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Poor Ovarian Response in IVF and CoQ10

Last updated December 20, 2021

 There is one golden rule of in vitro fertilization (IVF): the larger the number of eggs available for retrieval, the more likely the procedure will result in a successful fertilization and pregnancy. So, what happens when only a small number of eggs are available, complicating your fertility journey?

This is what fertility doctors call "poor response" to ovarian stimulation. One barrier to conception in this situation may be diminished ovarian reserve (DOR). This may happen naturally because of advanced maternal age, or due to oxidative stress (an imbalance of free radicals and antioxidants in the body), or from mitochondrial dysfunction (when the structures in the cells do not produce enough energy for the eggs). Genetics play a role, too.

Ovarian stimulation in IVF and poor response

To overcome poor ovarian response, your doctor may prescribe a higher dose of injectable medications as an important part of your IVF process. These ovarian stimulation drugs help stimulate the growth of the follicles, and in the production of multiple eggs in the ovaries. In general, the main medications used in ovarian stimulation includes the following:

  • Gonadotropins such as Follicle-stimulating hormones (FSH) and Luteinizing hormones are given early in the menstrual cycle. They act on the ovaries allowing the growth of multiple follicles helping the eggs mature.
  • Human chorionic gonadotropin (hCG) is administered once the eggs become mature enough, triggering ovulation.
  • Gonadotropin releasing hormone (GnRH) antagonists are hormones that prevent the ovaries from releasing an egg sooner than is expected in an average cycle - allowing your fertility specialist to retrieve it at the right time. 
  • Gonadotropin releasing hormone (GnRH) agonists increase the levels of LH and FSH, which trigger the ovaries to release the mature eggs. 


What might cause poor ovarian response to IVF

Insufficient preparation of the ovaries, not enough stimulation dosages, the wrong stimulation medication or poor injection techniques can all impact the outcomes of your fertility treatment. But sometimes, the ovaries just do not respond, leading to poor ovarian response. It's frustrating, but all hope is not lost. Consult with your doctor to discuss potential options if you think diminished ovarian reserve may explain your reproductive challenges.


CoQ10 and poor ovarian response

CoQ10, or coenzyme Q10, is an antioxidant that's abundant in human body. CoQ10 acts as an energy source for the mitochondria, which is the tiny structure within cells that provide the energy cells need to function and develop. It plays an important part in the electron transport chain involved in this continuous energy generation.

There is also evidence that CoQ10 helps prevent the production of reactive oxygen species (ROS) in the ovaries. ROS are unstable molecules, a byproduct of normal metabolic processes, that damage DNA, RNA and proteins, leading to cell damage and death in some cases. CoQ10 converts ROS into inactive compounds through its antioxidant process.

CoQ10 has been studied more extensively in the male fertility context than in the female fertility context. However, based on what we know about its effects on men (and in animal studies investigating the relationship between CoQ10, mitochondrial function and reproductive aging), many reproductive endocrinologists now incorporate CoQ10 for women who have experienced poor ovarian response in IVF.


Recent studies on DOR, CoQ10 and poor ovarian response

Some studies have come out, investigating CoQ10's effects on ovarian reserve. for example, a randomized controlled trial with 169 participants found that women with a prior history of poor ovarian response who took CoQ10 for 60 days had more eggs retrieved, higher fertilization rates and more embryos available for transfer than women who didn't receive CoQ10. While some studies (like this 2016 study) could not show a difference in pregnancy and live birth rates, a 2020 review of literature concluded that CoQ10 may increase pregnancy rates with IVF.


Aging and CoQ10

While CoQ10 is produced naturally in our body, as we age, our bodies produce less of it and may not be able to replace what gets degraded. While that is out of our control, you can fill in the gap by adding a CoQ10 supplement to your diet. Ideally, your supplement should contain ubiquinol, a form of CoQ10 that the body produces naturally. Ubiquinol, as opposed to ubiquinone, is also an active (reduced) form of CoQ10, which means that the body doesn't need to convert ubiquinone into ubiquinol in order to benefit from its antioxidant abilities.



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