Why Women Seek Functional Medicine PCOS Treatment

Many of my patients come to me looking for an alternative to the birth control prescription given to them by their OB/GYN. Others have friends or family with a PCOS diagnosis, and are wondering if that’s the reason for their own irregular and/or painful cycles. Some ladies worry if they’ll ever be able to have children, since PCOS has complicated their fertility, and still more patients come to me out of desperation—they’ve already worked with another “natural doctor” who had put them on an extremely restrictive diet and told them to lose weight. I have even heard of PCOS patients being prescribed gluten-free, dairy-free, low-carb, sulfur-free diets. Functional medicine PCOS treatment offers hope of realistic, sustainable treatment where most other providers give a grim prognosis or simply leave patients feeling overwhelmed.

In this post, we’ll be diving into the details about PCOS: what it is, what it isn’t, how it’s managed by most healthcare providers, functional medicine PCOS treatment strategies, and more. As a starting point, I encourage you to check out my fertility overview post (Female Fertility 101) if you aren’t familiar with the ins and outs of your menstrual cycle. That post lays the groundwork for understanding the status quo of periods, hormones, women’s health, and it’s important to understand these topics before we start talking about with cycles that fall outside of the norm. [Although it’s the most common, it’s not the only period problem faced by women. To learn more about what your period can tell you about your health, check out this post.]

What Is PCOS, and How Is It Diagnosed?

PCOS stands for Polycystic Ovarian Syndrome, one of the most common endocrine and metabolic disorders in women of reproductive age. The syndrome is defined by hormonal imbalances and ovarian dysfunction, and it’s diagnosed only after other causes for the patient’s symptoms have been ruled out (such as hypothalamic amenorrhea). Because of this, many women have to go through a frustratingly long and drawn out process in order to get answers for their health struggles. However, functional medicine PCOS treatment offers faster results because it gets to the root cause.

Functional Medicine PCOS Diagnosis

The name “polycystic ovarian syndrome” is a bit of a misnomer, because although ovarian cysts are common in PCOS patients, they aren’t part of the diagnostic criteria—many women with PCOS don’t have any cysts on their ovaries at all. Rather, a PCOS diagnosis is given when at least two of the three following criteria are met: [Reference]

• Hyperandrogenism (elevated androgen hormones, assessed via lab work)
• Anovulation or oligo-ovulation (absence of ovulation or infrequent ovulation, usually leading to irregular cycle length)
• Polycystic appearance of ovaries (assessed via ultrasound imaging)

The general consensus in the medical community is that a PCOS diagnosis should be given when a woman has either polycystic ovaries and/or irregular cycles in addition to high androgen levels on her blood work. When making the diagnosis, doctors are careful to rule out other causes of high androgens, such as adrenal disorders, thyroid disease, drug-induced androgen excess, and other hormonal disorders, as well as alternative causes for irregular cycles.

Types of PCOS

PCOS patients typically fall into two different categories: insulin resistant, and non-insulin-resistant types. As is the case with most hormonal disorders, more than one level is out of balance. The vast majority of women who suffer from PCOS also present with insulin resistance, glucose intolerance, dyslipidemia, and elevated levels of inflammation. Part of what makes treating PCOS so complex is that these hormonal imbalances feed off of each other: elevated insulin levels trigger a feedback loop via the HPATG axis that leads to further androgen levels, and vise-versa. Apart from the insulin resistance piece, functional medicine PCOS diagnosis further divides PCOS into 4 separate categories which you can read about here.

Symptoms of PCOS

The symptoms experienced by women with PCOS vary because not everyone meets the same diagnostic criteria, and the extent of those experiences can vary too. Some women experience only mild elevations in androgens, and symptoms are consequently lesser. Women who have cysts on their ovaries often experience pain related to the formation and/or rupture of cysts, which are symptoms that wouldn’t be experienced by women who do not have cysts. Likewise, symptoms for women who concomitantly deal with insulin resistance face different symptoms than women who do not.

• Symptoms Related to Excess Androgens
  • Excessive hair growth (face, chest, back, buttocks)
  • Thinning hair
  • Oily skin
  • Cystic acne
• Symptoms Related to Anovulation/Olig-ovulation
  • Long cycles (more than 35 days) or irregular cycle lengths
  • Difficulty conceiving or repeated miscarriages
  • Abnormal uterine bleeding
• Symptoms Related to Polycystic Ovaries
  • Painful periods and/or pelvic pain
  • Sudden, intense abdominal pain resulting from ruptured cysts
• Symptoms Related to Insulin Resistance
  • High blood pressure and/or high cholesterol
  • Fatigue after meals
  • Weight gain, especially in the abdominal area
  • Dark patches of skin, particularly along neck creases, in groin and under breasts (this is called ancanthosis nigricans)
  • Skin tags

Due to the fluctuating hormones, many women also experience generalized symptoms related to hormonal imbalances, which include (but are not limited to): fatigue, insomnia, anxiety, depression, headaches, etc.

