertil Steril. 2020;114(2):331-7.

El Refaeey A, Selem A, Badawy A. Combined Coenzyme q10 and clomiphene citrate for ovulation induction in clomiphene-citrate-resistant polycystic ovary syndrome. Reprod Biomed Online. 2014;29(1):119-24.

Lakshmi B, Bhavani K, Sudhakar M, Parveen, H. A study on quality of life and effect of Coenzyme q10 in polycystic ovarian syndrome patients. Int J Adv Pharm Med Bioallied Sci. 2018;6(1):14-21.

Ibrahim S. Comparative study between L-carnitine versus co-enzyme Q10 as an adjuvant therapy to clomiphene resistant pcos women on improving pregnancy rate and prevention of early pregnancy loss. Evidence Based Women's Health J. 2020;10(2):133-43.

Kuru Pekcan M, Tokmak A, Ozaksit G. Effect of short-term supplementation of Coenzyme q10 on cumulative pregnancy rates in young infertile women with polycystic ovarian syndrome. J Clin Obstet Gynecol. 2019;29(2):62-7.

Bentov Y, Esfandiari N, Burstein E, Casper RF. The use of mitochondrial nutrients to improve the outcome of infertility treatment in older patients. Fertil Steril. 2010;93(1):272-5.

Yahya AA, Abdulridha MK, Al-Rubuyae BJ, Al-Atar HA. The effect of vitamin D and Co-enzyme Q10 replacement therapy on hormone profile and ovulation status in women with chomiphene citrate resistant polycystic ovary syndrome. J Pharm Sci Res. 2019;11(1):208-15.

Samimi M, ZarezadeMehrizi M, Foroozanfard F, Akbari H, Jamilian M, Ahmadi S et al. The effects of coenzyme Q10 supplementation on glucose metabolism and lipid profiles in women with polycystic ovary syndrome: a randomized, double‐blind, placebo‐controlled trial. Clin Endocrinol. 2017;86(4):560-66.

Aarts S, Akker M, Winkens B. The importance of effect sizes. Eur J General Pract. 2014;20(1):61-4.