Acta Scientific Pharmaceutical Sciences (ASPS)(ISSN: 2581-5423)

Research Article Volume 5 Issue 11

Ova Size and Endometrial Thickness Post-treatment with Vitamin D and Coenzyme Q10 Supplements in PCOs Women Resistant to Clomiphene

Ansam Abdulameer Yahya1*, Manal Khalid Abdulridha2 and HaiderAbass Al-Atar3

1Babylon Health Department, Ministry of Health, Iraq
2Department of Clinical Pharmacy, College of Pharmacy, Mustansiriyah University, Iraq
3Babylon Gynecology and Obstetrics Health Department, Ministry of Health, Iraq

*Corresponding Author: Ansam Abdulameer Yahya, Babylon Health Department, Ministry of Health, Iraq.

DOI: 10.31080/ASPS.2021.05.0809

Received: August 18, 2021; Published: October 23, 2021



Clomiphene Citrate resistance is a term that refers to the persistence of ovulation after standard Clomiphene Citrate therapy, and about 15% of Polycystic ovary syndrome were resistant to the maximum dose of clomiphene citrate. The study aims to evaluate the effect of combining oral vitamin D3 and CoQ10 supplements to overcome Clomiphene resistance on hormonal profile and ovulation outcome(ova size and endometrial thickness) in clomiphene citrate resistance PCOS patients. The study was a prospective intervention comparative, open-label study include 35 PCOS patient aged (18-34) years are resistant to clomiphene citrate ellocated in two groups, group 1 include vitamin D deficient PCOS patient received clomiphene citrate 100mg daily clomiphene for five days in each month with 10000IU daily vitamin D for 2 months, group 2 include PCOS patient with no vitamin D deficiency received 100mg daily clomiphene for five days in each month plus CoQ10 200mg daily for 2 months. Fasting blood samples used to measure serum estradiol, antimullerian hormone (AMH), luteinizing hormone (L.H.), and follicle-stimulating hormone (FSH) to calculate L.H.:FSH ratio, mid-cycle transvaginal ultrasound for determination of ova size and endometrial thickness. Both Vitamin D3 supplementation and CoQ10 supplementation resulted in a significant increase in ova size (P < 0.001), while the increase in endometrial thickness was substantial only after vitamin D supplementation (P < 0.001). Meanwhile, serum estradiol levels increased in both study groups after intervention but still not significant (P > 0.05). In conclusion, receiving vitamin D and CoQ10 supplements by clomiphene resistance PCOS women improves serum hormone, including AMH and L.H.: FSH ratio, also improving ovulation outcome (ova size and endometrial thickness).

Keywords: Clomiphene Citrate Resistant; Polycystic Ovary Syndrome; Co-Q10; Vitamin D 3; Estradiol; Ovarian Functions; Endometrial Thickness



