We’ve all heard the stories before…
A woman in her late-30’s – who was told that none of her eggs were likely to be good – decided she wasn’t ready to go the route of donor eggs.
Instead, she took a cocktail of supplements and three months later she got pregnant naturally and gave birth to a healthy baby.
Of course, we know this isn’t always the outcome.
However, curious minds can’t help but ask…
“Which supplements did she take?”
Here’s a quick overview of what you’ll discover:
As we’ve talked about in our post on infertility facts and statistics, women are born with all the eggs they’ll ever have, which is typically around 1-2 million.
Over time, healthy egg supply decreases in a few distinct ways…
First, women lose part of their total egg quantity with every passing month. Commonly you may hear that the egg quantity lost is from the egg that is ovulated. However, each month there’s an entire cohort of follicles with potential eggs that ultimately, if not selected for ovulation, undergo apoptosis (cell death) and atresia.
So even in women who aren’t ovulating (e.g., PCOS, taking oral birth control, etc.) overall egg quantity still declines with time. In fact, approximately one thousand eggs are lost each month after puberty which happens progressively until menopause.
Egg quantity aside, there’s also a decline in egg quality as women age. For the most part, the eggs that you have remain dormant in your ovaries for most of your life. Just before ovulation, your eggs go through a process of cellular division and maturation. Unfortunately, older eggs are more likely to experience errors during the division process, which means they are more likely to contain abnormal amounts of DNA.
Another important aspect contributing to egg quality is mitochondrial health. Mitochondria are the powerhouse of your cells – they make the ATP that the egg cell uses for energy. As your eggs mature, going from a microscopic primordial follicle cell to a visible egg cell, mitochondria multiply exponentially to 100,000–500,000 or more in fully mature eggs. The reason for this staggering increase? It takes a lot of energy for an egg to be fertilized, implant, and grow into a baby!
As you age, the number and efficiency of mitochondria decline. This happens as part of the natural aging process but is often sped up by a number of lifestyle factors including a lack of proper nutrients. More on that in a moment…
Fertility testing, such as checking anti-Müllerian hormone (AMH) levels, or ultrasounds to look at an antral follicle count (AFC, the number of resting follicles in your ovaries) tests for markers of egg count (quantity), not egg quality. Knowing how many eggs you have left is important information, but it’s only part of the picture.
Without getting too nerdy, the only way to know for sure if an egg is “normal” is to attempt to fertilize it and perform genetic testing on the embryo. Although a lot of research has been done surrounding polar body biopsy, the genetic quality of an unfertilized egg isn’t reliably or routinely tested at this time.
Errors in our DNA increase over time just as the health of mitochondria decreases. And because the impact of age on egg quality is fairly consistent, your age can give fertility specialists a fairly accurate picture of egg quality as it is currently the best determinant. Luckily, there are a number of factors unrelated to age that can also help support the health of your eggs and could likely benefit regardless of whether age is on your side.
As you just learned, healthy mitochondria and DNA are both important when it comes to the quality of your eggs.
For proper mitochondrial function, the cells in your body need all the building blocks for producing adenosine triphosphate (ATP), the molecule which provides energy for all of the cells’ processes.
This includes plenty of b-vitamins, such as riboflavin (B2) and niacin (B3). Your mitochondria also need other micronutrients, such as omega-3 fatty acids, magnesium, iron, vitamin E, selenium, and CoQ10. (1)
Now before we dive into our discussion about supplements, here are a few everyday tips you can implement to improve the quality of your mitochondria:
Okay, we know that we got a little off-topic, but we wanted to share a few strategies beyond supplements that can help support and improve the quality of your eggs. We know it probably goes without saying, but taking a handful of supplements will never be able to overcome less than optimal dietary and lifestyle habits.
There are many vitamins and supplements out there beyond your everyday prenatal to consider when it comes to your fertility. Instead of trying to cover them all, we are going to focus on three of the supplements to potential use when it comes to improving egg quality.
Coenzyme Q10 (CoQ10) is a fat-soluble nutrient found in almost every cell of our bodies, including your ovaries and eggs. Among other things, it functions as an antioxidant – meaning it neutralizes toxic byproducts from everyday chemical reactions.
