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Clinical evidence of coenzyme Q10 pretreatment for women with diminished ovarian reserve undergoing IVF/ICSI: a systematic review and meta-analysis

Guangyao Lin, Xuanling Li, Stella Lim Jin Yie, Lianwei Xu
Annals of Medicine 2024 56(1):2389469

Bibliography

PubMed
PMID 39129455
PubMed Central
PMC11321116
DOI
10.1080/07853890.2024.2389469
Funding
Shanghai Science and Technology Commission, Grant 23Y21920300.
Competing interests
The authors reported no potential conflict of interest.

Study snapshot

DesignPRISMA systematic review and meta-analysis of randomized controlled trials; nine databases searched through 1 November 2023; PROSPERO CRD42023468370; Cochrane risk-of-bias assessment and sensitivity analyses.
ModelWomen with diminished ovarian reserve undergoing IVF/ICSI.
Sample6 RCTs; 1,529 participants.
InterventionCoQ10-containing pretreatment versus comparator. One trial tested CoQ10 alone for 60 days; five used CoQ10 combined with vitamin E, DHEA or Femoston against corresponding comparator regimens, generally for about 3 months.
DurationMost included studies used about 3 months of pretreatment; the isolated-CoQ10 Xu trial used 60 days.
EndpointsPrimary: clinical pregnancy rate; Primary: number of optimal embryos; Primary: cycle cancellation rate; Oocytes retrieved; Estradiol on hCG day; Miscarriage; Days of gonadotropin; Total gonadotropin dose

What the study showed, in plain terms

This 2024 meta-analysis pooled six randomized studies involving 1,529 women with diminished ovarian reserve undergoing IVF/ICSI. Clinical pregnancy favored CoQ10-containing pretreatment: OR 1.84 (95% CI 1.33–2.53; p=0.0002; I²=29%). Retrieved oocytes increased by a mean 1.30 (95% CI 1.21–1.40), and cycle cancellation was lower (OR 0.60, 95% CI 0.44–0.83).

Estradiol on hCG day increased (SMD 0.37, 95% CI 0.07–0.66), gonadotropin duration fell by 0.89 days, total gonadotropin dose fell by about 330 IU, and miscarriage was borderline lower (OR 0.38, 95% CI 0.15–0.98; p=0.05).

The critical caveat is that five of six trials did not test CoQ10 alone: they combined it with vitamin E, DHEA or Femoston. All six were unblinded and allocation concealment was inadequately described. This is evidence for CoQ10-containing pretreatment strategies, not six clean CoQ10-monotherapy RCTs.

Key findings

  • Clinical pregnancy: OR 1.84 (95% CI 1.33–2.53), p=0.0002, I²=29%.
  • Oocytes retrieved: MD +1.30 (95% CI 1.21–1.40), p<0.00001.
  • Cycle cancellation: OR 0.60 (95% CI 0.44–0.83), p=0.002.
  • Miscarriage: OR 0.38 (95% CI 0.15–0.98), p=0.05 — borderline significance.
  • Gonadotropin duration: MD −0.89 days; total dose: MD −330.44.
  • Risk of bias: allocation concealment unclear in all six trials; all six lacked blinding.
  • Five of six RCTs used CoQ10 with another active intervention; only one tested isolated CoQ10.

What this study can and cannot tell us

  • Combination-regimen contamination is the main interpretive limitation: most pooled studies cannot isolate the effect of CoQ10 from vitamin E, DHEA or Femoston.
  • All six trials were unblinded and allocation concealment was inadequately reported, increasing risk of bias.
  • Underlying trial methods were poorly described; the authors explicitly called for more rigorous RCTs.
  • A definitive live-birth benefit from isolated CoQ10 remains less certain than intermediate ART outcomes.

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Dr. Khaled Mahmoud, MBBChCritical Care Medicine, Longevity Science & Editorial Direction Dr. Amr Yasser, PhDCardiometabolic, Musculoskeletal, Gut & Bioavailability Dr. Abdulla Mostafa, PhDCellular Senescence, Neurological, Mitochondrial & Brain-Ageing Biology