Rates of involuntary childness are on the uprise which can bring high medical costs and emotional afflictions. This review explores the emerging roles of CoQ10 - including the ubiquinol form in fertility. PubMed, Science Direct and Google Scholar were searched for RCTs, retrospective or prospective controlled studies published between January 1, 2009, and April 31, 2024. The keywords CoQ10, ubiquinol, fer/sub/infertility, ovarian reserve, oocyte quality, ovulation, amenorrhea, polycystic ovary syndrome, sperm quality, seminal fluid, and IVF were used. A total of 15 publications were identified. From a mechanistic stance CoQ10 appears to improve mitochondrial energetics, attenuate oxidative stress and modifications to DNA, proteins, and lipids. Such mechanisms appear to underpin improvements in oocyte quality/fertilization, markers of sperm quality and more broadly PCOS symptoms and hormone levels which can impact on fertility. The role of the ubiquinol form looks particularly promising, which may be attributed to its bioavailability. Ongoing research is needed but there is scope to raise CoQ10 awareness amongst reproductive health experts.