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JOURNAL: Fertil Steril. 2004;81:93-98
AUTHORS: Giancarlo Balercia
ABSTRACT: Exogenous administration of coenzyme Q10 (CoQ10) may play a positive role in the treatment of infertile men with idiopathic asthenozoospermia, according to results of an open, uncontrolled pilot study.
COMMENTARY: "The positive effect of exogenous administration could be explained on the basis of the well-known involvement of CoQ10 in mitochondrial bioenergetics and of its widely recognized antioxidant properties," write Giancarlo Balercia, MD, and colleagues, from the University of Ancona in Italy.
Investigators selected 22 patients (mean age, 31 years; range, 25-39 years) with idiopathic asthenozoospermia. Subjects had a clinical history of primary intertility of at least three years. In addition to medical screening, researchers measured subjects' testicular volume using Prader's orchidometer.
Eligiblity criteria included (1) sperm count greater than 20 x 106/mL, sperm motility (forward motility, class a and b, according to World Health Organization [WHO] 1999 criteria) less than 50% at two distinct sperm analyses, and normal sperm morphology greater than 50%; (2) seminal white blood cells (WBCs) less than 1 x 106/mL, negative sperm culture, and Chlamydia and Mycoplasma ureoliticum detection; (3) normal serum levels of gonadotropins, T, E2, and PRL; (4) absence of infectious genital diseases, anatomical abnormalities of the genital tract including varicocele, and antispermatozoa antibodies (Ab); (5) absence of systemic diseases or treatment with other drugs during the three months before enrollment in the present study; and (6) absence of smoking, alcohol, drug addiction, or occupational chemical exposure.
Researchers employed hysterosalpingography to rule out abnormal fallopian tube anatomy in female partners. Ovulation was also deemed normal.
Patients underwent oral administration of CoQ10, 200 mg/day twice daily for six months. Researchers performed clinical examination, semen analysis including computer-assisted sperm analysis (CASA), and CoQ10 and phosphatidylcholine assays at baseline, after six months of therapy, and six months after termination (washout).
After treatment, CoQ10 levels increased in seminal plasma; the mean value rising significantly from 42.0 ± 5.1 ng/mL at baseline to 127.1 ± 1.9 ng/mL after six months of CoQ10 administration (P < .005). Researchers also detected a significant increase of CoQ10 content in sperm cells (from 3.1 ± 0.4 to 6.5 ± 0.3 ng/106 cells; P < .05).
Phosphatidylcholine levels increased significantly both in seminal plasma and sperm cells after treatment (from 1.49 ± 0.50 to 5.84 ± 1.15 µm; P < .05; and from 6.83 ± 0.98 to 9.67 ± 1.23 nmol/106 cells; P < .05, respectively)
Forward (class a+b) motility of sperm cells went from 9.13% ± 2.50% to 16.34% ± 3.43% after six months (P < .05). Investigators also found a significant increase of curvilinear velocity (VCL) (from 26.31 ± 1.50 to 46.43 ± 2.28 µm/second; P < .05) and straight progressive velocity (VSL) (from 15.20 ± 1.30 to 20.40 ± -2.17 µm/second; P < .05) after treatment.
Using the Cramer's index of association, the investigators found a positive dependence among the relative variations, baseline and after treatment, of seminal plasma or intracellular CoQ10 content and of VCL and VSL kinetic parameters (Cramer's V = 0.4637, 0.3818, 0.3467, and 0.5148, respectively). After six months of washout, the investigators found a significant reduction in sperm forward motility (from 16.34% µ 3.43% to 9.50% µ 2.28%; P < .001).
CoQ10 oral administration was well tolerated. Three couples (13.6%) achieved spontaneous pregnancy within three months of discontinuation of therapy.
"The data of the present study show a significant improvement of sperm cell kinetic features after 6 months of administration of CoQ10, on the basis of both manual and computer- assisted evaluation," write Dr. Balercia and colleagues.
"Furthermore, our results are the first to demonstrate that exogenous administration of CoQ10 leads to increased levels in seminal plasma and in sperm cells."