Low AMH is often associated with women in their later reproductive years. But diminished ovarian reserve può influenzare younger women too. Emerging research is therefore shifting the focus away from age alone and towards a woman’s individual ovarian reserve. One area attracting particular interest is Coenzima Q10 (CoQ10).
You’re in your early 30s – perhaps even younger – and suddenly you receive a result you weren’t expecting: your AMH is low.
It is just one blood test result, but it can raise a lot of questions. What does low AMH mean if I’m trying to conceive? Does it mean my egg reserve is running out? Do I have less time than I thought?
Let’s take a closer look.
What is AMH?
AMH stands for Anti-Müllerian Hormone. It is produced by small, developing follicles in the ovaries.
An AMH blood test is commonly used as a marker of ovarian reserve.
What is ovarian reserve?
Put simply, ovarian reserve refers to the number of eggs remaining in the ovaries.
Every woman is born with an individual number of eggs, and this supply naturally decreases throughout life.
In fact, our eggs are formed before we are even born. Their number reaches its peak during foetal development. At birth, it is estimated that around 1–2 million eggs remain, falling to approximately 300,000–500,000 by the start of puberty.
This means that ovarian reserve has already decreased considerably long before the first ovulation.
One reason is a completely natural process known as follicular atresia. Follicles containing eggs begin to develop but, rather than progressing all the way to ovulation, most are naturally broken down by the body. Far more eggs are lost through this process than through monthly ovulation.
This continues throughout a woman’s reproductive life, which is why ovarian reserve naturally declines with age.
As we cannot simply count the eggs remaining in the ovaries, clinicians use different markers to assess ovarian reserve. Two of the most important are:
- AMH (Anti-Müllerian Hormone), measured through a blood test
- AFC (Antral Follicle Count), which counts small follicles in both ovaries using an ultrasound, usually at the beginning of the menstrual cycle
Together, markers such as AMH and AFC can provide useful information about ovarian reserve.
There is, however, an important distinction to make: ovarian reserve primarily tells us about egg quantity, not egg quality.
This is particularly relevant when trying to conceive. Egg number and egg quality both change with reproductive ageing, but they are not the same thing.
What does diminished ovarian reserve mean?
Diminished ovarian reserve (DOR) generally means that fewer follicles are available than would be expected for a woman’s age.
A low AMH result is not a simple ‘fertility test’, nor does it mean that a woman cannot conceive naturally.
AMH is primarily useful for assessing ovarian reserve and helping predict how the ovaries may respond to stimulation if fertility treatment such as IVF is being considered.
Why egg quality matters too
We cannot increase the number of eggs remaining in the ovaries.
But when it comes to the chance of achieving a healthy pregnancy, the number of eggs is not the only factor that matters. Egg quality is important too.
This is one reason researchers are increasingly interested in the biological processes that support the remaining eggs – including their cellular energy supply.
Egg quality and cellular energy
An egg cell has exceptionally high energy requirements.
From maturation and the correct division of chromosomes through to fertilisation and early embryo development, numerous processes depend on an adequate supply of cellular energy.
This is where mitochondria come in.
Often described as the ‘powerhouses’ of our cells, mitochondria play a central role in producing cellular energy. With increasing reproductive age, not only does the number of available eggs decline, but mitochondrial function and energy production may also become less efficient. At the same time, oxidative stress can increase.
A growing body of fertility research is investigating this relationship between oxidative stress, mitochondrial function and reproductive ageing.
And this is particularly interesting because it may provide potential targets for supportive nutritional approaches.
What does Coenzyme Q10 have to do with egg quality?
This is where Coenzima Q10 (CoQ10) becomes interesting.
CoQ10 is an important component of the mitochondrial respiratory chain and is directly involved in cellular energy production. It also has antioxidant properties.
It is this combination that has attracted attention in reproductive medicine.
For some time, researchers have investigated CoQ10 supplementation in women of advanced reproductive age. More recently, however, another interesting question has emerged:
Could ovarian reserve – rather than age alone – help identify women for whom CoQ10 may be particularly relevant?
CoQ10 and diminished ovarian reserve: what does the research say?
An important contribution came from a 2024 systematic review and meta-analysis by Lin et al.
The researchers evaluated six randomised controlled trials involving a total of 1,529 women with diminished ovarian reserve undergoing IVF or ICSI.
CoQ10 pretreatment was associated with several favourable outcomes, including more eggs retrieved, more good-quality embryos and a higher clinical pregnancy rate. Treatment cycle cancellation rates were also lower.
The authors therefore described CoQ10 as a promising approach for women with diminished ovarian reserve.
However, there is an important caveat: some of the studies included relatively small numbers of participants and had methodological limitations. The authors therefore stressed that further high-quality research is needed.
For us, however, one detail is particularly interesting.
One of the randomised trials included in the analysis specifically looked at younger women with diminished ovarian reserve.
