Do DHEA and CoQ10 improve live birth rates in poor responders?

[Terminology: PCOS was renamed polyendocrine metabolic ovarian syndrome (PMOS) by global consensus in May 2026, published in The Lancet. The International Guideline now uses PMOS/PCOS in its recommendations and will use PMOS alone from 2028. Clinical content, diagnostic criteria and management are unchanged.]

On DHEA, ESHRE (2026) is unambiguous and has strengthened its position: DHEA before or during ovarian stimulation is not recommended for low responders (strong). DHEA is not recommended for normal responders (strong). Both are strong recommendations against. Earlier signals of increased oocyte yield have not translated into improved live birth rates. CoQ10 is not addressed as a separate recommendation in the 2026 guideline. That absence should be stated as absence rather than filled in — there is no ESHRE position to cite either way, and the supplement literature in this area is characterised by small studies with heterogeneous endpoints. For context, the guideline recommends against a broad set of adjuvants in this population: growth hormone (strong against in normal responders and PCOS; conditional against in low responders), testosterone (conditional against in low responders), myo-inositol (strong against in low responders and non-PCOS women), aspirin (strong against), and sildenafil (strong against in low responders). Practical counselling point: patients frequently arrive already taking several of these. The conversation is usually about stopping rather than starting, and it helps to be able to say which recommendations are strong.