Coenzyme Q10 for Female Fertility

Finding: Across 63 RCTs/7760 women, antioxidants as a class may increase live birth (OR 1.81, 95% CI 1.36-2.43, 13 RCTs, 1227 women) and clinical pregnancy (OR 1.65, 95% CI 1.43-1.89, 35 RCTs, 5165 women) but the evidence is GRADE very-low to low certainty so authors are uncertain of benefit; no difference in miscarriage (OR 1.13, 95% CI 0.82-1.55).

Finding: Pooling 20 RCTs/2617 women, antioxidants increased retrieved oocytes and high-quality embryo rate and raised clinical pregnancy; in subgroup analysis CoQ10 was more effective than melatonin/myo-inositol/vitamins, with the optimal regimen ~30 mg/d for 3 months pre-stimulation and clearest benefit in DOR women aged <35.

Finding: Across 6 RCTs/1529 DOR women, CoQ10 pretreatment raised clinical pregnancy rate (OR 1.84, 95% CI 1.33-2.53, p=0.0002), oocytes retrieved (MD 1.30, 95% CI 1.21-1.40) and lowered cycle cancellation (OR 0.60) and miscarriage (OR 0.38, 95% CI 0.15-0.98, p=0.05, borderline); live birth was NOT a reported outcome and authors caution the included trials were small with poorly described methods.

Finding: CoQ10 increased retrieved oocytes (median 4 vs fewer), fertilization rate (67.49%) and high-quality embryos and reduced cancelled transfers (8.33% vs 22.89%, p=0.04), but clinical pregnancy and live birth rates only trended higher and did NOT reach statistical significance (186 randomized, 169 evaluated: 76 CoQ10 vs 93 control).

Finding: CoQ10 significantly improved oocyte count, peak E2, antral follicle count (p=0.001), endometrial thickness (p=0.004) and embryos transferred (p=0.011), but chemical and clinical pregnancy rates and completed cycles were equivalent between groups (non-significant).

Finding: AMH fell significantly after surgery in both arms, but CoQ10 did NOT protect ovarian reserve: AMH percent change -28.2% (CoQ10) vs -20.07% (placebo), p=0.99; authors conclude 2-week CoQ10 pretreatment was ineffective (null result).