JBRA Assisted Reproduction 2025;29(Suppl.2 SBRA 2025):243
Poster Presentation
29^th Annual Congress of the SBRA. São Paulo/SP - Brazil, 2025
doi: 10.5935/1518-0557.20263838

P-231. The role of coenzyme Q10 in enhancing fertility outcomes in advanced maternal age

Gabriel Monteiro Pinheiro¹, Catarina Favero Monteiro Pinheiro¹

¹ Embrionare - São Paulo - Brasil

Objective: This narrative review examines the potential role of Coenzyme Q10 (CoQ10) supplementation as an adjunct to infertility treatments, with a particular focus on its capacity to enhance mitochondrial function, improve oocyte quality, and optimize fertility outcomes in women of advanced maternal age.
Methods: A literature review was conducted in PubMed, Cochrane, and Scopus to identify studies published between 2000 and 2025. Search terms included "Coenzyme Q10," "CoQ10," "ubiquinone," "mitochondrial dysfunction," "female fertility," "oocyte," and "advanced maternal age." Studies focusing on CoQ10 supplementation in female reproductive aging were prioritized, with twelve studies meeting the inclusion criteria for qualitative synthesis and critical appraisal.
Results: Female fertility significantly declines with age, primarily due to reductions in both oocyte quantity and quality. Oxidative stress and mitochondrial dysfunction, characterized by impaired oxidative phosphorylation and diminished ATP production, are central contributors to oocyte aging. CoQ10, a potent antioxidant essential for mitochondrial bioenergetics, mitigates oxidative stress, improves mitochondrial function, and enhances ROS neutralization. Supplementation with CoQ10 has demonstrated potential to improve oocyte maturation, optimize the ovarian microenvironment, and enhance reproductive outcomes. Oral CoQ10 supplementation has been evaluated as a pre-treatment in infertile patients undergoing assisted reproductive technologies (ART). Its effectiveness is difficult to assess due to heterogeneity in study populations, doses, treatment duration, and primary endpoints. Notably, a meta-analysis of 20 randomized clinical trials including 2,617 participants reported that CoQ10 outperformed other antioxidants, such as melatonin and myo-inositol, particularly when administered for three months prior to ovarian stimulation, highlighting its promise as an adjunctive strategy for counteracting age-related fertility decline. Individual studies have shown variable results depending on patient populations. In infertile women of advanced age (35–43 years), supplementation with 600 mg/day of CoQ10 for two months until oocyte retrieval increased the rates of top-quality embryos and reduced oocyte aneuploidy compared to controls. A recent meta-analysis of five randomized controlled trials suggested improved clinical pregnancy rates with CoQ10 (28.8% vs. 14.1%; p=0.006), although heterogeneity limits the strength of this conclusion. In older women, CoQ10 tended to improve embryo quality and reduce oocyte aneuploidy, though without statistical significance. In poor ovarian responders, CoQ10 supplementation did not significantly affect mature oocyte numbers, implantation, or clinical pregnancy rates, but improvements were noted in fertilization, blastocyst formation, and embryo quality. Women with diminished ovarian reserve showed improved follicular parameters, including antral follicle count and number of mature follicles, and required lower total gonadotropin doses, although retrieved oocytes, zygotes, blastocysts, and pregnancy rates were not significantly increased. In clomiphene citrate-resistant women with polycystic ovary syndrome, CoQ10 improved ovarian response, increasing the number and size of mature follicles, ovulation rates, and estradiol and progesterone levels, indicating positive effects on the follicular environment. Overall, CoQ10 supplementation appears to enhance the follicular environment and some embryological parameters, particularly in young or poor responder women, while its impact on oocyte quality and pregnancy outcomes in older women remains limited. Dosages varied across studies, ranging from 200 mg twice daily to 600 mg twice daily for 8 to 12 weeks.
Conclusion: Coenzyme Q10 (CoQ10) is a safe and well-tolerated supplement with a strong rationale for improving oocyte quality by enhancing mitochondrial function and reducing oxidative stress. While preliminary studies are promising, clinical evidence on pregnancy outcomes remains inconclusive. Further randomized trials are needed to establish its efficacy, optimal dosage, and timing in women of advanced maternal age undergoing infertility treatments. Additionally, given the already high costs associated with assisted reproductive technologies, it is essential for clinicians to carefully evaluate the cost-benefit ratio of nutritional supplementation on a case-by-case basis, ensuring that any adjunctive treatment provides meaningful clinical value to patients.