Evaluation of monotherapy of Coenzyme Q10, L-carnitine or combined therapy on semen parameters in idiopathic male infertility: A placebo-controlled double blind randomized clinical trial.

Introduction: Antioxidant therapy has been proposed to improve the semen parameters in idiopathic male infertility with no clear consensus on the proper way of management. Our study aimed to evaluate the monotherapy of Coenzyme Q10 (CoQ10), L-Carnitine, or combined therapy on semen parameters in idiopathic male infertility presented with oligoasthenoteratozoospermia (OAT). Materials and methods: Two hundred patients presented with OAT were randomly allocated into four equal groups representing CoQ10, L-Carnitine, or combined therapy of both versus placebo. Our primary outcome was to monitor the improvement in semen parameters. The secondary outcomes were to evaluate the impact on the sperm DNA fragmentation (SDF) index and hormonal profile. Results: After 3 months of medical therapy, 174 patients completed the follow-up period. A highly statistically significant difference was monitored in the monotherapy and combination therapy in all semen parameters and SDF index compared to the baseline, while the placebo group failed to show any improvement. A rise in testosterone level and a decrease in luteinizing hormone were seen in the monotherapy and combination therapy, while no change was noted in the placebo group. Prolactin levels showed no change in all groups. Conclusion: Antioxidant therapy improves semen parameters in patients with OAT. A combination therapy of CoQ10 and L-carnitine results in a superior improvement in semen parameters compared to monotherapy in men with idiopathic OAT.