Equally important to its antioxidant properties, CoQ10 is vital for energy production. Your eggs (oocytes) actually have the largest number of mitochondria of any cell in your body. This makes sense as the process of ovulation and forming an embryo takes a lot of energy!
So, what does the current scientific literature say about supplementing with CoQ10?
In one clinical trial, supplementation with CoQ10 led to a higher fertilization rate and more high-quality embryos (2). CoQ10 also has increased the number of ovarian follicles and improved ovulation rates in Clomid-resistant women with PCOS (3).
A recent meta-analysis (combined statistical analysis) looked at the combined results from 5 randomized controlled trials (including the 2 mentioned above) and noted that women who supplemented with CoQ10 had a higher odds of clinical pregnancy (28.8% vs 14.1%) (4).
And when researchers placed CoQ10 directly into the in-vitro maturation media (what the eggs are bathed in after they’re retrieved) among women undergoing IVF (≥ 38 years of age), they found (5):
Increased oocyte maturation rates (82.6% vs. 63.0%)
Decreased postmeiotic aneuploidies (i.e., cells with abnormal number of chromosomes) (36.8% vs. 65.5%)
Dehydroepiandrosterone (DHEA) is a naturally occurring hormone that has minor biological activity on its own but has powerful effects when converted into other hormones such as testosterone and estrogen.
One randomized, prospective study found that daily DHEA supplementation improved egg quality and pregnancy outcome in women who were “poor responders” to IVF stimulation medication (5).
Moreover, a recent meta-analysis looking at a total of 9 randomized clinical trials found that DHEA supplementation among women undergoing IVF-ICSI was associated with (7):
Increased mean number of retrieved oocytes
27% higher chance of clinical pregnancy rate
76% higher chance of live birth rate
Before moving on, we want to stress the importance of using DHEA under the guidance of a fertility specialist. It is a pretty powerful hormone and when used incorrectly it can cause damage to the liver. DHEA may also increase testosterone levels and worsen polycystic ovary syndrome-like symptoms and may negatively impact the endometrium.
The bottom line, not every supplement is meant for everyone, especially when trying to conceive. Speak with your physician to determine what may be best for you and your reproductive health.
Melatonin is a neuro-hormone produced in almost all of our cells but it’s only secreted by the pineal gland in the brain. Melatonin has been shown to have strong antioxidant properties, which help prevent free radicals and reactive oxygen species (ROS) from creating oxidative stress and cellular damage. Oxidative stress can negatively impact oocytes as well as the ovulatory process.
Interestingly, melatonin has been found in ovarian follicular fluid and in the oocytes themselves. Hence, supplementing with melatonin when TTC has become a growing topic of interest in the fertility world.
Much of the buzz around melatonin and fertility surrounds women undergoing IVF. Initial research has suggested that melatonin supplementation could (8-11):
Lower levels of oxidative stress and cellular damage in ovarian follicles.
Increase the number of mature oocytes & high-quality embryos
Increase fertilization rates
It’s important to note that melatonin has the potential to disrupt the hormones secreted from your brain that regulate the menstrual cycle and actually interfere with ovulation. Women not undergoing IVF and/or those with irregular cycles should not routinely supplement with melatonin while trying to conceive until we have a better understanding of its application.
There are so many vitamins and supplements out there that may or may not help increase your fertility and your efforts to get pregnant. When it comes to supplementation, it’s always important to first consider what the supplement has actually been shown to help improve as well as what the clinical studies show.
Important questions to ask yourself include:
Keep an open mind, but don’t be afraid to be critical. Supplements aren’t a magic bullet… and just because one combination of supplements worked for one woman, doesn’t mean it’s guaranteed to work for another. And remember, age will always be the best predictor of egg quality, so that has to be taken into consideration with the bigger picture.
Another important consideration when choosing supplements is cost. It probably goes without saying, but the cost of supplements can quickly add up, which is why it’s extra important to do your homework. Of course, it’s also extremely important to speak to your fertility specialist before taking a bunch of new fertility supplements.
Historically, it has been thought that interventions for improving egg quality must be applied while the egg is undergoing the maturation process and not when it has already matured and is ready for release… Hence, the whole 90-day concept you’ve read about on the internet.