The women in this study had an average age of around 32 and received CoQ10 for 60 days before ovarian stimulation.
In other words, this was not the typical scenario of declining fertility associated with later reproductive age. These were younger women whose ovarian reserve was already lower than expected.
The results suggested that CoQ10 pretreatment may improve the ovarian response to stimulation and certain embryological outcomes.
Under 35 with diminished ovarian reserve
A second large meta-analysis makes this point even more interesting.
In 2024, Shang et al. analysed randomised trials investigating different antioxidant interventions in women showing signs of ovarian ageing.
Importantly, the researchers separated participants into different groups, including:
- women over 35 with diminished ovarian reserve
- women over 35 with a suboptimal ovarian response
- women under 35 with diminished ovarian reserve
When the researchers analysed CoQ10 specifically, they found a particularly interesting result.
Tra women under 35 with diminished ovarian reserve, CoQ10 was associated with a significantly higher clinical pregnancy rate compared with the respective control groups (OR 2.38; 95% CI 1.26–4.50; p=0.007).
In their discussion, the authors concluded that CoQ10 showed particularly promising results among the antioxidant interventions studied and suggested that women with diminished ovarian reserve – especially younger women – may be an important group for further research.
This changes the perspective.
CoQ10 in fertility care has often been discussed primarily in the context of reproductive ageing after 35. These findings suggest that chronological age may not be the only factor worth considering.
A 2026 randomised controlled trial by Abdelrahman et al. adds further evidence.
The study included 100 women with a poor ovarian response undergoing ICSI. Importantly, participants ranged in age from 25 to 45.
Women received either folic acid alone or folic acid plus CoQ10, starting one month before ICSI and continuing during the treatment cycle.
Again, researchers observed differences in several fertility-treatment outcomes. Women receiving CoQ10 had more eggs retrieved, more mature eggs and more fertilised eggs, alongside improvements in a number of ovarian and embryological parameters.
However, there was no statistically significant difference in clinical pregnancy rates.
That distinction matters.
The study was relatively small, was not blinded and used a comparatively short treatment period. The researchers themselves therefore called for larger, longer randomised trials – particularly to establish whether CoQ10 has an effect on pregnancy and live birth rates.
So, what can we take from the research on CoQ10 when trying to conceive?
Taken together, the studies present an interesting – but not yet definitive – picture.
The recent study by Abdelrahman et al. found positive effects on ovarian response and several embryological parameters. The meta-analysis by Lin et al., covering six randomised controlled trials, also identified potential benefits of CoQ10 pretreatment in women with diminished ovarian reserve.
And Shang et al. provide a particularly interesting indication that younger women under 35 with diminished ovarian reserve may also be a relevant group.
However, one important point should not be overlooked.
For the outcome that matters most – having a baby – the evidence remains uncertain. Shang et al. found no statistically significant difference in live birth rates across seven randomised controlled trials involving 1,224 participants, and the quality of evidence was rated as low.
CoQ10 is therefore not a promise of pregnancy.
Instead, the evidence suggests that pretreatment may positively influence certain steps along the fertility-treatment pathway, including ovarian response, the number of eggs retrieved and some embryological outcomes.
Fertility is about more than your date of birth
Perhaps this is the most important message for women trying to conceive.
The age of 35 is an important biological marker – but fertility does not suddenly change overnight on your 35th birthday.
A 32-year-old woman with diminished ovarian reserve has a different reproductive starting point from another 32-year-old with an ovarian reserve that is typical for her age.
Equally, age alone cannot tell us everything about an individual woman’s fertility.
The emerging research into CoQ10 therefore supports an interesting shift in perspective: away from age as the only consideration and towards a more individual view of reproductive health and ovarian reserve.
For women aged 35 and over, CoQ10 remains of particular scientific interest because of its role in mitochondrial energy metabolism and research into reproductive ageing.
But the evidence increasingly suggests that the conversation should not necessarily stop there.
For younger women with low AMH or diagnosed diminished ovarian reserve, CoQ10 may also be a relevant topic to discuss with their fertility specialist.
Because when you are trying to conceive, sometimes it makes sense to look beyond the age on your birth certificate.
What could this mean for nutrition when trying to conceive?
Research into Coenzyme Q10 highlights why fertility support should not necessarily be based on age alone. A woman’s individual ovarian reserve may also be relevant.
Fertilovit® F 35 plus was developed as a micronutrient concept for women trying to conceive from the age of 35 and contains Coenzyme Q10 alongside selected micronutrients. Its formulation therefore includes a nutrient that is increasingly being investigated in reproductive medicine because of its role in mitochondrial energy metabolism.
Research involving younger women with diminished ovarian reserve raises the question of whether, when considering nutritional support, individual reproductive circumstances may be relevant alongside age.
