International Journal of Infertility & Fetal Medicine

Register      Login

VOLUME 14 , ISSUE 3 ( September-December, 2023 ) > List of Articles


Does Coenzyme Q10 Improve Ovulation and Pregnancy Rates in Clomiphene Citrate-resistant Polycystic Ovary Syndrome?

Shereen B Elbohoty, Ayman S Dawood, Abdelghaffar S Dawood, Mostafa A Elsayed

Keywords : Clomiphene citrate resistance, Coenzyme Q1O, Ovulation rate, Polycystic ovary syndrome, Pregnancy rate

Citation Information : Elbohoty SB, Dawood AS, Dawood AS, Elsayed MA. Does Coenzyme Q10 Improve Ovulation and Pregnancy Rates in Clomiphene Citrate-resistant Polycystic Ovary Syndrome?. Int J Infertil Fetal Med 2023; 14 (3):133-138.

DOI: 10.5005/jp-journals-10016-1327

License: CC BY-NC 4.0

Published Online: 28-11-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Background, aims, and objectives: Clomiphene citrate (CC) resistance remains one of the unsolved problems facing gynecologists during the stimulation of ovulation in polycystic ovarian syndrome (PCOS). This study was conducted to study the effect of coenzyme Q1O (Co-Q10) in reverting CC resistance in PCOS patients in improving ovulation and pregnancy rates. Materials and methods: This cohort study involved 50 CC-resistant PCOS infertile patients. This study was conducted at Tanta and Benha Universities in the period from 1st May 2019 to 30th April 2021. All PCOS resistant to CC received initial pretreatment with CO-Q10 capsules in a dose of 100 mg twice daily after meals for 3 months. Induction of ovulation started after the initial pretreatment using CC in a dose of 150 mg twice daily for 5 days starting at day 3 in each cycle. At the same time, Co-Q10 supplementations were used as an adjuvant with CC for 5 days. Results: The mean age of our patients was 27.46 ± 2.91 years, the mean BMI was 26.40 ± 2.67, and infertility duration was 3.92 ± 1.16 years. About 64% were overweight and obese and 36% were normal weight with BMI. Most cases (64%) had positive family history of infertility due to PCOS. After Co-Q10 supplementation, the serum estradiol was 171.66 ± 56.79 pg/mL, midluteal progesterone was 9.09 ± 1.79 pg/mL. Ovulation was present in 56%, representing significant improvement after use of Co-Q10. In addition, the rate of pregnancy was 28% and ongoing pregnancy rate was 16%. Conclusion: Coenzyme Q10 (Co-Q10) pretreatment before induction of ovulation in CC-resistant PCOS improved ovulation and pregnancy rates. Ongoing pregnancy rates were improved after Co-Q10 supplementation in CC-resistant women. Clinical significance: Co-Q10 could decrease CC resistance in most cases with improved ovulation and pregnancy rates. CO-Q10 could be an option for patient before shifting to second-line therapy.

