What is “egg quality” and why does it matter?
No, I’m not talking about the best before date on the eggs in your fridge! This article will educate you about eggs and empower you with strategies to improve egg quality.
“Egg quality” in a fertility context refers to the health of eggs, particularly their chromosomal normality. Chromosomes carry genetic material which is the blueprint for building an organism. Humans have 23 pairs of chromosomes (46 total), with half of each pair contributed by the egg and half by the sperm.
Egg quality influences the ability to be fertilized and develop into an embryo that results in a viable pregnancy. Supporting egg quality leads to higher likelihood of fertilization and subsequent successful pregnancy and birth, whether naturally or through assisted reproduction techniques such as intrauterine insemination (IUI) or in-vitro fertilization(IVF). For IVF as an example, better egg quality can also yield more viable eggs retrieved, more healthy embryos, and potentially fewer cycles, saving precious time, energy, and money.
My experience with egg quality
If you are over 30 and trying to have a baby, you may suddenly feel VERY OLD, even though you’re not even “middle-aged” yet! It doesn’t help that pregnancies after age 35 are labeled “advanced maternal age,” or the even more insulting term “geriatric pregnancy.” Only in the fertility world is someone in their 30’s or 40’s considered “old”, right?
So, if you’re worried about your egg quality, I’ve been there! I had my daughter at 37 years old and started trying to conceive again at nearly 39 years old, taking a prenatal supplement as I had before, plus basic egg quality support due to my excessive “maternal age.”
First, I had a chemical pregnancy, which is a positive pregnancy test but very early miscarriage occurring shortly after implantation. Then a couple of months later a pregnancy that ended in miscarriage.
At this point I dove deep into education on egg quality (and sperm quality, stay tuned for that article soon). As a result, I made further changes to our diet, lifestyle, and home environment. I also added supplements to nurture my ovarian environment where my eggs were maturing (and for my husband’s sperm development).
Knowing that it can take three to four months to see the full effect of any changes, I was simultaneously disappointed and encouraged by two more chemical pregnancies in the next four months. Finally in January 2020 I became pregnant with my son! Just in the knick of time before COVID shut the world down.
Click the links to learn more about me and how I work with patients to enhance fertility.
The incredible egg
Did you know that ovaries in a fetus begin to be formed during the first trimester and primordial follicles (that will mature into eggs) are formed in the second trimester of pregnancy?
That means that the follicle that became YOU was formed while your mother was a fetus INSIDE your grandmother! And if you have ovaries, they and the follicles (fluid-filled sacs in the ovaries that contains immature eggs) they contain were formed by the halfway point of your mother’s pregnancy with you.
This is amazing BUT can also be alarming! Because the health and ovarian environment of your grandmother and mother (over which you had no control!) affect your reproductive health today. This may feel daunting, but it shows how profoundly health matters, rippling to future generations. Environmental health matters, whether air quality, food and water quality, plastics, or environmental toxins, what we are exposed to has an influence on current and future generations. It can also be empowering, because your choices now influence not only your health but the health of future generations.
Can egg quality be measured?
It would be so great if there were a simple test for egg quality! Unfortunately egg quality, unlike sperm quality, cannot be directly measured. There are ways to measure ovarian reserve such as FSH, AMH, and antral follicle count but these do not assess chromosomal health or egg quality.
Can egg quality be improved?
Egg quality begins a gradual decline around age 30 and this decline accelerates noticeably after age 35. Immature follicles in the ovaries (that will develop into eggs) accumulate damage over time, so the older we are, the more damage occurs. While it is true that age is the strongest predictor of egg quality, it is not the whole story!
It is also currently accepted (although there is some research investigating follicle formation or renewal after birth) that people with ovaries are born with all the follicles they will ever have. Because the number of potential follicles is finite, it was assumed that egg quality was also set in stone and unchangeable.
But, good news! Immature follicles are affected by the ovarian environment which in turn is affected by lifestyle factors such as diet, sleep patterns, stress levels, as well as nutrition, medications, and exposure to various environmental elements. So while those follicles are hanging around waiting for their turn, you can take steps immediately to reduce the effects of aging.
Then, about four months BEFORE ovulation, immature follicles begin to develop, with typically only one maturing to release an egg. This window leading up to ovulation is a huge opportunity to positively influence the health of the egg that will be released.
How long does it take to improve egg quality?
While any improvements to overall health and the ovarian environment immediately impact developing follicles, it is ideal to allow at least three to four months to see the full effect of any changes or treatments. And beyond three to four months you can continue to benefit from reducing age-related decline in egg quality.
