*Updated 6/2024
As we age, both egg quality and quantity start to decline. Unfortunately, there is very little we can do to reverse that process once it starts. The best approach is a proactive one where your overall health is prioritized at a younger age. However, that doesn't stop accounts on social media from making false claims that the supplements, programs, protocols or courses they selling will improve your egg quality or even improve your overall fertility. These accounts are targeting a very vulnerable population of individuals who are struggling with infertility. These people may even spend thousands of dollars before they realize that what these accounts are selling is not evidence-based. Learn more about egg quality and what can be done.
I teamed up with two fertility experts, Dr. Blake Evans (@drblakeevans on IG) and Dr. Lucky Sekhon (@lucky.sekhon on IG) to share some facts and dispel some myths about egg quality.
What is egg quality?
Egg quality refers to whether an egg is chromosomally “normal” (euploid) or “abnormal” (aneuploid). It is the expected percentage of a person’s total number of eggs that have a normal set of chromosomes. This is also referred to as “egg health”. A euploid egg has 23 chromosomes and when fertilized by the sperm, which also has 23 chromosomes, the resulting euploid embryo has a total of 46 chromosomes. With advancing age, the number of aneuploid eggs with too few or too many chromosomes increases. Aneuploid eggs that are fertilized can result in implantation failure, pregnancy loss and genetic disorders in the embryo, fetus adnd neonate.
Learn more about egg count from Dr. Sekhon!
Can my egg quality be assessed?
Unfortunately, there is no blood test or ultrasound that can assess egg quality in any one individual. The only way to know if an egg is euploid is to attempt to fertilize it, and, if fertilization is successful, to perform a genetic test on the developing embryo. Because the proportion of eggs with missing or extra chromosomes increases with age, doctors can use age of the eggs as an indirect way to project the anticipated quality of the embryos that would result from those eggs.
What can my AMH level tell me about my fertility?
Anti-mullerian hormone (AMH is a hormone that has important functions. It is an indicator of an individual's ovarian reserve-the number of oocytes remaining in the ovary or egg quantity. AMH is secreted by important cells in the ovary throughout the reproductive years of life. Since you are born with all the eggs you will ever have, and the number of eggs decreases until menopause, AMH levels are expected to slowly decrease with age. Based on the limited data available, AMH and other tests of ovarian reserve are no more useful than age alone in predicting spontaneous pregnancy in those with infertility. However, AMH is a predictor of an individual's response to an IVF cycle. In other words, an AMH level for someone considering IVF can predict ovarian response (ie how many follicles with eggs develop for retrieval) to the medications prescribed for an IVF cycle. Unfortunately, AMH cannot tell anyone about the quality of their eggs.
What can negatively affect my egg quality?
- Smoking, including marijuana: Chemicals in cigarettes mutate the DNA in egg cells, making some of the eggs unsuitable for conception.
- Obesity: Linked to reduced fertility and decreased egg quality due to alterations of mitochondrial function and increased oxidative stress.
- Alcohol: <4 drinks per week and 2 drinks per day is associated with improved pregnancy rates.
- Immunological disorders
- Chemotherapy
- Drug use
- Stress
- Endometriosis
- History of ovarian surgery
What can improve my egg quality?
Coenzyme Q10 (CoQ10) is an antioxidant that may benefit those with poor ovarian reserve, poor response to ovarian stimulation, advanced age, or PCOS. What these conditions all have in common are fewer and, usually less competent, mature eggs. CoQ10 may slow changes in egg quality that occur with age by counteracting oxidative stress. However, these benefits do not necessarily translate into substantial egg improvements and higher pregnancy rates, especially in those individuals of older age.
What about DHEA and growth hormone?
Growth hormone and DHEA are not considered valid evidence-based strategies to improve egg count or quality. NEVER TAKE ANY SUPPLEMENTS WITHOUT DOCTOR SUPERVISION!
Learn more about DHEA from Dr. Sekhon!
What about nutrition?