Functional Medicine PCOS (Causes and Treatment)

The root cause isn’t really known. The current understanding is that it’s a mixture of genetic predisposition and environmental triggers, but other theories include nutritional conditions in the uterus, prenatal exposure to androgens, insulin resistance on an and more [reference]. Because of this, most treatments focus on managing symptoms—painful periods, irregular cycles, insulin resistance, etc. Hormonal contraceptive use also can induce a reversible type of PCOS, but the symptoms can continue for months or even years (called “post-pill PCOS”).

On a physiological level, we know that elevated androgens and insulin resistance result from dysfunction in the hypothalamic-pituitary-adrenal-thyroid-gonadal axis. In women with PCOS, the pituitary gland releases higher-than-normal levels of luteinizing hormone (LH), which stimulates the ovaries to produce more testosterone than usual. (Ovaries normally produce some testosterone, but problems result when they produce too much.) This over-stimulation of the ovaries by luteinizing hormone also cancels out the mid-cycle LH surge that typically triggers ovulation.

Pituitary Hormones and PCOS

At the same time, the pituitary gland releases lower-than-normal levels of follicle-stimulating-hormone, which prevents eggs from reaching full maturity. When this happens, the follicle does not release the egg (ovulation does not occur, AKA anovulation). The immature egg either dissolves, or remains in the follicle, forming a cyst. Since the follicular remnant after ovulation (called the corpus luteum) is responsible for producing progesterone during the luteal phase, many women experience additional symptoms related to low progesterone levels. (Read more about luteinizing hormone, follicle-stimulating hormone, progesterone, and the luteal phase in this post: Female Fertility 101)

The Birth Control Pill and PCOS

Most OB/GYNs prescribe oral contraceptives as a first line of treatment for PCOS, because the artificial hormones suppress the natural cycling of luteinizing hormone, follicle-stimulating hormone, estrogen, progesterone, and testosterone. The simulated hormonal environment causes the endometrial lining to develop and shed as it would in a natural period, but it take the ovaries out of the equation: no egg matures, no egg is released, and fertility is not possible.

My goal as a functional medicine doctor is to promote the natural fertility of my patients, empowering them to have healthy cycles rather than suppress the normal functioning of their bodies. That being said, sometimes the healthiest thing for a patient and her values is to reduce the pain, control the hormonal dysfunction, and reach a place where she feels that her health is manageable. If that means medication, that’s okay—the most important thing is that she is able to manage her wellbeing according to her values.

Prescription Medications for PCOS

Another medication used in the treatment of PCOS is spironolactone, which is typically used as a diuretic drug for individuals with cardiovascular disease. However, this drug also has a secondary effect of reducing androgen levels in the body, which can be helpful in controlling irregular bleeding, hair growth, and other symptoms of high androgens in women with PCOS. Like birth control pills, using spironolactone targets hormonal pathways of PCOS without addressing the root cause. This is where functional medicine treatment for PCOS can fill a huge gap and meet a huge need.

The third medication that is used in the management of PCOS is metformin, which is a drug typically given to patients with diabetes. Metformin improves insulin resistance, which can be helpful in the treatment of PCOS because of the amplifying effect that insulin plays in the production of testosterone. When insulin sensitivity improves, often testosterone levels follow suit. You can read more about the use of metformin as a fertility drug (and natural alternatives) in this post.

Functional Medicine Treatment for PCOS: Lifestyle & Supplements  

Most of my patients come to me because they are looking to avoid the use of prescription drugs in managing their fertility. If that describes you too, keep reading!