What to AVOID to improve egg quality
Let’s start with what NOT to do! Many exogenous toxins (harmful substances from outside our bodies) negatively impact fertility by causing chromosomal damage and disrupting hormones, for both egg and sperm contributing partners. Reducing exposure can have a significant beneficial effect on egg quality.
Smoking or vaping:
Perhaps the most obvious, smoking tobacco can lead to egg loss and early menopause on top of all the other known negative health effects. We are still learning about health impacts of vaping, but it doesn’t look good, so rather than wait, I recommend patients stop vaping too.
Cannabis (and other recreational drugs):
Cannabis use, even as infrequently as once per week, can impact female fertility, with increased negative effects when combined with alcohol or cigarettes. Many other recreational drugs also have negative effects so I recommend avoiding altogether for optimal fertility.
Alcohol:
Alcohol intake is associated with higher miscarriage rates and less success in fertility procedures like IUI and IVF. Even small amounts affect fertility, so I recommend that patients abstain from alcohol entirely for at least 12 weeks prior to trying to conceive naturally or via fertility procedures.
Medications:
Some medications have known fertility effects such as such as antidepressants (SSRIs), anti-seizure medications, and antiretrovirals. Any concerns about current medications should be discussed with your healthcare professional to assess what is safe for you.
Caffeine:
Sorry coffee lovers, high caffeine intake is linked to higher miscarriage rates. I recommend that patients trying to conceive aim to bring their caffeine consumption to at most three cups of coffee daily before pregnancy and at most one cup black tea or half a cup of coffee during pregnancy. Consider abstaining entirely from caffeine for at least four weeks prior to fertility procedures like IUI or IVF.
Environmental toxins:
This is a big topic with data continuing to grow, but it is clear that environmental toxins have a negative effect on fertility. There are simple steps you can take to reduce your exposure to the most harmful toxins immediately.
Bisphenol A (BPA)
BPA is an endocrine disruptor with wide-ranging effects, even from very small amounts. It has been associated with chromosomal abnormalities and increased risk of miscarriage, among many other health risks such as diabetes, heart disease, liver toxicity, thyroid disorders, and other hormonal imbalances. Avoid BPA whenever possible, including:
- Packaging containing BPA: Cans are usually lined with BPA and BPA substitutes can also be problematic so choose packaging other than cans, especially canned tomatoes (worst due to acidity)
- Products coated with BPA, such as most receipts
- Plastics made with BPA: usually number 7 recycling code and avoid hard/clear plastics
Phthalates
Phthalates are widely used in food processing, plastics, vinyl, cleaning/personal care products, nail polish, and fragrances. They are known estrogen and testosterone disruptors, impair egg development and embryo survival, reduce sperm quality, and they may increase likelihood of miscarriage. Reduce your exposure to phthalates by:
- Cook at home more often, using whole/less-processed foods
- Avoid products that list “fragrance” or “perfume” as an ingredient as these often contain phthalates (choose fragrance-free products instead)
- Avoid nail polish (contains high levels of phthalates), fabric softener (choose dryer balls instead), and products made with PVC, such as shower curtains or yoga mats
Plastics
Many plastics (probably all plastics to some extent) also act as endocrine disruptors, including those labelled BPA-free. Reduce your plastic exposure by:
- Never use plastic for reheating, cooking, and food storage (choose glass, stainless steel, or ceramic for food storage, bowls, cups, kettles, colanders, and other kitchenware)
- Hand wash plastics to avoid high heat from dishwasher
- Avoid highly processed foods which are more exposed to plastics via processing and packaging (choose whole/less-processed foods instead)
- Avoid buying/using plastic water bottles, straws, disposable drink cups/lids, plastic bags, and plastic toys (choose glass or stainless steel for drinking, use cloth bags and washable produce bags)
How to improve egg quality
Now that you know key things to avoid that negatively impact egg quality, there are several key steps you can take to proactively improve egg quality starting NOW.
Thorough health evaluation:
Good health = good reproductive health. For any patient working on fertility, the most important starting point is to review your overall health and what has been assessed and diagnosed (or ruled out) so far. In nearly every case, and especially if patients are embarking on fertility treatments like IUI and IVF, I recommend additional assessment to rule out often overlooked conditions. Each of these conditions has a strong link to infertility and miscarriage and are often NOT tested automatically by fertility clinics:
- Insulin resistance
- Vitamin D deficiency
- Low (or high) DHEA-S
- Autoimmune thyroid conditions
- Celiac disease/gluten sensitivity
Testing can be done in by a medical doctor or can be fairly affordable if ordered by a naturopathic doctor (paid out-of-pocket), especially if you have health benefits that cover naturopathic testing.
Good sleep:
Sleep is vitally important for health, including reproductive health. Poor sleep can wreak havoc with the body’s hormonal balance which of course affects egg quality.