  1. El Hayek S., et al. “Poly Cystic Ovarian Syndrome: An Updated Overview”. Frontiers in Physiology 7 (2016): 124.
  2. Azziz R., et al. “Task Force on the Phenotype of the Polycystic Ovary Syndrome of The Androgen Excess PCOS Society. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report”. Fertility Sterility 91 (2009): 456-488.
  3. R Dumitrescu., et al. “The Polycystic Ovary Syndrome: An update on metabolic and hormonal mechanisms”. Journal of Medicine and Life 2 (2015): 142-145.
  4. Brown J., et al. “Clomiphene and anti-oestrogens for ovulation induction in PCOS”. Cochrane Database of Systematic Reviews 4 (2009).
  5. National Collaborating Centre for Women's and Children's Health/National Institue for Clinical Excellence. Fertility: assessment and treatment for people with fertility problems. Clinical Guideline No. 11, RCOG Press, London, UK (2004).
  6. HASHIM, Hatem Abu. Management of Women with Clomifene Citrate Resistant Polycystic Ovary Syndrome-An Evidence-Based Approach. In: Polycystic Ovary Syndrome. InTech (2012).
  7. Chang R and Kazer R. Glob. Lib. women's med (2014).
  8. Tola H., et al. “Assessment of the Role of the Anti-Mullerian Hormone, Luteinizing Hormone/Follicle Stimulating Hormone Ratio in the Diagnosis of Polycystic Ovary Syndrome in Sudanese Women”. Open Access Macedonian Journal of Medical Sciences 7 (2018): 1244-1247.
  9. Thomson RL., et al. “Vitamin D in the etiology and management of polycystic ovary syndrome”. Clinical Endocrinology3 (2012): 343-350.
  10. Dipanshu Sur and R Chakravorty. “The relationship between vitamin D, insulin resistance, and infertility in PCOS women”. Gynecology and Obstetrics (Sunnyvale)294 (2015): 2161-0932.1000294.‏
  11. Pal L., et al. “Vitamin D Status Relates to Reproductive Outcome in Women With Polycystic Ovary Syndrome: Secondary Analysis of a Multicenter Randomized Controlled Trial”. The Journal of Clinical Endocrinology and Metabolism 8 (2016): 3027-3035.
  12. Daniel Levine MD. CoQ10, and Fertility (2019).
  13. Giannubilo SR., et al. “CoQ10 Supplementation in Patients Undergoing IVF-ET: The Relationship with Follicular Fluid Content and Oocyte Maturity”. Antioxidants (Basel)10 (2018): 141.
  14. , et al. “Pretreatment with coenzyme Q10 improve ovarian response and embryo quality in low-prognosis young women with decreased ovarian reserve: a randomized controlled trial”. Reproductive Biology and Endocrinology 16 (2018): 29.
  15. Gouveia FL. “Coenzyme Q10 and polycystic ovary syndrome: Systematic review”. Clinical and Medical Investigations 4 (2018): 1-4.
  16. Human serum Estradiol ELISA kit (catalog No: 4925-300) [product insert on the internet]. USA: Mobobind.
  17. Human serum FSH Maglumi kit (catalog No: 130202001M) China: Snipe.
  18. Human serum LH Maglumi kit (catalog No: 130202002M)[product insert on the internet]. China: Snibe.
  19. Human serum AMH ELISA kit (catalog No: 032417) [product insert on the internet]. USA: AnshLabs.
  20. Hoffman B. Polycystic Ovarian Syndrome and Hyperandrogenism, in Williams GYNECOLOGY. 3rd ed. New York: McGraw-Hill Education (2016): 387-389-397.
  21. Panchal S and Nagori CB. “Follicular Monitoring”. Donald School Journal of Ultrasound in Obstetrics and Gynecology3 (2012): 300-312.
  22. Ochie Kalu., et al. “Sonographic Assessment Of The Foliclecular Size And Endometrial Thickness In Apparently Normal Women And Among Women With Infertility”. International Journal of Advanced Research 5 (2015): 1223-1228.
  23. Eckhardt M. “Blood Groups Serology”. A. G. Medizinische Information. W. Germany (1975): 12-13.
  24. El Refaeey A., et al. “Combined coenzyme Q10 and clomiphene citrate for ovulation induction in clomiphene-citrate-resistant polycystic ovary syndrome”. Reproductive Biomedicine Online1 (2014): 119-124.
  25. Lakshmi B., et al. “A study on quality of life and effect of coenzyme-Q10 in polycystic ovarian syndrome patients”. International Journal of Advances in Pharmacy Medicine and Bioallied Sciences1 (2018): 14-21.
  26. Almoayad HA., et al. “Comparison of antimullerian hormone level between women with polycystic ovary syndrome and normal ovulatory infertile women of reproductive age”. Iraqi Journal of Medical Sciences3 (2017): 234-241.
  27. Maktabi M., et al. “The effects of vitamin D supplementation on metabolic status of patients with polycystic ovary syndrome: a randomized, double-blind, placebo-controlled trial”. Hormone and Metabolic Research7 (2017): 493-498.
  28. Wang F., et al. “Analyses of optimal body mass index for infertile patients with polycystic or non-polycystic ovary syndrome during assisted reproductive treatment in China”. Scientific Reports 6 (2016): 34538.
  29. Gomathi K., et al. “Biochemical parameters in women with polycystic ovary syndrome in Ajman, UAE”. Nepal Journal of Obstetrics and Gynaecology 2 (2012): 7-10.
  30. El Hayek S., et al. “Poly Cystic Ovarian Syndrome: An Updated Overview”. Frontiers in Physiology124 (2016).
