Comparative effects of pentoxifylline and coenzyme Q10 on sperm motility in subfertile men with asthenozoospermia: a randomized controlled trial

Authors

  • Rafikunnahar Renu Department of Obstetrics and Gynaecology, Dhaka Medical College Hospital, Dhaka, Bangladesh
  • M. Mehedi Hassan Department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh
  • Jesmine Banu Department of Reproductive Endocrinology and Infertility, Bangladesh Medical University, Dhaka, Bangladesh
  • Sharmin Sultana Bangladesh Institute of Tropical and Infectious Disease, Chittagong, Bangladesh
  • Asma Akter Department of Obstetrics and Gynaecology, Dhaka Medical College Hospital, Dhaka, Bangladesh
  • Shakeela Ishrat Bangladesh Institute of Tropical and Infectious Disease, Chittagong, Bangladesh
  • Tahmida Islam Department of Obstetrics and Gynaecology, 250 Bedded Mohammad Ali Hospital, Bogura, Bangladesh

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20260870

Keywords:

Male infertility, Randomized controlled trial, Coenzyme Q10, Pentoxifylline, Asthenozoospermia, Subfertility, Sperm motility

Abstract

Background: Asthenozoospermia, characterized by reduced sperm motility, is a leading cause of male subfertility. While both pentoxifylline and coenzyme Q10 have demonstrated beneficial effects on semen parameters, comparative evidence regarding their efficacy remains limited. This study aimed to assess and compare the effects of pentoxifylline and coenzyme Q10 on sperm motility and other seminal parameters in sub fertile men with asthenozoospermia.

Methods: This randomized controlled trial was conducted at the Department of Reproductive Endocrinology and Infertility, Bangladesh Medical University, from April 2022 to March 2023. A total of 104 subfertile men diagnosed with asthenozoospermia were randomly assigned to receive either pentoxifylline (400 mg twice daily) or Coenzyme Q10 (100 mg twice daily) for three months. Semen parameters, including ejaculate volume, sperm concentration, total and progressive motility, total motile sperm count, and morphology, were evaluated before and after treatment. Statistical analysis was performed via SPSS v26.0, with p<0.05 considered significant.

Results: Baseline demographic characteristics were comparable between the two groups. Both treatments resulted in significant improvements in sperm motility and total motile sperm count after three months. However, the pentoxifylline group demonstrated significantly greater improvements in total sperm motility (41.28±12.38% vs. 36.15±11.84%), progressive motility (32.30±10.26% vs. 24.95±10.40%), total motile sperm count (55.04±41.18 vs. 32.85±25.62 million), and ejaculate volume (2.83± 0.96 ml vs. 2.32 ± 0.96 ml) than did the CoQ10 group (p<0.05). No significant differences in the sperm concentration or morphology were detected between the groups.

Conclusions: Both pentoxifylline and Coenzyme Q10 effectively improve semen quality in men with asthenozoospermia, but pentoxifylline appears to be more effective in enhancing motility-related parameters and the ejaculate volume. Pentoxifylline may be considered a preferred first-line option in the pharmacologic management of asthenozoospermia.

References

Yu S, Rubin M, Geevarughese S, Pino JS, Rodriguez HF, Asghar W. Emerging technologies for home‐based semen analysis. Andrology. 2018;6(1):10-9. DOI: https://doi.org/10.1111/andr.12441

Del Giudice F, Busetto GM, De Berardinis E, Sperduti I, Ferro M, Maggi M, et al. A systematic review and meta-analysis of clinical trials implementing aromatase inhibitors to treat male infertility. Asian J androl. 2020;22(4):360-7. DOI: https://doi.org/10.4103/aja.aja_101_19

Daneshmandpour Y, Bahmanpour Z, Hamzeiy H, Mazaheri Moghaddam M, Mazaheri Moghaddam M, Khademi B, et al. MicroRNAs association with azoospermia, oligospermia, asthenozoospermia, and teratozoospermia: a systematic review. J assist reprod genet. 2020;37(4):763-75. DOI: https://doi.org/10.1007/s10815-019-01674-9

Hirsh A. Male subfertility. BMJ. 2003 ;327(7416):669-72. DOI: https://doi.org/10.1136/bmj.327.7416.669

Barratt CLR, Björndahl L, De Jonge CJ, Lamb DJ, Osorio Martini F, McLachlan R, et al. The diagnosis of male infertility: an analysis of the evidence to support the development of global WHO guidance—challenges and future research opportunities. Hum Reprod Update. 2017;23(6):660-80. DOI: https://doi.org/10.1093/humupd/dmx021