1. Lifestyle Factors for Balancing Hormones: The #1 thing we can do to support hormonal balance is building a foundation for well-being. This means taking nutrition, rest, exercise, stress management, and psychological/emotional health into account. Neglecting even one of these areas can create huge interruptions in the HPATG axis, making symptoms of PCOS and other hormonal disorders so much worse. These lifestyle factors include eating enough (in terms of calories, macronutrients, and micronutrients) as well as eating frequently enough to keep blood sugar stable. It also involves balancing exercise and rest to prevent elevations in cortisol, the stress hormone, which interrupts the production of sex hormones like progesterone. This is part of the reason why stress management, sleep hygiene, and social support are so important.
2. Eating a Diverse Diet:Gut health is a huge topic in the media lately, and research continues to show that the best way to support GI health and microbiological diversity is to eat a varied diet, with many different types of plant foods and fibers. The more restrictive our diet (limiting the types of foods we eat to just a few varieties), the more likely we are to disturb our gut microbiome, which plays a huge role in balancing our hormones. (Did you know that bacteria both produce and metabolize hormones When we disturb our gut microbiome, it affects our bodies ability to make hormones as well as clean out the old, broken down ones.) Gut health also helps modulate blood sugar control, which is an important consideration in insulin-resistant PCOS. Check out this study to learn more about the relationship between PCOS and the gut microbiome.
3. Micronutrient Balance: Research has shown that women with PCOS tend to follow certain patterns of vitamin deficiencies, including vitamin D and B vitamins (especially folic acid). Vitamin D plays an important role in supporting the thickness of the endometrial lining, which is often depleted in women with PCOS due to low progesterone levels. Likewise, B vitamins such as folic acid play an important role in follicular maturation, and supplementing with elvels at 700 μg/day can support successful ovulation. Other nutritional deficiencies have also been identified in the majority of women with PCOS, including calcium, zinc, selenium, and chromium. [Reference] While the best way to prevent nutrient deficiencies such as these is to eat a varied and balanced diet (and avoid restriction of food groups of calories), some women may benefit from using supplements—especially Vitamin D. Studies have also shown that supplementing with omega-3 fatty acids, such as those found in cod liver oil, prevent excess inflammation, help manage dysglycemia, and support hormonal balance in women. [Reference]
4. Evidence-Based Supplements:
   1. Inositol: Inositol is a type of sugar alcohol that has been shown to improve insulin sensitivity, lipid synthesis, hormonal signaling, and maturation of oocytes (female eggs) during the follicular phase. Supplementation of inositol in women with PCOS lowers androgen levels, improves insulin sensitivity, and increases rates of ovulation in women with anovulatory cycles. Supplementation is effective when administered in ratios of 40:1 of myo-inositol to D-chiro-inositol, at levels of 4000 mg per day in conjunction with 400 μg of folic acid.
   2. Alpha-Lipoic Acid: This chemical is a free-radical scavenger, meaning that it prevents premature breakdown of biochemicals and hormones in the blood stream. Studies show that supplementation with alpha-lipoid acid decreases prevalence of ovarian cysts and increases progesterone levels in women with PCOS.
   3. Melatonin:While this hormone is typically thought of as a supplement for promoting sleep, it is not a sleeping pill, but rather a hormone. (There are many reasons to avoid using melatonin as a sleep aid, but that’s a topic for another post.) When used in women with PCOS, supplementation at night has been shown to improve ovulation rates, corpus luteum formation, progesterone levels, and pregnancy rates for those who are trying to conceive. Melatonin supplementation also decreases hirsutism and androgen levels when used at 10 mg/night.
   4. Black Cohosh: As described in this post about fertility drugs, research has shown that dosing 20 mg daily of black cohosh at the beginning of the cycle modulates the LH surge during the follicular phase, improving rates of ovulation. This supplement also results in higher progesterone levels during the luteal phase, improving the thickness of the endometrial lining and supporting a luteal phase that is long enough for implantation and pregnancy in women who are trying to conceive.

Closing thoughts…

As if the symptoms of PCOS aren’t difficult enough, the journey towards a diagnosis to explain the symptoms, and finding a treatment strategy that works for you in the context of your own life can add enormous loads of stress to an already challenging life experience. There is a whirlwind of information out there, which only adds to the confusion and frustration of trying to manage your health. It can be a lonely and scary place, but I want you to know that you’re not alone. Consider making an appointment with a functional medicine doctor who can deliver personalized care and help you achieve your health goals.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

Become a Patient

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Sign Me Up!

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Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

The post Functional Medicine PCOS Treatment appeared first on Dr. Alexandra MacKillop.

PCOS is diagnosed when a woman meets two of three criteria: elevated androgen levels on blood work, ovulatory dysfunction and polycystic appearance of ovaries on ultrasound.

1. Elevated Androgens: Testosterone and DHEA are the two androgen levels we test for in women with suspected PCOS. The tests we use to evaluate these include: free and total testosterone levels, sex hormone binding globulin, bioavailable testosterone and DHEA-sulfate. You don’t need to fast for these tests, but the test should be drawn on the third day of your cycle if you are having periods

2. Ovulatory Dysfunction: This is the driving force behind irregular periods in PCOS. Ovulatory dysfunction refers to irregular, anovulatory or absent menstrual cycles.

3. Polycystic Appearance of Ovaries on Ultrasound: First of all, this is not the same thing as true ovarian cysts. Rather, in PCOS, imbalanced hormone levels cause more than one follicle (immature egg) to develop on ovaries in any given cycle, and then they halt in an advanced but still underdeveloped stage of development. This makes the ovaries look bumpy when viewed with ultrasound. However, these cysts don’t become enlarged, burst, or bleed like the other medical condition of ovarian cysts.

