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

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.