In women with polycystic ovarian syndrome (PCOS), clomiphene citrate (CC) is the first-line therapy for ovulation induction. CC has both estrogen agonist and estrogen antagonist properties; it binds to estrogen receptors in the hypothalamus causing a decrease in estrogen levels, increasing gonadotropin levels, promoting ovulation, and improving menstrual irregularities.
Antioxidant supplementation such as Coenzyme Q10 (CoQ10) can neutralize free radicals and reduce oxidative stress. Coenzyme Q10 (CoQ10) is a fat-soluble coenzyme found in the inner membrane of mitochondria, which has been used as an antioxidant and oxidative stress reducer in PCOS. A study was conducted to compare the effects of CoQ10 and CC versus CC alone for ovulation induction in patients with PCOS.
A total of 136 PCOS patients [68 in each group: group-A (CoQ10 + CC) and group-B (CC alone)] were studied over a period of 12 months (February 2021 to January 2022) at the Department of Obstetrics and Gynecology, Lady Aitchison Hospital, Lahore, Pakistan. Patients were diagnosed with PCOS based on Rotterdam criteria: a) irregular menstrual cycles (oligomenorrhea or secondary amenorrhea), b) polycystic ovaries defined by ultrasonography and can have signs of hyperandrogenism or acne, without other endocrine disorders or other causes of hyperandrogenism.
Selected patients in the study group (group-A) were administered CC 100 mg/day from cycle days 2-6 for 45 days (2 cycles) and CoQ10 soft capsules at a dose of 3 x 50 mg starting from cycle day 2 until HCG administration. Patients in the control group (group-B) received CC alone at a dose of 100 mg/day, twice daily from cycle days 2-6 for 45 days. The primary outcome of the study was the result of ovulation induction in the CoQ10+CC group compared to CC alone.
Results showed that the CoQ10 + CC group experienced greater ovulation induction success (23.5%) than the single CC group (17.6%). However, the majority of individuals in both groups, 76.5% in the CoQ10 + CC group and 82.4% in the single CC group did not experience successful ovulation induction. Follow-up findings showed that the CoQ10 + CC group was associated with slightly superior cycle duration outcomes and post-therapy hirsutism scores compared to single CC.
Conclusion
CoQ10 appears to be a potential adjuvant to therapy with clomiphene citrate. In women with PCOS, combination therapy of CoQ10 and clomiphene citrate increases the occurrence of ovulation more than clomiphene citrate alone.
Image: Illustration (Source: karolina-grabowska-Pexel)
Reference:
Jamal H, Waheed K, Mazhar R, Sarwar MZ. Comparative study of combined co- enzyme Q10 and clomiphene citrate vs clomiphene citrate alone for ovulation induction in patients with polycystic ovarian syndrome. J Pakistan Med Assoc. 2023; 73: 1502-5.