If you have been told that you have low AMH, diminished ovarian reserve or other abnormal ovarian reserve markers, speak to your GP, fertility specialist or fertility clinic about what your results mean for you and whether any additional supportive measures may be appropriate.
Frequently asked questions about low AMH, diminished ovarian reserve and CoQ10
Yes. Although ovarian reserve naturally declines with reproductive age, younger women can also have diminished ovarian reserve.
No. AMH is mainly used to assess ovarian reserve and help predict how the ovaries may respond to stimulation during fertility treatment.
A low AMH result alone does not mean that you cannot conceive naturally. It is also important to distinguish between egg quantity and egg quality – they are related to fertility, but they are not the same thing.
CoQ10 plays an important role in the mitochondrial respiratory chain and therefore in cellular energy production. It also has antioxidant properties.
Egg cells have very high energy requirements, while mitochondrial changes and oxidative stress are areas of particular interest in research into reproductive ageing and impaired ovarian function. This makes CoQ10 an interesting subject for fertility research.
Yes. One particularly interesting study by Xu et al. specifically investigated younger women with diminished ovarian reserve, with an average age of around 32. Participants received CoQ10 for 60 days before ovarian stimulation.
Shang et al. also analysed women under 35 with diminished ovarian reserve as a separate subgroup. In this subgroup, CoQ10 was associated with a significantly higher clinical pregnancy rate.
The evidence needs to be interpreted carefully.
Some studies have observed higher clinical pregnancy rates and more eggs retrieved following CoQ10 pretreatment. Other research has found improvements in ovarian and embryological outcomes without demonstrating a significant improvement in clinical pregnancy or live birth rates.
CoQ10 should therefore not be viewed as a guarantee of pregnancy.
There is currently no universally established optimal dose or treatment duration for CoQ10 in fertility treatment.
Study protocols vary considerably. For example, Xu et al. used 60 days of pretreatment, whereas Abdelrahman et al. started CoQ10 one month before ICSI and continued it during the treatment cycle.
The authors of the more recent study specifically note that the optimal dose and duration still need to be established.
Fertilovit® F 35 plus was primarily developed as a micronutrient concept for women trying to conceive from the age of 35.
However, current CoQ10 research is interesting because the nutrient is also being specifically investigated in younger women with diminished ovarian reserve.
If you are under 35 and have been diagnosed with diminished ovarian reserve or have low AMH, it is best to discuss your individual circumstances and nutritional requirements with your doctor or fertility specialist.
Riferimenti
Abdelrahman MA, Gamal M, Salem SA, Ibrahim ARN, Rabea H. Coenzyme Q10 Impact on Ovarian Reserve Measures and the Intra-Cytoplasmic Sperm Injection (ICSI) Outcomes in Women with Poor Ovarian Response: A Randomized Controlled Study. Drug Des Devel Ther. 2026;20:583321. doi:10.2147/DDDT.S583321.
Ben-Meir A, Burstein E, Borrego-Alvarez A, et al. Coenzyme Q10 restores oocyte mitochondrial function and fertility during reproductive aging. Aging Cell. 2015;14(5):887–895. doi:10.1111/acel.12368.
Ben-Meir A, Kim K, McQuaid R, et al. Co-Enzyme Q10 Supplementation Rescues Cumulus Cells Dysfunction in a Maternal Aging Model. Antioxidants (Basel). 2019;8(3):58. doi:10.3390/antiox8030058.
Bentov Y, Hannam T, Jurisicova A, Esfandiari N, Casper RF. Coenzyme Q10 Supplementation and Oocyte Aneuploidy in Women Undergoing IVF-ICSI Treatment. Clin Med Insights Reprod Health. 2014;8:31–36. doi:10.4137/CMRH.S14681.
Florou P, Anagnostis P, Theocharis P, Chourdakis M, Goulis DG. Does coenzyme Q10 supplementation improve fertility outcomes in women undergoing assisted reproductive technology procedures? A systematic review and meta-analysis of randomized-controlled trials. J Assist Reprod Genet. 2020;37(10):2377–2387. doi:10.1007/s10815-020-01906-3.
Lin G, Li X, Jin Yie SL, Xu L. Clinical evidence of coenzyme Q10 pretreatment for women with diminished ovarian reserve undergoing IVF/ICSI: a systematic review and meta-analysis. Ann Med. 2024;56(1):2389469. doi:10.1080/07853890.2024.2389469.
Shang Y, Song N, He R, Wu M. Antioxidants and Fertility in Women with Ovarian Aging: A Systematic Review and Meta-Analysis. Adv Nutr. 2024;15(8):100273. doi:10.1016/j.advnut.2024.100273.
Xu Y, Nisenblat V, Lu C, Li R, Qiao J, Zhen X, Wang S. 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. 2018 Mar 27;16(1):29. doi: 10.1186/s12958-018-0343-0. PMID: 29587861; PMCID: PMC5870379.