The National Sleep Foundation recommends seven to nine hours of sleep per night for adults 26-64 years old. This need seems hard-wired for humans, which means that while we can survive on less sleep, for optimal health and performance this amount is pretty non-negotiable. Getting less than seven hours of sleep per night is consistently associated with many negative health outcomes, and less than five hours of sleep per night carries even more significant health risks.
Key recommendations for better sleep:
- Get into bed at least 8 hours before you need to wake the following day
- At least 1 hour before bed avoid stimulating/stressful activities and dim household lights and screens
- Keep your bedroom cool (18-20 degrees Celsius is recommended) and dark (if you open your eyes in the night, you shouldn’t be able to see anything)
If you still have trouble falling or staying asleep, seek appropriate treatment from a naturopathic doctor. There is so much we can do to improve sleep, you don’t have to struggle!
Nutrition:
Nutrition also has a dramatic impact on health. Most patients tell me they want to eat better and in my experience nutritional advice is best individualized depending on the patient and their needs. Changes are most sustainable when implemented gradually and with accountability and support from a healthcare practitioner educated in nutrition, such as a naturopathic doctor.
When focusing on fertility, there are some consistent recommendations that are shown to improve reproductive health:
Carbohydrates and fibre
Diets high in refined carbohydrates are associated with higher rates of infertility. I recommend:
- Prioritize beans/legumes, nuts, seeds, whole fruit, and especially vegetables: aim for at least 1-2 servings of vegetables at every meal
- Choose whole grains: Whole rolled/steel cut oats, brown rice, wild rice, quinoa, buckwheat, and other whole grains
- Limit simple carbohydrates like white rice, potatoes, corn
- Avoid processed grains like pasta, breads, cereals, quick/instant oats
- Avoid baked goods, candy, dried fruit, and fruit juice
- Avoid white/brown sugar, corn syrup, rice syrup, agave, and artificial sweeteners, choosing minimal amounts of more natural, less processed sweeteners like maple syrup, honey, molasses
Fats
Higher intake of saturated fats is associated with worst fertility outcomes, while higher intake of healthy fats are associated with better fertility and lower miscarriage rates. I recommend:
- Limit saturated fats found in red meat, butter, and coconut oil
- Increased healthy fats found in olive oil, nuts, seeds, plant-based oils, and fish
Protein
Finally, many adults do not eat sufficient protein. Proteins provide essential amino acids necessary for health, including hormonal health and reproduction. Aim for at least 0.5-1 gram of protein per pound (1-2 grams per kilogram) of target body weight daily. Here are some examples of protein content for various foods:
- Chicken or turkey breast OR extra-lean ground beef (3 ounces): 25-26g
- Halibut OR salmon (3 ounces): 18-21g
- Pea or whey protein powder (1 scoop): 20-24g
- Greek yogurt (half cup plain, whole) OR mozzarella cheese (1.5 ounces): 11-13g
- Lentils (half cup cooked) OR Pumpkin seeds (1 ounce) OR Tofu (firm, half cup): 9g
- Soybeans OR black beans OR pinto beans (half cup, cooked): 8g
- Chicken egg (1 large) OR Almonds (1 ounce) OR Nutritional yeast (2 Tablespoons): 6g
- Chia seeds OR hemp hearts (1 Tablespoon): 3g
Supplements:
There are so many supplements sold for fertility, but it is best to work with a naturopathic doctor to tailor a plan to your needs and ensure safety and efficacy. A few commonly used supplements to support egg quality:
- Prenatal multivitamins provide broad nutrient and antioxidant support essential for egg health, can help prevent birth defects, and can reduce miscarriage rates. Look for formulations containing at least 1mg of methylfolate (rather than folic acid) and a gentle form of iron. A naturopathic doctor can help you find a prenatal that works for you.
- Coenzyme Q10 (CoQ10) is a powerful antioxidant that enhances energy production within developing egg cells. It has been extensively studied and shown to improve egg quality, conception rates, prevent chromosomal errors, and support embryo implantation. There are variations in dosing and form depending on your needs, so best to seek professional advice.
- Omega-3 Fatty Acids are associated with higher quality embryos and increased pregnancy rates, and support progesterone production and uterine blood flow. There is a lot of variation in quality and potency, so best to seek professional guidance to ensure this is indicated and effective for you.
- N-acetyl-cysteine (NAC) boosts the body’s production of glutathione, a master antioxidant. It can improve egg and embryo quality, increase chances of pregnancy, and reduce miscarriage rates. It is not right for everyone and can cause minor side effects, so speak to a professional if you think this may be right for you.
Beyond these basics, there are other supplements than may be indicated to support fertility, so work with a naturopathic doctor to find out what is right for you.
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