| Intervention | Evidence | For me |
|---|---|---|
| CoQ10 600 mg/day × 60+ days | Solid (RCT meta-analysis) | Bump from current 100–300 to trial-protocol dose |
| Melatonin 3 mg nightly | Moderate (RCT meta-analysis) | Reasonable to add |
| Omega-3 / DHA 1–2 g/day | Mild positive (mixed studies) | Check prenatal first; add if not covered |
| Vitamin D | Status matters; supplementation neutral | Measure 25-OH-D first, titrate to sufficiency |
| Myo-inositol | No benefit in DOR | Skip — it's a PCOS intervention |
| L-arginine 3–6 g/day | Weak (pilots only) | Discuss with CZ clinic; thickness gain, no pregnancy signal |
| Vitamin E + pentoxifylline | Not supported by RCT | Skip |
| Acupuncture | Mixed; small early miscarriage signal | Optional, not therapeutic |
| Mediterranean diet | Modest positive (observational) | Easy yes |
| Yoga / mind-body | Wellbeing only, no pregnancy effect | Yes for sanity, not for biology |
| Moderate pre-cycle exercise | Mild positive | Continue; back off during stim |
CoQ10 in DOR: 6 RCTs, n=1,529. Clinical pregnancy OR 1.84 (95% CI 1.33–2.53). Trial-protocol dose was 600 mg/day in divided doses for 60 days; the landmark Xu 2018 RCT roughly doubled oocyte yield and fertilization rate at that dose. My current 100–300 mg/day is below trial-protocol. Caveat: all 6 RCTs were Chinese; applicability is reasonable but not certain.
Melatonin: 11 RCTs, n=1,481. Clinical pregnancy OR 1.59, MII oocytes SMD 0.99, fertilization OR 1.32. Lower doses (≤3 mg/day) had cleaner effects. Live birth not consistently reported. Mechanism (mitochondrial antioxidant in follicular fluid) is biologically plausible for the DOR / age-40 oxidative-stress hypothesis. Stacks well with CoQ10. Suggested: 3 mg/night at bedtime, 6–8 weeks pre-retrieval.
Omega-3: 11 studies, 1,789 IVF/ICSI women. IVF pregnancy OR 1.74, fertilization OR 2.14. Dosing inconsistent across studies. Defensible adjunct at 1–2 g/day EPA+DHA. Often bundled in prenatals — check my Materna content before stacking.
Myo-inositol: Zhang 2025 meta-analysis explicitly stratified PCOS vs poor responders. POR women showed no MII benefit (OR 0.97). Skip — it's a PCOS-specific intervention.
Vitamin D: The SUNDRO RCT (Somigliana 2021) showed single oral 600,000 IU dose did NOT improve pregnancy rate in deficient/insufficient women. Status correlates with outcomes cross-sectionally; supplementing a deficient woman doesn't reliably move IVF outcomes. Action: measure my serum 25-OH-D before megadosing. My 2000 IU daily is reasonable maintenance.
L-arginine: Takasaki 2010 pilot and follow-up series show artery resistance and thickness improve in 67–89% of thin-lining patients. But no controlled pregnancy benefit. 3–6 g/day during stim is low risk. Worth discussing with CZ clinic before adding, especially if clinic already plans vasodilators (sildenafil, etc.) — don't stack accidentally.
Vitamin E + pentoxifylline: Quasi-experimental studies show thickness gains, but the only RCT was negative and the systematic review concluded "no certainty about effectiveness." Skip the 6-month commitment. If endometrium is the bottleneck, protocol-level adjustments (PRP, sildenafil, freeze-all + natural FET) have better evidence.
Mind-body / yoga: The strongest RCT to date — 168 women, 10-week structured program vs active control. No between-group difference in pregnancy or live birth. Both groups improved psychologically. Earlier Domar 2011 work suggested big pregnancy effects but hasn't replicated under active-control conditions. Do it for sanity, not biology.
Acupuncture: Xu 2024 meta-analysis (25 trials, n=4,757) showed clinical pregnancy 43.6% vs 33.2% and live birth 38.0% vs 28.7%. But Wang 2024 trial-sequential meta-analysis flagged a significant increase in early miscarriage rate (RR 1.51) alongside the pregnancy benefit. Cochrane-style reviews with sham controls show smaller / null effects. Mixed; quality concerns; not therapeutic.
Mediterranean diet: Three meta-analyses (Kellow 2022, Winter 2023, Muffone 2023) consistently associate adherence with higher live birth in ART. All cohort/cross-sectional — no RCT randomizes diet. Reverse causation plausible. Zero downside, plausible upside, free. The HU summer makes it the natural default.
Exercise: Mena 2018 meta-analysis shows pre-IVF moderate activity improves clinical pregnancy and live birth. During treatment, no clear benefit for vigorous activity. Moderate-to-vigorous activity associates with higher live birth in healthy-weight women specifically (BMI 21 = applicable). Reduce intensity during stim and around retrieval — ovaries are enlarged and torsion risk is real.
I'm already on CoQ10 100–300 mg/day, vitamin D 2000 IU, prenatal vitamins, and have a normal BMI. The single highest-value tweak from this evidence base: bump CoQ10 to 600 mg/day in divided doses for at least 60 days before my next retrieval. Adding melatonin 3 mg/night is the next-best add. Mediterranean diet and moderate exercise are baseline anyway. I should also measure 25-OH-D before next cycle to see if my 2000 IU dose is enough.
| Intervention | Confidence in benefit | Note |
|---|---|---|
| CoQ10 600 mg/day in DOR | High | Strong meta-analysis signal; my current dose is below trial protocol. |
| Melatonin 3 mg/night | Medium | Plausible mechanism, RCT meta-analysis support on surrogate endpoints. |
| Omega-3 1–2 g/day | Medium | Mixed studies; reasonable add if not in prenatal. |
| Vitamin D supplementation moves IVF outcomes | Low | Status correlates; supplementation doesn't reliably help. Test, don't megadose. |
| Mediterranean diet helps | Medium | Observational only; reverse causation possible. Zero downside. |
| Acupuncture improves pregnancy outcomes | Low | Mixed evidence; sham-control bias; miscarriage signal flagged. |
| Pre-cycle moderate exercise | Medium | Mostly observational; reduce intensity during stim. |
| Myo-inositol, vitamin E + pentoxifylline | Low | Not supported for DOR. Skip. |