Fertility Supplements for Egg Quality (and Egg Freezing)

If you’ve been told that your egg quality is low, you’re probably wondering whether there exist any effective fertility supplements for egg quality. TTC is an emotionally charged season. From hormone fluctuations to the overwhelming desire for a child, to the fears and frustrations of unknowns, family planning is anything but easy. It requires enormous investments of time, energy, emotions, and for many, money.

With IVF or egg freezing, the number one concern my patients have is how to ensure that the process will be worth it—the hormones, the injections, the lengthy procedure, and all the emotions that come with it. With starting a family in general, most feel a deep sense of urgency which begs the question of how to make pregnancy happen sooner and reduce the risk of complications or loss.

For many women, delayed conception, miscarriage, or failed IVF (or egg retrieval attempts) result from problems with egg quality. In many fertility circles, egg quality is seen as something that cannot improve, and can only decline due to age. But the good news is that the research tells a different story. As a functional medicine doctor, I help patients improve egg quality on a daily basis, whether using fertility supplements for egg quality, or other lifestyle strategies. Egg quality is something that should be on everybody’s radar, IVF or not, to ensure the healthiest possible outcomes.

Why Care About Egg Quality?

As a refresher from Sex Ed in high school, pregnancy = the implantation of an embryo, and embryos are formed when the sperm meets the egg. Sperm and eggs each contain half a set of DNA, so when the two meet and rendezvous, a person with a ‘complete’ set of DNA is formed. (Way cool!)

Although a woman is born with all the eggs she will ever have, they aren’t all mature. Eggs take about 3 months to mature, with one (typically) achieving full maturity over the course of one menstrual cycle. Of course, this process can be overridden for the purposes of IVF by using medication, and some women may occasionally release more than one mature egg in a given cycle. (If fertilized, this would result in fraternal twins.)

The entire process of egg maturation affects the resultant quality of the egg released in a given cycle (or harvested during an egg retrieval.) This means that each of the 90 days leading up to the egg release/retrieval is important in terms of nutrient quality and availability, exposure to toxins or inflammation, and the delicate balance of hormones that ebbs and flows to bring that egg to maturity. To say that preparation is important for egg quality is an understatement!

One of the most important factors when considering egg quality is not just the fertility supplements for egg quality that you take at the time of IVF, or at the time of TTC, but also for the 3 months leading up to that day of ovulation. Furthermore, the hormonal environment in those preceding three months (or years) also matters. So, if you’re looking to maximize egg quality, you need to also focus on your hormones.

Many factors contribute to egg quality, such as diet, lifestyle, and more. But today’s post is all about evidence-based supplements (supported by research) that can be used to maximize egg quality, ovulation, and fertility.

If you are trying to conceive, preparing for an egg retrieval for IVF or egg freezing, this post is for you!

How Do I Know if I Have Low Egg Quality?

Age is not a clear marker when it comes to egg quality. While we do know in the research that egg quality declines with age, and particularly rapidly after age 35, not all women in their 30’s have poor egg quality. What’s more is that plenty of women can and do have poor egg quality in their younger years.

Diagnosing Low Egg Quality/Ovarian Reserve

Egg quality is classically assessed using a blood test for anti-mullerian hormone, or AMH. In most cases, a low AMH level indicates poor egg quality/ovarian reserve, and a higher number relates to better egg quality. Note that in women with PCOS, AMH levels may become quite high due to the polycystic phenomenon occurring in the ovaries. This is not necessarily a sign of good egg quality but is more a reflection of the number of follicles on the ovaries. With age, women tend to have fewer quality follicles, which is why AMH levels drop.

While egg quality, ovarian reserve and AMH levels may vary, even among otherwise healthy women, we do tend to see a decline in AMH levels with age. Researchers have identified the following “median” AMH levels for women of different ages, summarized in the following table:

Age of Woman (years)	Median AMH Level (ng/mL)
20	4.2
25	3.3
28	2.8
31	2.3
34	1.7
37	1.0
40	0.5
43	0.2
45	0.1

Antral Follicle Count

While AMH is more classically used as a marker of egg quality, counting the number of follicles on the ovaries through ultrasound imaging can also be used as a measure of ovarian reserve. With this type of imaging (typically only conducted through IVF retrieval cycles), the lower the number, the lower the likelihood of a quality, mature egg.

Lifestyle Strategies to Support Egg Quality

Across the board, research shows that lifestyle strategies are one of the best ways to reduce inflammation and oxidation of egg quality (and sperm quality). Here are a few key areas that I always extensively counsel my patients on, when trying to conceive:

• An antioxidant-rich, whole-food diet, limiting processed foods (especially processed carbohydrates and refined vegetable oils)
• Sleeping at least 8-9 hours per night
• Moderate exercise (30-45 minutes daily) such as brisk walking, light jogging, yoga, Pilates and weight training
• Stress management
• Social support, including counseling if necessary
• Avoid smoking/nicotine and other drug use, alcohol consumption, and excess caffeine
• Limit or avoid exposure to toxins, including endocrine toxins (such as VOCs, fragrance, plastic, BPA, phthalates, aluminum, mercury and other heavy metals, etc.)

