Coenzyme Q10 in assisted reproductive technology programs in women of older reproductive age: pathogenetic rationale and current evidence base

Background: The persistent tendency to postpone childbearing determines the increase in the proportion of patients with reduced ovarian reserve (ROR) in assisted reproductive technology (ART) programs. In addition to an increase in the frequency of chromosomal abnormalities, an important pathogenetic mechanism of age-associated decline in oocyte quality is mitochondrial dysfunction due to the progressive depletion of endogenous coenzyme Q10 (CoQ10), a key cofactor of oxidative phosphorylation and a major intracellular antioxidant.

Objective: Systematic analysis of the biological mechanisms of CoQ10 action and assessment of the clinical effectiveness of its use in ART programs in women with ROR based on current data.

Results: An age-related decrease in CoQ10 synthesis (due to impaired Pdss2 and Coq6 gene expression) reproduces the pathological patterns of oocyte mitochondrial dysfunction: a decrease in ATP production and an increase in the frequency of spindle abnormalities. The largest meta-analysis (Lin et al., 2024; 6 RCTs; n=1529) showed that the preliminary use of CoQ10 was associated with a statistically significant increase in the clinical pregnancy rate (OR=1.84, 95% CI 1.33–2.53), the number of oocytes obtained and quality embryos, a decrease in the dose of gonadotropins and the rate of cycle discontinuation. According to network meta-analyses, among other adjuvants, CoQ10 demonstrates the greatest efficacy in relation to the frequency of live birth compared with DHEA, growth hormone and testosterone. The available evidence base is characterized by significant limitations: small samples, predominance of surrogate markers over live birth as the primary endpoint, and heterogeneity of administration regimens.

Conclusion: CoQ10 has a clear pathogenetic rationale for adjuvant use in ART programs in women with ROR and a favorable safety profile. However, current international clinical guidelines (ESHRE, ASRM) do not include CoQ10 in the list of recommended interventions due to insufficient evidence. Its use is individual and requires informing the patient about the current status of the drug.