Antioxidants can play a pivotal role in the treatment of infertility for men and women. Coenzyme Q-10 (CoQ10) is a vitamin-like protein that humans produce in mitochondria, the energy production center of cells. This substance is critical for normal body function, especially reproduction. Large amounts of mitochondria are located in both the ovary and testicle, to facilitate energy production for the production of eggs and sperm. CoQ10 is an anti-oxidant, and protects eggs and sperm from free- radicals and oxidative (cellular) stress, while improving energy flow. With aging, mutations in mitochondrial DNA may increase the risk for poor sperm quality in men. In women, these mutations may lead to decreased egg quality and pregnancy rates with increased rates of miscarriage. CoQ10 supplementation may contribute to improved fertility rates in men and women due to its antioxidant effects, with decreased free radicals and oxidative stress, improved energy production and an ultimate decrease in genetic mutations.
CoQ10 in Men
Men have high numbers of mitochondria and CoQ10 production in the human testis. Low levels of Co Q10 in semen and sperm, with lack of associated antioxidant effect and increased free radicals, may contribute to otherwise unexplained male factor infertility. One study of unexplained male factor infertility showed improved semen analysis and male hormone production in 212 infertile men after they received 300 mg CoQ10 for a 26 week trial period vs. 106 women who received a placebo. (Safarinejad et al, Journal of Urology, 182, 2009). Similarly, 28 men with unexplained male infertility who took CoQ10 200 mg/day for 6 months had significant improvement in semen analysis, especially sperm motility, as well as increased levels of CoQ10 in both semen and sperm, vs. 27 that received placebo. (Balerica et al, Fertility and Sterility, 91, 2009) . These studies suggest that CoQ10 supplementation can be an important adjunct for to the treatment of men with otherwise unexplained male factor fertility.
CoQ10 in Women
The decreased fertility, and higher miscarriage, rates with aging seen in women has been felt to be predominately related to the fact that women are born with all the eggs that they will have in their lifetime, and the eggs that are left in women in their late 30s and 40s are of lesser number and quality. The biology of making normal eggs is also felt to be less efficient, with a higher chance of genetic mutations leading to genetically abnormal eggs. New research, however, suggests that specific mutations in mitochondrial DNA that may occur as a result of exposure to excess free radicals with aging may be a significant cause of the decreased reproductive outcomes seen in older women. This is similar to the decreased pregnancy rates seen in diabetics, which is also felt to be related to free radical exposure and oxidative stress, even in young women. The logical theory is that anti-oxidants, such as COQ 10, may be able to improve the chance of making genetically normal eggs, even in older women, by decreasing free radicals.
In an animal study, CoQ10 was able to improve ovarian response to stimulation and pregnancy outcome in older mice. (Casper et al, Fertility and Sterility, 92, 2009). A human study using 600 mg of CoQ10, for women undergoing IVF with genetic testing, showed decreased genetic abnormalities (46 % in CoQ10 group vs. 63% in the placebo group.) Higher pregnancy rates (33% for the CoQ10 group vs. 27% for the placebo group) were seen as well. While felt to be statistically not significant due to small numbers, the clinical findings are strong in favor of a beneficial effect of CoQ10 on reproductive outcome. (Casper et al, Clinical Medical Insights: Reproductive Health, 8, 2014).
CoQ10 has also been demonstrated to help women with Polycystic Ovarian Syndrome (PCOS), who have decreased reproductive outcomes similar to diabetics. This effect is again felt to be due to the effect of free radicals produced as a result of obesity and hormonal imbalance. In a clinical study of women with PCOS who were resistant to the standard oral ovulation medication, clomiphene citrate, COQ10 resulted in statistically significant improvement in stimulated follicles, ovulation, clinical pregnancy rates and improved endometrial (uterine lining) thickness. The effects of COQ10 were again ascribed to the anti-oxidant properties of CO Q 10. (El Refaeey et al, Reproductive Medicine Online, 29, 2014)
CoQ10 is an important adjunct to reproductive treatment for both men and women who struggle with infertility. New research is necessary to explore how this supplement may be utilized in the future, as we strive to develop new and improved therapies to help individuals and couples achieve their reproductive dreams.
Daniel Levine, MD