There is one golden rule of in vitro fertilization: the more number of eggs available for retrieval, the more likely the procedure will result in a successful fertilization. So what happens when a decreased number of eggs are complicating your fertility journey?
Understanding Poor Ovarian Response
One barrier to conception may be diminished ovarian reserve, meaning a low number of eggs are produced. This may happen because of advanced maternal age or oxidative stress (an imbalance of free radicals and antioxidants in the body), or mitochondrial dysfunction (when the structures in the cells do not produce enough energy).
That is why fertility medication and injections are an important part of the IVF process - they help stimulate the growth of the follicles, and in the production of multiple eggs in the ovaries. The main course of ovarian stimulation includes a combination of the following drugs:
- 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.
Insufficient preparation of ovaries, not enough stimulation dosages, the wrong stimulation medication, or poor injection techniques can all impact your treatment. If any of these human errors are to blame, you might need to start the ovarian stimulation process all over again.
But sometimes, the ovaries just do not respond - which is known as poor ovarian response. It can be frustrating but all hope is not lost.
CoQ10 to the Rescue
We now know that one of the possible causes of poor ovarian response is a mitochondrial disorder. The maturation of an egg and ovulation itself is an energy-demanding job. If the mitochondria - the tiny, rice-like structures that are highly concentrated in egg cells - are not working properly, less energy is produced, leading to improper egg development and embryo formation. If we consider the mitochondria as the batteries that charge cells, then in order to produce and release good quality eggs that lead to good embryos, the ovaries require a steady fuel supply.
Women at high risk for poor ovarian response can benefit from taking CoQ10. CoQ10 is an antioxidant that acts as an energy source in the mitochondria, playing a part in the mitochondrial electron transport chain involved in continuous energy generation.
CoQ10 has a long history as a coenzyme used to treat infertility. Research published in Reproductive Biology and Endocrinology (PDF) tested the effectiveness of CoQ10 on ovarian response, egg, and embryo quality in women who underwent IVF cycles. In short, the analysis found that among women who took 200mg CoQ10, three times a day for a couple months before doing IVF:
- Produced a higher number of retrievable eggs
- Had more eggs fertilized
- Developed more good-quality embryos
- Responded better to stimulation
- Had fewer cancelled IVF cycles
- Had fewer chromosomal abnormalities
This study builds on existing evidence, found in publications such as the National Library of Medicine and Reproductive Biomedicine Online, that suggests an improved response to ovarian stimulation and ultimately better egg and embryo quality.
There’s also evidence that CoQ10 helps prevent the production of reactive oxygen species (ROS) in the ovaries. These are unstable molecules that damage DNA, RNA, and proteins, leading to cell death in some cases. CoQ10 converts ROS into inactive compounds through its antioxidant process.
While CoQ10 is produced naturally in our bodies, as we age our bodies produce less. While this is out of your control, you can fill in the gap by adding a CoQ10 supplement to your diet before starting IVF. Ideally, your supplement should contain ubiquinol, a variant of CoQ10 that the body produces naturally, and which is more readily absorbed in a softgel format.
The Center for Human Reproduction recommends people diagnosed by a doctor with diminished ovarian reserve should take a daily dose of about 1000mg, and that those undergoing IVF should take the supplement for at least two months in advance of a treatment.
As always, consult with your doctor if you think diminished ovarian reserve may explain your fertility challenges, and discuss taking any supplements.