Although there’s definitely truth to this adage, and most studies look at outcomes after 3 months of supplementation, it can downplay or overlook the short-term effect of lifestyle factors, which have been shown to have an impact in less than 90 days!
The quality of developing eggs and their response to natural or external hormonal stimulation can be affected by stress, environmental contaminants, poor diet, inflammation, drug abuse, excessive smoking, hormonal imbalance, etc.
Supplements that help address these factors may indirectly improve egg quality and increase your chances of getting pregnant much sooner than 90 days. So, remember, it may start with the egg, but the quality of your eggs isn’t the only factor at play.
The topic of eqq quality and quantity is important for any woman trying to conceive. Although the age of the female is the biggest factor determining egg quality, there are actually many other things under your control that can help optimize overall egg health.
Supplements receive a great deal of attention because they are one of the easiest strategies to implement and it fits the traditional paradigm of taking a pill to improve one’s health.
Before popping a handful of pills though, it’s important to know which supplements have actually been shown to potentially benefit egg quality or quantity. You might be surprised to learn that many of the popular supplements that women are taking have little to no impact on egg health.
It’s also important to remember that no amount of supplements will reverse the negative effects of a pro-inflammatory diet and suboptimal lifestyle choices.
As always, empower yourself with the best information you can and partner with a physician and fertility specialist who is knowledgeable about the topic.
Wesselink E, Koekkoek WAC, Grefte S, et al. Feeding mitochondria: Potential role of nutritional components to improve critical illness convalescence. Clin Nutr. 2019 Jun;38(3):982-995.
Xu Y, Nisenblat V, Lu C, et al. Pretreatment with coenzyme Q10 improves ovarian response and embryo quality in low-prognosis young women with decreased ovarian reserve: a randomized controlled trial. Reprod Biol Endocrinol. 2018 Mar 27;16(1):29.
El Refaeey A, Selem A, Badawy A. Combined coenzyme Q10 and clomiphene citrate for ovulation induction in clomiphene-citrate-resistant polycystic ovary syndrome. Reprod Biomed Online. 2014 Jul;29(1):119-24.
Florou P, Anagnostis P, Theocharis P, et al. Does coenzyme Q 10 supplementation improve fertility outcomes in women undergoing assisted reproductive technology procedures? A systematic review and meta-analysis of randomized-controlled trials. J Assist Reprod Genet. 2020 Oct;37(10):2377-2387.
Ma Long, Cai L, Hu M, et al. Coenzyme Q10 supplementation of human oocyte in vitro maturation reduces postmeiotic aneuploidies. Fertil Steril. 2020 Aug;114(2):331-337.
Wiser A, Gonen O, Ghetler Y, et al. Addition of dehydroepiandrosterone (DHEA) for poor-responder patients before and during IVF treatment improves the pregnancy rate: a randomized prospective study. Hum Reprod. 2010 Oct;25(10):2496-500.
Xu L, Hu C, Liu Q, Li Y. The Effect of Dehydroepiandrosterone (DHEA) Supplementation on IVF or ICSI: A Meta-Analysis of Randomized Controlled Trials. 2019 Jul;79(7):705-712.
Jahromi B, Sadeghi S, Alipour S, et al. Effect of Melatonin on the Outcome of Assisted Reproductive Technique Cycles in Women with Diminished Ovarian Reserve: A Double-Blinded Randomized Clinical Trial. Iran J Med Sci. 2017 Jan;42(1):73-78.
Eryilmaz O, Devran A, Sarikaya E, et al. Melatonin improves the oocyte and the embryo in IVF patients with sleep disturbances but does not improve the sleeping problems. J Assist Reprod Genet. 2011 Sep;28(9):815-20.
Batıoğlu A, Sahin U, Gürlek B, et al. The efficacy of melatonin administration on oocyte quality. Gynecol Endocrinol. 2012 Feb;28(2):91-3.
Nishihara T, Hashimoto S, Ito K, et al. Oral melatonin supplementation improves oocyte and embryo quality in women undergoing in vitro fertilization-embryo transfer. Gynecol Endocrinol. 2014 May;30(5):359-62.
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