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BACKGROUND

Seminal oxidative stress has been shown to be a key factor in the development of male infertility. However, the benefits of infertility treatments with antioxidants such as coenzyme Q10 (CoQ10) remains controversial.

OBJECTIVES

The aim of the present study was to assess the effects of CoQ10 supplementation on semen quality, i.e., semen volume, total sperm number, sperm concentration, total sperm motility, percentage of progressive sperm motility and sperm morphology. In addition, the effects of CoQ10 supplementation on circulating testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and inhibin B levels were evaluated.

DESIGN

A systematic review and a meta-analysis of randomized controlled trials (RCTs) were performed to assess the effects of CoQ10 supplementation on semen quality and serum levels of male reproductive hormones.

METHODS

We conducted a strategic literature search in the Cochrane, EMBASE, PubMed/MEDLINE, Scopus, and Web of Science databases and collected only RCTs. The data in the collected RCTs were then meta-analyzed according to PRISMA guidelines.

RESULTS

Out of 2,144 collected studies, only eight were classified eligible. The studies included a total of 877 male subjects; 462 CoQ10-treated and 415 untreated/placebo-treated. We found significantly higher total sperm counts (SMD -13.38 [95% CI: -16.33, -10.43] < 0.0001), total (SMD -7.26 [95% CI: -10.15, -4.36] 0.00001) and progressive motility (SMD -6.386 [95% CI: -10.04, -2.73] 0.0006), and normally formed sperm (SMD -1.96 [95% CI: -3.29, -0.62] 0.004) in CoQ10-treated male subjects compared with untreated/placebo-treated male subjects. Nonetheless, there was a significant inter-study heterogeneity in these studies. Moreover, significantly higher serum testosterone (SMD -0.59 [95% CI: -0.79, -0.40] 0.00001) and inhibin B levels (SMD -0.92 [95% CI: -1.47, -0.37] 0.001) were recorded in CoQ10-treated subjects compared to untreated/placebo-treated subjects. In addition, CoQ10 supplementation significantly lowered serum LH (SMD 1.77 [95% CI: 1.26, 2.28] 0.00001) and FSH concentrations (SMD 1.60 [95% CI: 1.38, 1.81] 0.00001). Interestingly, there was no significant inter-study heterogeneity in the hormonal studies. However, CoQ10 supplementation had no significant effect on semen volume (SMD 0.12 [95% CI: -0.13, 0.37] = 0.34) and sperm concentration (SMD -6.69 [95% CI: -16.28, 2.90] 0.17).

CONCLUSION

Our study shows that CoQ10 supplementation increases total sperm count, total and progressive sperm motility, and the proportion of normally formed sperm in association with higher serum testosterone and inhibin B levels. Our study therefore supports the view in the literature of a beneficial use of CoQ10 in male infertility treatment. However, further well-designed RCTs with sufficiently large numbers of subjects are required to reach a final conclusion.

背景

精液氧化应激已被证明是男性不育症发展的关键因素。然而，使用抗氧化剂如辅酶Q10（CoQ10）进行不育治疗的益处仍存在争议。

目的

本研究的目的是评估补充CoQ10对精液质量的影响，即精液量、总精子数、精子浓度、总精子活力、进行性精子活力百分比和精子形态。此外，还评估了补充CoQ10对循环睾酮、促黄体生成素（LH）、促卵泡生成素（FSH）和抑制素B水平的影响。

设计

进行了一项系统评价和随机对照试验（RCT）的荟萃分析，以评估补充CoQ10对精液质量和男性生殖激素血清水平的影响。

方法

我们在Cochrane、EMBASE、PubMed/MEDLINE、Scopus和Web of Science数据库中进行了策略性文献检索，仅收集RCT。然后根据PRISMA指南对收集的RCT中的数据进行荟萃分析。

结果

在收集的2144项研究中，只有8项被分类为合格。这些研究总共包括877名男性受试者；462名接受CoQ10治疗，415名未接受治疗/接受安慰剂治疗。我们发现，与未接受治疗/接受安慰剂治疗的男性受试者相比，接受CoQ10治疗的男性受试者的总精子数显著更高（标准化均值差[SMD] -13.38 [95%置信区间：-16.33，-10.43] < 0.0001）、总活力（SMD -7.26 [95%置信区间：-10.15，-4.36] < 0.00001）和进行性活力（SMD -6.386 [95%置信区间：-10.04，-2.73] < 0.0006），以及正常形态精子（SMD -1.96 [95%置信区间：-3.29，-0.62] < 0.004）。尽管如此，这些研究中存在显著的研究间异质性。此外，与未接受治疗/接受安慰剂治疗的受试者相比，接受CoQ10治疗的受试者的血清睾酮（SMD -0.59 [95%置信区间：-0.79，-0.40] < 0.00001）和抑制素B水平（SMD -0.92 [95%置信区间：-1.47，-0.37] < 0.001）显著更高。此外，补充CoQ10显著降低了血清LH（SMD 1.77 [95%置信区间：1.26，2.28] < 0.00001）和FSH浓度（SMD 1.60 [95%置信区间：1.38，1.81] < 0.00001）。有趣的是，激素研究中没有显著的研究间异质性。然而，补充CoQ10对精液量（SMD 0.12 [95%置信区间：-0.13，0.37] = 0.34）和精子浓度（SMD -6.69 [95%置信区间：-16.28，2.90] < 0.17）没有显著影响。