  1. Shokrpour M, Hakimi F, Najdi N, et al. Effects of coenzyme Q10 supplementation on anti-müllerian hormone levels in patients with polycystic ovarian syndrome. Ann Med Health Sci Res 2019;9:440–442.
  2. Samimi M, Zarezade Mehrizi M, Foroozanfard F, 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 (Oxf) 2017;86(4):560–566. DOI: 10.1111/cen.13288
  3. Suresh S, Vijayakumar T. Correlations of insulin resistance and serum testosterone levels with LH:FSH ratio and oxidative stress in women with functional ovarian hyperandrogenism. Indian J Clin Biochem 2015;30(3):345–350. DOI: 10.1007/s12291-014-0447-z
  4. Neagu M, Cristescu C. Anti-Műllerian hormone–a prognostic marker for metformin therapy efficiency in the treatment of women with infertility and polycystic ovary syndrome. J Med Life 2012;5(4):462.
  5. Xu Y, Nisenblat V, Lu C, et al. Pretreatment with coenzyme Q10 improves ovarian response and embryo quality in low-prognosis young women with decreased ovarian reserve: a randomized controlled trial. Reprod Biol Endocrinol 2018;16(1):29. DOI: 10.1186/s12958-018-0343-0
  6. Özer A, Bakacak M, Kıran H, et al. Increased oxidative stress is associated with insulin resistance and infertility in polycystic ovary syndrome. Ginekol Pol 2016;87(11):733–738. DOI: 10.5603/GP.2016.0079
  7. Mantle D, Hargreaves IP. Coenzyme Q10 and endocrine disorders: an overview. Antioxidants (Basel) 2023;12(2):514. DOI: 10.3390/antiox12020514
  8. Yahya AA, Abdulridha MK, Al-Rubuyae BJ, et al. The effect of vitamin D and Co-enzyme Q10 replacement therapy on hormonal profile and ovulation status in women with clomiphene citrate resistant polycystic ovary syndrome. J Pharm Sci Res 2019;11(1):208–215.
  9. Luce K, Weil AC, Osiewacz HD. Mitochondrial protein quality control systems in aging and disease. Adv Exp Med Biol 2010;694:108–125. DOI: 10.1007/978-1-4419-7002-2_9
  10. Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Consensus on infertility treatment related to polycystic ovary syndrome. Fertil Steril 2008;89(3):505–522. DOI: 10.1016/j.fertnstert.2007.09.041
  11. Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 2004;19(1):41–47. DOI: 10.1093/humrep/deh098
  12. Chinta P, Rebekah G, T Kunjummen A, et al. Revisiting the role of serum progesterone as a test of ovulation in eumenorrheic subfertile women: a prospective diagnostic accuracy study. Fertil Steril 2020;114(6):1315–1321. DOI: 10.1016/j.fertnstert.2020.06.030
  13. Rahmani E, Jamilian M, Samimi M, et al. The effects of coenzyme Q10 supplementation on gene expression related to insulin, lipid and inflammation in patients with polycystic ovary syndrome. Gynecol Endocrinol 2018;34(3):217–222. DOI: 10.1080/09513590.2017.1381680
  14. Akbari M, Ostadmohammadi V, Lankarani KB, et al. The effects of vitamin D supplementation on biomarkers of inflammation and oxidative stress among women with polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled trials. Horm Metab Res 2018;50(4):271–279. DOI: 10.1055/s-0044-101355
  15. Jacewicz-Święcka M, Kowalska I. Polycystic ovary syndrome and the risk of cardiometabolic complications in longitudinal studies. Diabetes Metab Res Rev 2018;34(8):e3054. DOI: 10.1002/dmrr.3054
  16. Amin MM, Asaad GF, Abdel Salam RM, et al. Novel CO-Q10 antidiabetic mechanisms underlie its positive effect: modulation of insulin and adiponectin receptors, Tyrosine kinase, PI3K, glucose transporters, sRAGE and visfatin in insulin resistant/diabetic rats. PLoS One 2014;9(2):e89169. DOI: 10.1371/journal.pone.0089169
  17. Wang F, Dai W, Yang XH, et al. Analyses of optimal body mass index for infertile patients with either polycystic or non-polycystic ovary syndrome during assisted reproductive treatment in China. Sci Rep 2016;6:34538. DOI: 10.1038/srep34538
