Growth hormone, DHEA, CoQ10 and acupuncture
Four popular adjuvants. Not one has been shown to produce a baby, and for one of them nobody has measured.
Growth hormone. The Cochrane review covers 16 randomized trials in 1,352 women. Live birth in poor responders comes from 8 of those trials, in 737 women: odds ratio 1.77 (95% CI 1.17 to 2.70). The reviewers rated that very low certainty, because the trials were small, few, and used different doses.
The best single trial contradicts it. A double-blind placebo-controlled trial in documented poor responders found live birth of 14.5% (9 of 62) with growth hormone against 13.7% (7 of 51) with placebo, a risk difference of 0.8 percentage points, with a confidence interval running from −12.1 to +13.7, so the trial could not exclude a large effect in either direction. Growth hormone did raise the odds of getting to an egg retrieval (odds ratio 5.67) but not of reaching an embryo transfer (odds ratio 1.42, 95% CI 0.50 to 4.00). The trial was also stopped early without reaching its target size, which is a real limitation.
The pattern is worth naming: growth hormone reliably improves the intermediate step and does not improve the outcome.
DHEA and testosterone. 28 randomized trials in about 3,000 women, nearly all of them in poor responders. In the 9 trials that reported live birth or ongoing pregnancy, covering 1,433 women, the odds ratio was 1.30 (95% CI 0.95 to 1.76) at moderate certainty. Translated: a baseline of 12% becomes 12% to 20%. The interval includes no benefit, and moderate certainty of no clear benefit is a stronger negative statement than most of the findings in this stage.
Coenzyme Q10. A meta-analysis of 6 randomized trials in 1,529 women with diminished ovarian reserve reported higher clinical pregnancy (odds ratio 1.84) and more eggs retrieved. It does not report live birth at all. The authors concede relatively limited sample sizes with poor descriptions of their methodologies.
There is no verified live birth evidence for CoQ10.
Acupuncture. The definitive trial randomized 848 women across 16 centres to real acupuncture or to sham acupuncture, three sessions around stimulation and transfer:
Risk difference 0.5 percentage points, confidence interval −4.9 to +5.8. The authors: These findings do not support the use of acupuncture to improve the rate of live births among women undergoing IVF.
If acupuncture helps you cope with treatment, that is a real benefit and this guide is not arguing you out of it. It is not a fertility treatment, and it should not be sold to you as one.