Healthy foods improve overall health, including helping your eggs stay healthy and of high quality. Nutrition may also improve overall fertility. “Fertility" diets, intermittent fasting, paleo diet, etc. are more likely related to an improved BMI and its effects on fertility rather than any one specific diet improving egg quality..
What should I avoid...
- People and social media accounts selling male and female “fertility supplements”. These are not proven to be beneficial AND we cannot say they don't cause harm.
- People and social media accounts selling courses or access to their special program or diet that can “improve egg quality”.
- Anyone claiming to be a fertility specialist who does not have the necessary credentials. The only fertility experts or specialists are those individuals with board certification on OBGYN and Reproductive Endocrinology and Infertility(REI).
- You can check the credentials of an REI specialist by going to ABOG.org ➡️ "Verify Your Physician's Certification" ➡️ Then type name pf the specialist and the state where they practice. You should find that the specialist has "Reproductive Endocrinology and Infertility Subspecialty Certification". If it doesn't say this, they are not board certified in REI or they may be "board-eligible" (ie a recent REI fellowship grad in the process of board certification).
What can I do about my egg quality?
As said before, the best approach is a proactive one where you maintain an overall healthy lifestyle starting at an earlier age. If you anticipate that you will be delaying childbearing for any reason to your late 30s, or even 40s, see an REI specialist to get some information and a baseline fertility assessment of where you stand. Finally, please don't assume that because your mom, sister, aunt or any other family member had no trouble conceiving later in life that you will not have any problems. Fertility is not inherited. Empower yourself with education about YOUR fertility!
Key points from ASRM Committee Opinion, "Optimizing Natural Fertility":
Over age 35
- The chances of pregnancy and live birth for persons significantly decrease after age 35, as the risks of aneuploidy and miscarriage increase.
- Time to conception increases with age. For those over 35, consultation with an REI specialist should be considered after 6 months of unsuccessful efforts to conceive.
Fertile window
- The ‘‘fertile window’’ spans the 6-day interval ending on the day of ovulation. Frequent intercourse (every 1–2 days) during the fertile window yields the highest pregnancy rates, but results achieved with less frequent intercourse (2–3 times per week) are nearly equivalent. Couples should not be advised to limit the frequency of intercourse when trying to achieve pregnancy.
- For couples who are unable to have regular frequent intercourse, fertility-awareness methods, such as ovulation detection kits and cervical mucus monitoring, may help time frequent intercourse to the fertile window and increase the probability of conceiving in a given menstrual cycle.
- Specific coital positions and postcoital routines have no impact on fertility.
Lifestyle
- Smoking and recreational drugs should be discouraged in couples attempting pregnancy. Alcohol and caffeine use should be limited to minimal to moderate use while trying to conceive.
- A healthy lifestyle and diet should be encouraged in people attempting to achieve pregnancy for their effects on general health. There is insufficient evidence that a specific diet or intake of particular macronutrients can improve natural fertility.
- Individuals wishing to become pregnant should take a daily folic acid supplement (400 mcg) to help prevent fetal neural tube defects like anencephaly.
- Reproductive-aged individuals should be encouraged, to the extent possible, to limit their exposure to endocrine-disrupting chemicals, such as polychlorinated biphenyls, in food, air, water, and personal care products, and to air pollution.
Resources
- Extended Fertility, Egg Quality
- Does Coenzyme Q10 Supplementation Improve Human Oocyte Quality?, Int. J. Mol. Sci. 2021, 22(17), 9541
- Gleicher N, Barad DH. DHEA supplementation in diminished ovarian reserve (DOR). Reprod Biol Endocrinol. 2011 May 17;9:67. doi: 10.1186/1477-7827-9-67.
- Sood A, Mohiyiddeen G, Ahmad G, Fitzgerald C, Watson A, Mohiyiddeen L. Growth hormone for in vitro fertilisation (IVF). Cochrane Database of Systematic Reviews 2021, Issue 11. Art. No.: CD000099.
- Optimizing natural fertility: a committee opinion, ASRM Pages, January 2022
- Testing and interpreting measures of ovarian reserve: a committee opinion, ASRM