CoQ10 Supplementation for fertility
Co-authored by Rachelle Mallik, MA, RD and Lauren Manaker, RD
As dietitians we are food-first (see our article on antioxidants when TTC), but there are some nutrients that are difficult to get adequate amounts from through food alone. Additionally, there are fertility-specific supplements that we discuss with clients. We’re digging into the research on CoQ10, vitex (chasteberry), omega-3s and inositol to see what’s worth it and what to skip. As a reminder, this article is not meant to replace individualized medical or dietary advice and is for informational purposes only.
What is CoQ10?
Co-enzyme Q10, aka CoQ10, is a fat-soluble compound that is found in almost all cell membranes in our bodies, including mitochondria, and it functions as an antioxidant. CoQ10 can be synthesized by the body and is also naturally occurring in some foods. These foods include meat, poultry, fish, nuts, seeds and vegetable oils like canola and peanut; some fruits and vegetables also provide CoQ10 in smaller amounts. CoQ10 is not considered a vitamin because our bodies can make it, and at this time there is also no recommended daily intake as there are for vitamins and minerals (1).
CoQ10 may support fertility parameters in men, including improved sperm count, motility, and morphology. A 2012 study of men with unexplained infertility found that those who received 200mg daily of ubiquinol (a form of CoQ10) for 26-weeks had improved sperm count, motility and morphology.(4) A 2017 study examined the role of CoQ10 along with zinc and D-aspartic acid on sperm in vitro (ie men were not taking oral supplements with CoQ10) (5). The researchers found this combination improved sperm motility in men with reduced sperm motility.
CoQ10 supplementation has been shown to improve total sperm motility and sperm count in some studies, while other studies showed no effect with supplementation. Although there is no standard dose, studies have supported supplementation from 100 mg/day to 300 mg/day. (6, 7) However, one study indicated that consumption of CoQ10 from food sources does not have an effect on sperm parameters.(8) That’s not surprising since it would be impossible to obtain these therapeutic amounts (100-300 mg) of CoQ10 from food alone. One of the highest food sources of CoQ10, beef contains 2.6 mg in a 3-ounce serving (9), which means you would have to eat at least 39 servings! And that amount of red meat would not have a favorable effect on fertility.
Several studies have looked at the use of CoQ10 in combination with other medicines or supplements. A 2015 study found that in women undergoing IUI and IVF, a combination of DHEA (dehydroepiandrosterone) plus CoQ10 significantly increased antral follicle count and improved ovarian response compared to DHEA alone. (10) Dosage of CoQ10 was not included in the study methods. Another study in women with PCOS undergoing IUI found that CoQ10 in combination with clomiphene citrate (commonly referred to as Clomid) improved ovulation and clinical pregnancy rate. (11) In this study, women took 60 mg of CoQ10 three times daily from cycle day 2 through the HCG shot. Additionally some research has shown a high level of CoQ10 in follicular fluid is associated with higher pregnancy rates. (12)
CoQ10 has also been studied in regards to maternal age. A small 2018 study was the first to demonstrate that oral supplementation with 200mg of CoQ10 significantly increased CoQ10 quantities in follicular fluid, which correlated with improved oxidative metabolism and egg quality, especially in women over 35 years of age. (13) Another study also from 2018 found that taking CoQ10 prior to an IVF-ICSI cycle improved ovarian response in women under 35 years of age with poor ovarian reserve. (14)
It is important to note that there are some studies that do not suggest a strong association between CoQ10 supplementation and fertility parameters. In other words, it is not a magic pill for everyone who is TTC, but in some cases may help.
There is not a consensus on the most appropriate dosage for CoQ10 because of limited studies. The range of dosage varies and appears to be, on average, from 150-600 mg/day for women (with higher dosages split throughout the day) and 100-300 mg/day for men, according to some experts. You may need to take more CoQ10 depending on which source you choose (ubiquinone vs ubiquinol...more on that below).
If you are choosing a supplement that includes a “proprietary blend” that includes CoQ10, there is no way to know if you are getting a clinical dose of the nutrient. It is important to know how much of the nutrient you are taking to ensure that it will have the intended effect.
Ubiquinol vs. ubiquinone
If you are deciding to take CoQ10 to support your fertility, many clinicians prefer that you choose the ubiquinol form. When you ingest CoQ10 in the ubiquinone form, your body needs to convert it to the active ubiquinol form. In other words, the CoQ10 in the ubiquinol form is already in the active form. Ubiquinol may be a little more expensive, but your body may actually be utilizing CoQ10 in this from more effectively, and therefore is worth the investment in our opinion. You may require less dosage if you are choosing a ubiquinol source since you will likely absorb more of the nutrient. The form of CoQ10 should be shown on the supplement label. CoQ10 is fat-soluble and is better absorbed when taken with a source of fat.
FYI: a good and trustworthy option is this one! If you want specific recommendations, just reach out to one of us!
CoQ10 is generally safe, but people taking warfarin (a blood thinner) should speak with their doctor before taking CoQ10 at the same time.
The research appears to be lacking for CoQ10’s role on clinical pregnancy and more importantly live birth. Therefore we wouldn’t recommend this as a first-line treatment (especially since CoQ10 is a more expensive supplement) but in combination with a nutritious diet and perhaps other supplements, CoQ10 could improve antral follicle counts, egg quality and response to ovarian stimulation, especially in women over 35 or women under 35 with poor ovarian reserve. Additionally, it may be a good addition for your male-partner if he is already eating a Mediterranean-style diet and making lifestyle changes to support his fertility. Specific lifestyle and dietary changes for men can be found in the book Fueling Male Fertility. As always, we recommend that you work with your health care team to determine an individualized treatment and nutrition plan.