Comparative study between L-carnitine versus co-enzyme Q10 as an adjuvant therapy to clomiphene resistant pcos women on improving pregnancy rate and prevention of early pregnancy loss

Aim of the work: Compare the effectiveness of L-carnitine versus Co-enzyme Q10 on improving pregnancy rates and decraese the rate of early pregnancy loss in patients with PCO resistant to clomiphene citrate.Setting and Design: A prospective randomized controlled study conducted in infertility clinic of a tertiary care center from June 2017 to June 2019.Patients and Methods: A total of 225 subjects presenting with infertility and diagnosed with PCOS (based on Rotterdam criteria 2003) and resistant to clomiphene citrate were enrolled in the study. Subjects were randomly allocated into three groups. Group A: received clomiphene citrate (CC) only, Group B: received clomiphene citrate plus L-carnitine (2gm). Group C: received clomiphene citrate plus co- enzyme Q10 (200 mg). Main outcome measures include the ovulation rate, cumulative clinical pregnancy rate (CPR) are the primary outcome measures.Results: The ovulation rate was significantly higher among the groups B,C compared to group A (62.5%, 66.6% vs 18.3% respectively). Total number of cases who get pregnant were higher in Group B 35(47.3%), Group C 33(44.6%) compared to Group A 6(8.1%). Cumulative Clinical pregnancy rate was 3%, 49.3%, and 47.8% for Group A, Group B, and Group C, respectively. The abortion rate was low in Group B 4 % and significantly lower in Group C 2.7% compared to Group A 6.7%.  Conclusion: Adding either L-carnitine or Co-enzyme Q10 to clomiphene citrate in patients with clomiphene-resistant PCOS were beneficial in increasing the quality of ovulation, the clinical pregnancy rate ،also in decreasing the rate of early pregnancy loss.