Fertility Supplements for Egg Quality

There are many supplements on the market for fertility, but it can be challenging to know what will work and why. For example, some supplements serve as an alternative to fertility drugs, whereas others may serve to help regulate cycles in women who have irregular periods. These hormone-regulating supplements therefore also can be seen as fertility supplements for egg quality.

However, the second most important reason that egg quality declines is due to “aging,” or, more accurately, due to oxidative stress. With time, but also with exposure to toxins in the environment, oxidation reactions take place in the eggs, causing damage. The bad news about this is that toxins are everywhere and, when we view time as a “toxin,” it’s unavoidable. But the good news is that for most women, we can combat the effects of time by focusing on other aspects of egg quality degradation.

The majority of the following fertility supplements for egg quality focus on reducing cellular aging by acting as antioxidants. We are exposed to countless chemicals in our environments and through the natural processes of daily life that produce inflammation, so antioxidant power is everything when it comes to egg quality!

CoQ10

Ubiquinol (not to be confused with ubiquinone) is an antioxidant. This means that it reduces chemical stress in the body and supports mitochondrial function to prevent cell damage. When cells, especially oocytes or eggs, become damaged, it’s more likely that they will die prematurely or multiply into further cells that are not viable. While oxidative stress is a risk factor to all cells, it’s of particular importance with regards to egg quality and fertility.

CoQ10 is also beneficial in egg retrievals in individuals with decreased ovarian reserve. Supplementation with CoQ10 increases the number of healthy eggs that are harvested during a stimulation cycle, and makes it more likely that a healthy egg will be released during a natural cycle.

Ubiquinol is found in foods at very low levels, but these levels are not enough to produce a therapeutic effect. The research shows benefit from 600 mg of ubiquinol taken daily with food leading up to conception.

Note: it is dangerous to suddenly discontinue CoQ10 if it has been used as a supplement for a substantial period of time. If you are planning to discontinue CoQ10, such as in the case that a healthy pregnancy has been established, talk to your doctor about weaning off gradually.

Which type of CoQ10 should you use?

Ubiquinol is the active form that is used by cells to support egg quality. Ubiquinone, on the other hand, needs to be converted into ubiquinol by the body before being used, and this may or may not take place effectively. For this reason, studies are performed using ubiquinol, and that is the form that I recommend to my fertility patients.

EPA and DHA (Omega 3 Fatty Acids)

EPA and DHA are two key omega-3 fatty acids that are of utmost importance for fertility, egg quality and pregnancy. Research has shown that dietary supplementation with omega-3s improves egg quality, delays ovarian aging, and reducing the risk of birth defects. Studies have shown that an excess of omega-6 fatty acids in comparison to omega 3’s leads to very poor egg quality, so supplementation of EPA and DHA is important for anyone whose diet does not already support healthy fatty acid balance. EPA and DHA are of particular importance as fertility supllements for egg quality for women over age 35 who are trying to conceive because fertility naturally starts to decline after this point.

In my practice, I recommend that my pateints use Prenatal DHA from Nordic Naturals.

NAC

NAC is a powerful antioxidant. Part of its job is to recycle glutathione, which is part of the body’s natural detoxification system which can be rapidly depleted with illness or use of acetaminophen. Because it is an antioxidant, NAC is important for egg quality, IVF, fertility and pregnancy for many of the same reasons as omega-3 and CoQ10 supplementation, however it accomplishes these outcomes through a different pathway. Like Omega-3s, NAC is safe to take during pregnancy, especially when periods of illness occur. Evidence in research demonstrates that NAC delays aging of eggs and ovaries, and improves blastocyst quality.

NAD+

NAD+ is a naturally occurring coenzyme involved in hundreds of metabolic processes in the body. One of its primary roles is in mitochondrial function, cell regeneration and reduction in oxidative stress. Because mitochondrial function is an essential factor in oocyte (egg) aging and quality, focusing on mitochondrial function is an important consideration for fertility and egg retrieval. Niacin (vitamin B3) is one of the main nutrients involved in regeneration of NAD in the body (also known as NAD+ and NADH), however supplementing with pure niacin can cause a flushing of the skin which is accompanied by intense itching. Nicotinamide is sold as an alternative to niacin without the risk of flushing, however it has the potential to inhibit other enzymes (sirtuins) involved in cellular repair.