Many factors contribute to an individual woman’s experience with PCOS and no two cases look exactly the same. However, there are certain similarities among the hormone imbalances and fertility problems seen in PCOS, so let’s dive into the root cause.

There Are Four Types of PCOS

Knowing which kind you have is fundamental to treating PCOS because it tells us how to get to the root cause.

Insulin-Resistant PCOS

An estimated 50-70% of PCOSis the insulin resistant type. In this category, women have difficulty regulating their blood sugar which leads to elevated insulin levels. This high insulin does a couple of key things:

1. High insulin makes the ovaries more sensitive to LH, a signal from the brain that begins maturing follicles (eggs). This causes a greater number of follicles to start differentiating.

2. High insulin also interferes with the ovary’s ability to choose a single dominant follicle, so the polycystic appearance progresses and no follicle reaches full maturity. As a result, the cycle usually ends up being anovulatory.

3. Because high insulin increases the ovary’s reactivity to LH, they produce more androgens than normal as a result. Because the FSH levels don’t match the LH levels, the ovary can’t keep up with converting this increased testosterone into other hormones so the levels keep rising.

4. These high testosterone levels feed forward into estrogen excess which stimulates the body’s fat cells to grow. As they do so, they produce even more insulin and the cycle continues.

To treat insulin-resistant PCOS, we need to interrupt the cycle, which usually involves addressing blood sugar control.

Adrenal PCOS

The adrenal glands regulate electrolyte balance, blood sugar and sex hormones. They produce small amounts of progesterone and estrogen, but relatively higher amounts of DHEA. They also produce cortisol.

1. High DHEA levels convert into high testosterone levels. This meets the criteria for elevated androgens.

2. Cortisol produces inflammation which disrupts the maturation process of ovarian follicles and can lead to arrested development…hence, a polycystic appearance.

3. High cortisol levels interrupt signaling from the brain to the ovaries, often getting in the way of ovulation. This results in anovulatory cycles and/or missed periods.

Treating adrenal PCOS necessitates finding out what’s taxing the adrenal system so much. Stress can be purely psychological and have this effect, or it may stem from many other forms.

Inflammatory PCOS

Inflammation is the culprit behind so many health problems, including PCOS. Sometimes inflammation is the driving force behind PCOS, especially if insulin is normal and DHEA/cortisol are not both elevated. However, all types of PCOS involve inflammation.

1. Inflammatory chemicals like cytokines directly stimulate the ovaries to produce androgens. [source]

2. Inflammation, especially coming from the chemical TNFα also stimulates adipocyte to produce higher levels of insulin. This higher level of insulin creates all the problems we already outlined in the previous section.

3. Inflammation disrupts follicular maturation and halts development, affecting ovulation rates and creating partially developed follicles—ergo, “polycystic ovaries”

Targeted anti-inflammatory nutrition and supplementation strategies are fundamental in treating PCOS cases that are predominantly characterized by inflammation. It’s also really important to figure out what’s going on beneath the surface that’s driving the inflammation.

Post-Pill

The whole point of the birth control pill is to override the body’s natural signaling to prevent ovulation. That’s how it gets its contraceptive function. But in many cases, ovulation remains suppressed even after a woman discontinues taking it.

1. This type of PCOS is primarily characterized by ovulatory dysfunction because the body needs to figure out how to start ovulating again after months, years or decades of being actively prevented from doing so. However, there’s also a bit more at play.

2. Coming off the pill often results in excess or “rebound” androgen production. This is especially common after using contraceptives that contain drospirenone.

Provided that periods and hormone levels were normal before using the pill, this type of PCOS is usually temporary. However, recovery can take months, sometimes up to even 2 years. I usually work with post-pill PCOS patients on detoxing from the pill in conjunction with treating the elevated androgens and utilizing anti-inflammatory lifestyle strategies.

Leave a comment below: which type of PCOS do you have?

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

• How to Get Pregnant Naturally with PCOS
• Natural Alternatives to Fertility Drugs
• Progesterone Deficiency

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

Become a Patient

Don’t miss out! Join the email list.

Sign Me Up!

Love this post Share it!

• Facebook
• Pinterest
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Want more Grab a copy of my new book, The Postpartum Check-In !

Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

The post Are There Different Types of PCOS Understand Your Diagnosis and More appeared first on Dr. Alexandra MacKillop.

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:

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.

Look for the Kaneka seal on ubiquinol suppleements to ensure that you are purchasing verified/tested ubiquinol. I recommend the brand Protocol for Life Balance, which carries this seal.

Dosages come in 100 mg, 200 mg, 400 mg, and 600 mg. The research is clear: the more the better. I recommend that my patients take 600 mg daily if they do not have any contraindications for doing so.

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

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

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Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

The post Fertility Supplements for Egg Quality (and Egg Freezing) appeared first on Dr. Alexandra MacKillop.