  18. El Hayek S, Bitar L, Hamdar LH, et al. Poly cystic ovarian syndrome: an updated overview. Front Physiol 2016;7:124. DOI: 10.3389/fphys.2016.00124
  19. Tehrani HG, Mostajeran F, Shahsavari S. The effect of calcium and vitamin D supplementation on menstrual cycle, body mass index and hyperandrogenism state of women with poly cystic ovarian syndrome. J Res Med Sci 2014;19(9):875–880.
  20. Begum GS, Shariff A, Ayman G, et al. Assessment of risk factors for development of polycystic ovarian syndrome. Diabetes 2017;4(1):2454–7379.
  21. Yuan C, Liu X, Mao Y, et al. Polycystic ovary syndrome patients with high BMI tend to have functional disorders of androgen excess: a prospective study. J Biomed Res 2016;30(3):197–202. DOI: 10.7555/JBR.30.20140111
  22. Moini A, Eslami B. Familial associations between polycystic ovarian syndrome and common diseases. J Assist Reprod Genet 2009;26(2-3):123–127. DOI: 10.1007/s10815-009-9297-7
  23. Al-Qadhi HI, Kadhim EJ, Ali RH. Coenzyme Q10 effects on body weight, serum testosterone level and oxidative stress in women with polycystic ovarian syndrome (PCOS). Int J Pharm Sci Res 2017;8(3):378–383.
  24. Lakshmi B, Bhavani K, Sudhakar M, et al. A study on quality of life and effect of coenzyme-Q10 in polycystic ovarian syndrome patients. International Journal of Advances in Pharmacy Medicine and Bioallied Sciences; 2018;6(1):14–21.
  25. Wiser A, Shehata F, Holzer H, et al. Effect of high LH/FSH ratio on women with polycystic ovary syndrome undergoing in vitro maturation treatment. The Journal of reproductive medicine; 2013;58(5-6):219–23.
  26. Izhar R, Husain S, Tahir MA, et al. Effect of Administrating Coenzyme Q10 with Clomiphene Citrate on Ovulation Induction in Polycystic Ovary Syndrome Cases with Resistance to Clomiphene Citrate: A Randomized Controlled Trial. J Reprod Infertil. 2022 Jul-Sep;23(3):177–183. DOI: 10.18502/jri.v23i3.10008
  27. Gat I, Mejia SB, Balakier H, et al. The use of coenzyme Q10 and DHEA during IUI and IVF cycles in patients with decreased ovarian reserve; 2016.32(7):534–537.
  28. Akarsu S, Gode F, Isik AZ, et al. The association between coenzyme Q10 concentrations in follicular fluid with embryo morphokinetics and pregnancy rate in assisted reproductive techniques. J Assist Reprod Genet. 2017; 34(5):599-605. DOI: 10.1007/s10815-017-0882-x
  29. Badr SA, Althanoon. A review of the effect of Coenzyme Q10 in patients with polycystic ovary syndrome. Iraqi Journal of Pharmacy. 2021; 18(1), 108–117.
  30. Gouveia F, Costa R, Lemos TMAM. Coenzyme Q10 and polycitic ovary syndrome: systematic review. Clin Med Invest. 2018; 3,1–4
  31. Izadi A, Ebrahimi S, Shirazi S, et al. Hormonal and metabolic effects of coenzyme Q10 and/or vitamin E in patients with polycystic ovary syndrome. The Journal of Clinical Endocrinology & Metabolism. 2019; 104(2), 319–327
  32. Liu M, Zhu H, Hu X, et al. Efficacy of coenzyme Q10 supplementation on glucose metabolism, lipid profiles, and biomarkers of inflammation in women with polycystic ovary syndrome: A protocol for a systematic review and meta-analysis. Medicine (Baltimore). 2020;99(46):e23130. DOI: 10.1097/MD.0000000000023130
  33. Zhang T, He Q, Xiu H, et al. Efficacy and safety of Coenzyme Q10 supplementation in the treatment of Polycystic Ovary Syndrome: A systematic review and meta-analysis. Reproductive Sciences. 2023;30(4):1033–1048
  34. Florou P, Anagnostis P, Theocharis P et al. Does coenzyme Q10 supplementation improve fertility outcomes in women undergoing assisted reproductive technology procedures? A systematic review and meta-analysis of randomized-controlled trials. J Assist Reprod Genet 37, 2377–2387 (2020).
  35. Giannubilo SR, Orlando P, Silvestri S, et al. CO-Q10 supplementation in patients undergoing IVF-ET: The relationship with follicular fluid content and oocyte maturity. Antioxidants. 2018;7,141.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.