One of the most recently discovered types of NAD-boosting vitamins comes from Nicotinamide Riboside, the main ingredient in the supplement “Tru Niagen.” Because supplements can be expensive, you may also consider using a low-dose combination of niacin and nicotinamide in combination with a diet rich in fish, green vegetables and mushrooms which are excellent food sources of vitamin B3.

Pterostilbene

You may have heard that red wine has antioxidant health benefits. Of course, alcohol is not high on the list of foods to consume when TTC, and the main antioxidant chemical found in red wine, resveratrol, hasn’t been proven for safety in pregnancy either. However, resveratrol’s blueberry-derived cousin Pterostilbene offers the same revolutionary antioxidant benefits as resveratrol itself. Specifically, this chemical increases the expression of proteins called sirtuins which are responsible for cellular repair and anti-aging in ovaries. When it comes to egg quality, this function is essential, and is a key reason that pterostilbene is such an important fertility supplement for egg quality, particularly among aging women.

Pycnogenol

Pycnogenol is an antioxidant which helps prevent the breakdown of nitrous oxide in the blood stream and at the ovarian level. Nitrous oxide dilates blood vessels, increasing blood flow and oxygen availability to cells. Poor oxygen availability harms cells and leads to cell breakdown whereas relaxed blood vessels, strong blood flow and plenty of oxygen helps prevent oxidative stress, promote cellular repair and prevent egg aging.

Melatonin/Inositol/Alpha Lipoic Acid

Additional antioxidant benefit has been shown in the reserach when using melatonin, inositol and alpha lipoic acid as fertility supplements for egg quality. There is some evidence that melatonin helps improve egg quality regardless of a PCOS diagnosis by forming a barrier between inflammatory chemicals and eggs themselves by accumulating in follicular fluid. However, melatonin should not be used long-term or during pregnancy. Like CoQ10, it’s not a good idea to abruptly discontinue melatonin use; it should be gradually weaned. Other considerations are to ensure that inositol supplements include a 40:1 ratio of myo-inositol and D-chiro inositol (many simply contain myo-inositol). Likewise, alpha-lipoic acid can act as an anti-inflammatory and protectant non-PCOS women against egg damage, oxidative stress, inflammation and neurotoxins both when TTC as well as during pregnancy.

DHEA

DHEA is unique because although it is not directly an antioxidant chemical, it reverses aging processes in ovaries. However, this hormone should be used with caution, particularly in women who already have elevated levels of DHEA or testosterone, as seen is PCOS. As with other hormones, there are risks both when the level is too low (accelerated ovarian aging) as well as when too high (irregular periods, delayed or absent ovulation, hair loss.) That being said, there is strong evidence that DHEA supplementation can both improve chances of natural pregnancy as well as IVF outcomes, especially in women over age 40.

A note of caution: excess DHEA supplementation may produce androgenic symptoms, like excess sweating, acne, hair loss and hot flashes. I always test my patients’ DHEA levels before supplementing, and monitor blood levels thereafter. I have seen many IVF clinics blindly recommend a 25 mg starting dose and while this may be appropriate for some women, a safer place to start is lower, around 5 or 10 mg.

Other Ways to Support Egg Quality Apart from Supplements

Supporting egg quality, as with anything in functional medicine, comes down to understanding the root cause and making a correct diagnosis for the underlying problem. While age-related ovarian decline is a great reason to seek out fertility supplements for egg quality, and is a big reason that I recommend these antioxidant strategies in my practice, it’s also important to keep in mind that ovarian aging is not simply a supplement deficiency.

Here are some other important ways that I have helped my patients reverse low AMH and poor egg quality:

• Identifying and treating underlying autoimmune disease (including Hashimoto’s and ANA+ autoimmunity)
• Eliminating food allergens
• Treating chronic infections (including viral and bacterial infections)
• Balancing the gut microbiome
• Supplementing with bioidentical progesterone
• Hormetic/mitochondrial strategies like red light, cold plunging and supervised fasting
• Correcting blood sugar imbalances

To sum things up…

If you’ve been told that your egg quality is low, know that this is not a hopeless diagnosis. While age and time do influence ovarian reserve, egg quality is dynamic and responsive to the environment you create in the months leading up to ovulation or retrieval. By focusing on the critical 90-day window of egg maturation, addressing inflammation and oxidative stress, optimizing hormones, and using targeted fertility supplements for egg quality when appropriate, you can meaningfully improve your chances of healthy conception. Fertility supplements for egg quality can be powerful tools, but they work best when combined with personalized testing, root-cause evaluation, and supportive lifestyle changes. Whether you are preparing for IVF, egg freezing, or trying to conceive naturally, taking proactive steps to support egg quality can help you move forward with greater confidence and clarity.

If you loved what you read here, check out these related posts:

• Natural Alternatives to Fertility Drugs
• Progesterone Deficiency