The role of Coenzyme Q10 in fertility

Coenzyme Q10 (or CoQ10 for short) is a vitamin-like compound suggested to enhance both male and female fertility. It can be found in foods such as meats, fish, nuts, and vegetable oils as well as dairy products, vegetables, fruits, and cereal albeit at lower levels. It can also be taken in supplement form as ubiquinol or ubiquinone.Here we will explain a bit more about its role in the human body, how this relates to male and female reproduction and what evidence there is to support its role as a supplement to aid fertility.

What is it and what does it do?

CoQ10 is present in the mitochondria of all our tissues and cells, the main role of which is to produce energy for our cells/body to function.

CoQ10 acts as a cofactor to support the mitochondria in this process. The human egg contains more mitochondria than any other cell in the body and active and optimal energy production is required for rapid oocyte (egg) and embryo development. Production of CoQ10 declines as we age, reducing mitochondrial energy production and its decline is associated with the age related decline in fertility that is observed in women aged 35 and above (1). CoQ10 also acts as a powerful antioxidant in our cells, higher than normal levels of oxidative stress can affect both male and female fertility.

Evidence for beneficial effects on fertility

As we age oxidative damage in cells accumulates, leading to increased reactive oxygen species in oocytes. Mitochondria in particular are a sensitive site for oxidative damage impeding their function and impairing fertility.

CoQ10 supplementation has been shown to restore oocyte mitochondrial function and fertility during reproductive ageing (2). High follicular fluid CoQ10 level is associated with optimal embryo development and higher pregnancy rates (3). Oral supplementation with 200mg has been found to result in a significant increase in active CoQ10 level in follicular fluid of women over 35 years of age undergoing IVF which may support egg quality and improved oxidative metabolism and therefore fertility in this group of women (4).

Women at any age can suffer from reduced ovarian reserve or poor ovarian response, the main cause has not been elucidated however, oxidative stress is proposed as an important contributor to this condition. A study investigating the antioxidant effects of CoQ10 found that it improved ovarian reserve to stimulation and embryological parameters in young women undergoing IVF-ICSI cycles (5).

The antioxidant effects of CoQ10 could also be beneficial for women with PCOS (6). The presumed cause of PCOS in most cases is insulin resistance, of which oxidative stress plays a key role in the development. CoQ10 supplementation for 12 weeks in people with PCOS has been shown to elicit beneficial effects on glucose metabolism and cholesterol levels in these people.

Males

The energy producing role of mitochondria is integral for optimal sperm function, in particular for motility. Oxidative stress is also a major cause of DNA damage in sperm. CoQ10 can therefore play a role in promoting male fertility (7). In sub fertile men 200–300mg/day of CoQ10 has been shown to improve sperm concentration, density and motility (8).

Evidence suggests that in males, supplementation in the dose range of 200-600mg/day (9) is more effective than food sources (10) of CoQ10 in improving sperm parameters. While supplementation has been deemed successful in improving sperm concentration and motility it has yet to be shown if this translates into increased live birth or pregnancy rates (9).  

How to choose a supplement and what dose?

CoQ10 supplements can be found as ubiquinol or ubiquinone. Ubiquinol is the activated form and is more easily absorbed so it is considered the more effective of the two, however it is more expensive, and benefits can still be seen from taking ubiquinone, which is converted to ubiquinol in the body. The studies discussed use a range of different doses from 50-600mg/day. While evidence does point towards a benefit of supplementation with CoQ10 in the scenarios outlined above, no consensus has yet been reached on a recommended dose for male or female fertility as more research is required. The dose you require may depend on your unique situation therefore it is recommended to consult your doctor prior to incorporating into your daily supplement regime.  

