Abstract
Background: The definition of World Health Organization (WHO) to the infertile couple is the failure of female get pregnancy in spite of having regular sexual activity for at least 1 year without using any contraceptive methods, worldwide it is estimated that 15 % of reproductive-age couples are struggling with infertility.
 In many cases, infertility cannot be treated, new treatment options with promising value were involved in the recent clinical trials.
 Aim: This study was designed to evaluate the effects of letrozole plus coenzyme Q10 combination on spermiogram and sex hormones in men with idiopathic oligoasthenoteratozoospermia (iOAT) syndrome.
 Patient and methods: fifty-five patients are enrolled in this study, but only 40 patients complete the study, they are treated with a combination of Letrozole 2.5 mg tablet orally twice a week plus Co-enzyme Q10 400mg per day for three months. Seminal fluid sample, follicle-stimulating hormone, estradiol, and testosterone were analyzed before starting the treatment and at the end of month 1, 2 and 3.Results: sperm concentration, sperm morphology, total sperm count and motility, serum testosterone and follicle stimulation hormone levels, in addition to testosterone/estradiol ratio were significantly improved, while estradiol levels significantly decreased after 3 months of treatment. However, seminal fluid volume showed no significant change. Finally, as a notable outcome, one spontaneous conception occurred after treatment as well as three azoospermia cases responded well after completing the course of treatment.
 Conclusions: a combination of Letrozole and CO Q10 can effectively improve sperm parameters in Iraqi men with iOAT.
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