  31. Vilmann LS., et al. “Development of obesity and polycystic ovary syndrome in adolescents”. Hormone Research in Pediatrics5-6 (2013): 269-278.
  32. Tehrani HG., et al. “The effect of calcium and vitamin D supplementation on the menstrual cycle, body mass index and hyperandrogenism state of women with the polycystic ovarian syndrome”. Journal of Research in Medical Sciences: The Official Journal of Isfahan University of Medical Sciences9 (2014): 875.
  33. Begum GS., et al. “Assessment of Risk Factors for development of Polycystic Ovarian Syndrome”. Diabetes 1 (2017): 2.
  34. Kausar-Miller MD., et al. “Prevalence of polycystic ovary syndrome (PCOS) in first-degree relatives of patients with PCOS”. Fertility and Sterility1 (2001): 53-58.
  35. Ma YM., et al. “Characteristics of abnormal menstrual cycle and polycystic ovary syndrome in community and hospital populations”. Chinese Medical Journal (Engl) 123 (2010): 2185-2189.
  36. Moran C., et al. “Prevalence of polycysticovary syndrome and related disorders in Mexican women”. Gynecologic and Obstetric Investigation 69 (2010): 274-280.
  37. Tehrani FR., et al. “The Prevalence of metabolic disorders in various phenotypes of polycystic ovary syndrome: a community-based study in Southwest of Iran”. Reproductive Biology and Endocrinology 12 (2014): 89.
  38. Lauritsen MP., et al. “The Prevalence of polycystic ovary syndrome in an average population the Rotterdam criteria versus revised criteria including anti-Mullerian hormone”. Human Reproduction 29 (2014): 791-801.
  39. Li R., et al. “Prevalence of polycystic ovary syndrome in women in China: a large community-based study”. Human Reproduction 28 (2013): 2562-2569.
  40. Yildiz BO., et al. “Prevalence, phenotype and cardiometabolic risk of polycystic ovary syndrome under different diagnostic criteria”. Human Reproduction 27 (2012): 3067-3073.
  41. Aaiad Hameed Aajil. “The Association Between HLA-Class I Antigens and Polycystic Ovary Syndrome in a Sample of Iraqi Patients”. American Journal of Medical Genetics 1 (2011): 52-56.
  42. , et al. “Epidemiological correlate among women with Polycystic ovary syndrome in South India”. International Journal of Current Research and Academic Review 2.9 (2014): 181-186.
  43. Rahul P., et al. “Polycystic Ovary Syndrome, Blood Group and Diet: A Correlative Study In South Indian Females”. International Journal of Medical Research and Health Sciences (IJMRHS)3 (2014): 604-609.
  44. Dana M., et al. “Impact of Serum Estradiol on Biomarkers of Oxidative Stress in Polycystic Ovary Syndrome and Ovulatory Women”. Clinical Medicine Insights: Women's Health 5 (2012): 45-51.
  45. Speroff L and Fritz MA. “Anovulation and the polycystic ovary”. Clinical Gynecologic Endocrinology and Infertility. 7th ed. Philadelphia, PA: Lippincott, Williams and Wilkins (2015): 465-498.
  46. KUIPER E A M., et al. “Reproductive hormone concentrations in pregnancy and neonates: a systematic review”. Reproductive Biomedicine Online 1 (2013): 33-63.‏
  47. Normal RJ., et al. “Polycystic ovary syndrome”. Lancet 370 (2007): 685-697.
  48. LE Minh Tam., et al. “Explored the role of anti‐Mullerian hormone and LH/FSH ratio in the diagnosis of polycystic ovary syndrome”. Clinical Endocrinology4 (2019): 579-585.
  49. Wiser A., et al. “Effect of high LH/FSH ratio on women with polycystic ovarysyndrome undergoing in vitro maturation treatment”. The Journal of Reproductive Medicine 5-6 (2013): 219-223.
  50. Dravecká I., et al. “The effect of alfacalcidol and metformin on phenotype manifestations in women with polycystic ovary syndrome-a preliminary study”. Physiological Research5 (2016): 815.
  51. Irani M., et al. “Vitamin D supplementation appears to normalize serum AMH levels in vitamin D deficient premenopausal women”. Fertility and Sterility3 (2013): S338.
  52. S Sharma. “Evaluation of the effect of vitamin D supplementation onserum AMH in vitamin D deficient PCOS women” (2018).
  53. Devine P J., et al. “Roles of reactive oxygen species and antioxidants in ovarian toxicity”. Biology of Reproduction2 (2011): 27.
  54. Ansam Abdulameer Yahya., et al. “The Effect of Vitamin D and Co-enzyme Q10 Replacement Therapy on Hormonal Profile and Ovulation Status in Women with Clomiphene Citrate Resistant Polycystic Ovary Syndrome”. Journal of Pharmaceutical Sciences and Research 1 (2019): 208-215.
  55. Rasekhjahromi Athar., et al. “The effect of vitamin D in the treatment of infertile PCOS patients”.
  56. Asadi M., et al. “Vitamin D improves endometrial thickness in PCOS women who need intrauterine insemination: a randomized, double-blind placebo-controlled trial”. Archives of Gynecology and Obstetrics 4 (2013): 865-870.‏


Citation: Ansam Abdulameer Yahya., et al. “Ova Size and Endometrial Thickness Post-treatment with Vitamin D and Coenzyme Q10 Supplements in PCOs Women Resistant to Clomiphene". Acta Scientific Pharmaceutical Sciences 5.11 (2020): 45-54.


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