Greenhall E, Vessey M. The prevalence of subfertility: a review of the current confusion and a report of two new studies. Fertil steril. 1990;54(6):978-83. DOI: https://doi.org/10.1016/S0015-0282(16)53990-9

Osadchuk LV, Osadchuk AV. Individual Lifestyle and Male Fertility. Hum Physiol. 2023;49(2):123-36. DOI: https://doi.org/10.31857/S0131164622600690

Virtanen HE, Jørgensen N, Toppari J. Semen quality in the 21st century. Nat Rev Urol. 2017;14(2):120-30. DOI: https://doi.org/10.1038/nrurol.2016.261

Levine H, Jørgensen N, Martino-Andrade A, Mendiola J, Weksler-Derri D, Mindlis I, et al. Temporal trends in sperm count: a systematic review and meta-regression analysis. Hum reprod update. 2017;23(6):646-59. DOI: https://doi.org/10.1093/humupd/dmx022

WHO. WHO laboratory manual for the examination and processing of human semen. 2021. Available at: https://www.who.int/publications/i/item/9789240030787. Accessed on 12 May 2025.

Ortega C, Verheyen G, Raick D, Camus M, Devroey P, Tournaye H. Absolute asthenozoospermia and ICSI: what are the options?. Hum reprod update. 2011;17(5):684-92. DOI: https://doi.org/10.1093/humupd/dmr018

Bisht S, Faiq M, Tolahunase M, Dada R. Oxidative stress and male infertility. Nat Rev Urol. 2017 ;14(8):470-85. DOI: https://doi.org/10.1038/nrurol.2017.69

Ebner T, Shebl O, Mayer RB, Moser M, Costamoling W, Oppelt P. Healthy live birth using theophylline in a case of retrograde ejaculation and absolute asthenozoospermia. Fertil Steril. 2014;101(2):340-3. DOI: https://doi.org/10.1016/j.fertnstert.2013.10.006

Nabavi N, Todehdehghan F, Shiravi A. Effect of caffeine on motility and vitality of sperm and in vitro fertilization of outbreed mouse in T6 and M16 media. Iran J Reprod Med. 2013;11(9):741-6.

Heite H. The influence of pentoxifylline on the spermiogram-A clinical study in patients with reduced fertility. Akt Dermatol. 1979;5:247.

Saber M, Shafey A, Alabedeen M, Massoud A, Elwan M. Comparison between Platelet Activation Factor and Pentoxifylline on Sperm in Asthenozoospermia Cases. Egypt J Exp Biol (Zoo). 2022;18(1):53. DOI: https://doi.org/10.5455/egysebz.20220313032140

Purkiewicz A, Pietrzak-Fiećko R, Sörgel F, Kinzig M. Caffeine, Paraxanthine, Theophylline, and Theobromine Content in Human Milk. Nutrients. 2022;14(11):2196. DOI: https://doi.org/10.3390/nu14112196

Appiah MO, Asante-Badu B, Zhao J, Liu H, Wang J, Lu W. Possible protective mechanisms of coenzyme Q10 action on spermatozoa during cryopreservation or cooled-stored condition. Cryoletters. 2020;41(5):246-56.

Crane FL, Hatefi Y, Lester RL, Widmer C. Isolation of a quinone from beef heart mitochondria. Biochim Biophys Acta. 1957;25(1):220-1. DOI: https://doi.org/10.1016/0006-3002(57)90457-2

Arenas‐Jal M, Suñé‐Negre JM, García‐Montoya E. Coenzyme Q10 supplementation: Efficacy, safety, and formulation challenges. Compr Rev Food Sci Food Safe. 2020;19(2):574-94. DOI: https://doi.org/10.1111/1541-4337.12539

Özturan Şi̇Ri̇N A, Akdeveli̇Oğlu Y. Erkek İnfertilitesinde Koenzim Q10. Turkiye Klinikleri J Health Sci. 2021;6(1):139-47. DOI: https://doi.org/10.5336/healthsci.2020-75062

Gou C, Zhou Z, Chen Z, Wang K, Chen C, Chen B, et al. Studies on improving semen quality and increasing pregnancy chances through the in vitro addition of L-carnitine and coenzyme Q10 to semen in patients with asthenozoospermia. Basic Clin Androl. 2022;32(1):17. DOI: https://doi.org/10.1186/s12610-022-00167-7

Alahmar AT. Coenzyme Q10 improves sperm motility and antioxidant status in infertile men with idiopathic oligoasthenospermia. Clin Exp Reprod Med. 2022;49(4):277-84. DOI: https://doi.org/10.5653/cerm.2022.05463

Rauchová H. Coenzyme Q10 effects in neurological diseases. Physiol Res. 2021;70(4):S683-714. DOI: https://doi.org/10.33549/physiolres.934712

Moein MR, Khalili MA, Davoudi A. The effect of oral administration of Pentoxifylline on sperm motility of asthenozoospermic ejaculates from men with or without testicular varicoceles. Iran J Reprod Med. 2005;3:25-9.