References

1. Miles M V., Horn PS, Tang PH, Morrison JA, Miles L, Degrauw T, et al. Age-related changes in plasma coenzyme Q10 concentrations and redox state in apparently healthy children and adults. Clin Chim Acta [Internet]. 2004 Sep [cited 2020 Jul 23];347(1–2):139–44. Available from: https://pubmed.ncbi.nlm.nih.gov/15313151/
2. Ben-Meir A, Burstein E, Borrego-Alvarez A, Chong J, Wong E, Yavorska T, et al. Coenzyme Q10 restores oocyte mitochondrial function and fertility during reproductive aging. Aging Cell [Internet]. 2015 Oct 1 [cited 2020 Jul 10];14(5):887–95. Available from: https://pubmed.ncbi.nlm.nih.gov/26111777/
3. Akarsu S, Gode F, Isik AZ, Dikmen ZG, Tekindal MA. The association between coenzyme Q10 concentrations in follicular fluid with embryo morphokinetics and pregnancy rate in assisted reproductive techniques. J Assist Reprod Genet [Internet]. 2017 May 1 [cited 2020 Aug 23];34(5):599–605. Available from: /pmc/articles/PMC5427661/?report=abstract 4
4. Giannubilo SR, Orlando P, Silvestri S, Cirilli I, Marcheggiani F, Ciavattini A, et al. CoQ10 supplementation in patients undergoing IVF-ET: The relationship with follicular fluid content and oocyte maturity. Antioxidants [Internet]. 2018 Oct 13 [cited 2020 Jul 14];7(10). Available from: /pmc/articles/PMC6210096/?report=abstract
5. Xu Y, Nisenblat V, Lu C, Li R, Qiao J, Zhen X, et al. Pretreatment with coenzyme Q10 improves ovarian response and embryo quality in low-prognosis young women with decreased ovarian reserve: A randomized controlled trial. Reprod Biol Endocrinol [Internet]. 2018 Mar 27 [cited 2020 Jul 14];16(1). Available from: /pmc/articles/PMC5870379/?report=abstract
6. Samimi M, Zarezade Mehrizi M, Foroozanfard F, Akbari H, Jamilian M, Ahmadi S, et al. The effects of coenzyme Q10 supplementation on glucose metabolism and lipid profiles in women with polycystic ovary syndrome: a randomized, double-blind, placebo-controlled trial. Clin Endocrinol (Oxf) [Internet]. 2017 Apr 1 [cited 2020 Aug 7];86(4):560–6. Available from: https://pubmed.ncbi.nlm.nih.gov/27911471/
7. Wright C, Milne S, Leeson H. Sperm DNA damage caused by oxidative stress: Modifiable clinical, lifestyle and nutritional factors in male infertility [Internet]. Vol. 28, Reproductive BioMedicine Online. Elsevier; 2014 [cited 2020 Aug 7]. p. 684–703. Available from: https://pubmed.ncbi.nlm.nih.gov/24745838/
8. Safarinejad MR, Safarinejad S, Shafiei N, Safarinejad S. Effects of the reduced form of coenzyme Q10 (ubiquinol) on semen parameters in men with idiopathic infertility: A double-blind, placebo controlled, randomized study. J Urol [Internet]. 2012 Aug [cited 2020 Aug 7];188(2):526–31. Available from: https://pubmed.ncbi.nlm.nih.gov/22704112/
9. Lafuente R, González-Comadrán M, Solà I, López G, Brassesco M, Carreras R, et al. Coenzyme Q10 and male infertility: A meta-analysis. J Assist Reprod Genet [Internet]. 2013 Sep [cited 2020 Aug 7];30(9):1147–56. Available from: https://pubmed.ncbi.nlm.nih.gov/23912751/
10. Tiseo BC, Gaskins AJ, Hauser R, Chavarro JE, Tanrikut C. Coenzyme Q10 Intake From Food and Semen Parameters in a Subfertile Population. Urology [Internet]. 2017 Apr 1 [cited 2020 Aug 7];102:100–5. Available from: /pmc/articles/PMC5376356/?report=abstract