Nabi A, Khalili MA, Fesahat F, Talebi A, Ghasemi-Esmailabad S. Pentoxifylline increase sperm motility in devitrified spermatozoa from asthenozoospermic patient without damage chromatin and DNA integrity. Cryobiology. 2017;76:59-64. DOI: https://doi.org/10.1016/j.cryobiol.2017.04.008

Çetintaş S, Esinler İ, Durak T, Öktem M, Kuşçu E, Zeyneloğlu H. The affect of Pentoxifylline on sperm parameters in Normozoospermic, Asthenozoospermic and Oligo-Asthenozoospermic Males. Gynecol Obstet Reprod Med. 2007;13(1):38-42.

Amer M, Metawae B, Hosny H, Raef A. Beneficial effect of adding pentoxifylline to processed semen samples on ICSI outcome in infertile males with mild and moderate asthenozoospermia: a randomized controlled prospective crossover study. Iran J reprod med. 2013;11(11):939-44.

Ghasemzadeh A, Karkon-Shayan F, Yousefzadeh S, Naghavi-Behzad M, Hamdi K. Study of pentoxifylline effects on motility and viability of spermatozoa from infertile asthenozoospermic males. Nigerian Med J. 2016;57(6):324-8. DOI: https://doi.org/10.4103/0300-1652.193857

Alahmar AT, Calogero AE, Sengupta P, Dutta S. Coenzyme Q10 improves sperm parameters, oxidative stress markers and sperm DNA fragmentation in infertile patients with idiopathic oligoasthenozoospermia. World J men’s health. 2020;39(2):346-51. DOI: https://doi.org/10.5534/wjmh.190145

Hasoon MA. Using of the L-arginine and coenzyme Q10 shows improvement of the male subfertility. Int J Drug Dev Technol. 2019;9:544-51.

Alahmar AT, Sengupta P, Dutta S, Calogero AE. Coenzyme Q10, oxidative stress markers, and sperm DNA damage in men with idiopathic oligoasthenoteratospermia. Clin exp reprod med. 2021;48(2):150-5. DOI: https://doi.org/10.5653/cerm.2020.04084

Tiseo BC, Gaskins AJ, Hauser R, Chavarro JE, Tanrikut C, EARTH Study Team. Coenzyme Q10 intake from food and semen parameters in a subfertile population. Urology. 2017;102:100-5. DOI: https://doi.org/10.1016/j.urology.2016.11.022

Alahmar AT, Singh R. Comparison of the effects of coenzyme Q10 and Centrum multivitamins on semen parameters, oxidative stress markers, and sperm DNA fragmentation in infertile men with idiopathic oligoasthenospermia. Clin Exp Reprod Med. 2022;49(1):49-56. DOI: https://doi.org/10.5653/cerm.2021.04910

Debnath M, Deeba F, Ishrat S, Satu FK, Chowdhury F, Ara KS, et al. Coenzyme Q 10 in Infertile Men with Idiopathic Asthenozoospermia: A Single Blind Placebo-Controlled, Randomized Trial. Sch J App Med Sci. 2023;11(7):1356-65. DOI: https://doi.org/10.36347/sjams.2023.v11i07.026

Balercia G, Buldreghini E, Vignini A, Tiano L, Paggi F, Amoroso S, et al. Coenzyme Q10 treatment in infertile men with idiopathic asthenozoospermia: a placebo-controlled, double-blind randomized trial. Fertil steril. 2009;91(5):1785-92. DOI: https://doi.org/10.1016/j.fertnstert.2008.02.119

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Published

2026-03-27

How to Cite

Renu, R., Hassan, M. M., Banu, J., Sultana, S., Akter, A., Ishrat, S., & Islam, T. (2026). Comparative effects of pentoxifylline and coenzyme Q10 on sperm motility in subfertile men with asthenozoospermia: a randomized controlled trial. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 15(4), 1162–1168. https://doi.org/10.18203/2320-1770.ijrcog20260870

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Original Research Articles