There are two things that we know whether we’re wanting to get pregnant or freeze our eggs:One: as much as we may wish it was not the case, as we get older, the number of genetically normal eggs we have declines. On average (the word ‘average’ here is a big caveat) it drops from around 80% genetically normal at 28yrs old down to 50% at 35yrs old. With a pretty rapid decline thereafter.Two: one of the root causes of damaged eggs is something called Oxidative Stress (click here for more). In a nutshell this is where the powerhouse of the cell the mitochondria and the DNA is damaged. This happens naturally as we age, it also happens for a number of other reasons. (More to come!)Now, everyone is an individual of course. So this does happen with variance. So, we are going to look at what can cause damage, but most importantly, what you can do about it. As always, based on science and research!
Five ways to boost egg quality backed by evidence:Ok so, as above, you want to avoid damage to cells. Errr obviously! Before we get into that - just a couple of basics:One of the quickest ways to cause damage at an accelerated pace is to smoke cigarettes. Once again because it is such a huge generator of the culprit behind damage: Oxidative Stress.Simple solution: regardless of any other health concerns. One of the fastest ways to kill your fertility is smoking. So, if it’s important to you cut it out.The other elements are also common sense. In order to reduce this oxidative stress keeping a healthy BMI is crucial. Research has linked obesity with Oxidative Stress and subsequent fertility issues. Other factors which are positive to get a handle on are: diet (lots of whole unprocessed foods), reducing physical and mental stress. Not exactly rocket science...
But, What happens if you’re doing all of that? Here are the top five science backed ways to boost your egg quality:We will take a look at what they are, how they work, the science and evidence as well as how you can implement into your life. These range from supplements to lifestyle tweaks and changes.
ONE: CoEnzymeQ10 (CoQu10) and egg quality:So, as above, we know a lot of damage comes from oxidative stress. Well, CoQu10 is a powerful antioxidant. The very thing that counteracts the potentially damaging effect of oxidation which can negatively impact our cells and DNA. Great!
How does it work?In brief: CoQu10 is produced naturally in your body but alas it too declines with age. It plays a crucial role in how our cells generate energy. Frankly they need a lot of energy to build a whole new person!At the root of how CoQ10 works is the fact that it gets involved in the very area where this oxidation occurs – the mitochondria. The energy site aka. ‘powerhouse’ within our cells. This is what makes it potentially very effective as a protective factor. (2,3)
Translation:It can get to the root of potential problems within our cells that can lead to problems with fertility.
But, does it actually work?In the clinical setting, CoQ10 supplementation led to better response to ovulation induction and lower odds of fatal aneuploidy (abnormal number of chromosomes) in 35-43yr old women.’ (1)Further, another extensive study demonstrated that ‘that CoQ10 supplementation preserves ovarian reserve and increased mitochondrial performance and ovulation rates.’ (3)
Translation: It has shown evidence of doing what we want it to!
So, how do we get more?The good news here is that research suggests that there are no real downsides to taking this as a supplement. It has also been demonstrated it is safe up to around 900 mg/day. The less good news is that there is no clear consensus of how much to take and how long to take it for. (1)A number of the studies we considered looked at shorter duration (60 days) and then up to 6-8 months of use and ranged from 200mg – 600 mg doses/day.
So how much should you take for egg quality?Well obviously, first and foremost you should always consult with your doctor before you do anything. Secondly, always follow the instructions on the supplement that you buy. Both important steps to take before you consider this as a supplement. It’s important!
So which supplement is the best?Now this is where it gets more interesting. The trouble with the supplement market is that it is pretty unregulated and often not very clear. This is why we are pretty sceptical on the whole on supplements click here for more. However, when it comes to CoQ10, research suggests that on the margin you want to take the reduced form which is known as Ubiquinol:
Why is Ubiquinol worth considering for egg quality?‘Reduced Q10 is the most abundant endogenous cellular antioxidant and is a safe and effective therapeutic antioxidant.’ (2)The research is frankly a bit patchy about what form is ‘best’ but some studies have suggested that the reduced form was slightly better absorbed (4). We know that it’s no good taking these supplements unless they can be absorbed, of course. It may be marginal but worth bearing in mind.
TWO: Melatonin and egg quality:You may know Melatonin as the ‘sleep hormone’. However, research has shown it is much more than that. It can also play a significant role in preserving our all important egg quality.
How does it work?Just as with the case of CoQu10, Melatonin is an antioxidant. So, without sounding like a broken record, it counteracts some of the key cause of cell damage. Oxidative stress.
So how do we get more?This is something that is produced by the body and comes out at night. It is also something that declines with age and can be pushed off by our modern lifestyles.Research has shown that by far the biggest impact on it’s production is related to our exposure to the cycles of light and dark. The bad news is that with our modern lifestyles not only are we sleeping on average 1-2hrs less (5). We are also exposed far more to something that is a powerful disruptor of our body’s ability to produce more: artificial and blue light. Aka. Our mobile phones/tablets and indoor lighting.
An easy win:It is possible to buy a Melatonin supplement. However, a really easy way to help your body produce more of its own is simple exposure to the natural cycles of light and dark. That means getting outside in the morning and getting natural light. Even more crucially (for our modern times) it is making a genuine effort to reduce the artificial and particularly blue light from our many devices at least a couple of hours before bed.
So what to do?Research has shown that prioritising good quality sleep can be really powerful in producing more of this much needed hormone/antioxidant. Many of us do not make sleep and particularly good sleep a priority. However there are easy things to do with evidence backing:
- Reduce your blue and bright light exposure a couple of hours before bed
- Sleep in a cool, dark, tech free room
- Prioritise getting a regular bedtime
- Expose yourself to the natural daylight in the morning/during the day and reduce exposure of artificial and blue light in the early evening.
THREE: Intermittent Fasting and egg quality?!Ok so not only is this a hot topic in the diet world these days, but, there is some evidence that it may help preserve our all important eggs.Now, major caveat alert.....Much more research needs to be done here for anything to be conclusive and this will not work for everyone’s body and lifestyle, but, there is some interesting research that means it could be worth considering.
So what is this?This can be done in several ways but it is essentially having a regular ‘fast’ with no food or drinks containing calories. The most popular ways to do it currently are the 5:2 which is five days of eating normally and two days of very restricted calorie intake (around 500/day). Or the 16:8 which is sixteen hours in a twenty four hour period of not eating and eight hours when you can. As always, it is about finding what works for you.
How does it work?Most of the work is still in animal studies and is not yet fully understood. Hence the caveat! But, the bottom line is that it has been demonstrated that periods of fasting (which effectively temporarily shut down reproductive functions) could potentially prolong fertility, improve egg quality and halt some of the decline that comes with age.
Really?!Once again it appears to relate to the cell’s powerhouse, the Mitochondria. As we age the number and activity of these starts to fall which is in part why we have less good quality eggs as we get older. Whether it is evolutionary (to preserve fertility during times of famine) we are not sure. What seems to happen is that the number and activity of Mitochondria in the cells is boosted via fasting. (6) Pretty cool stuff.As one study in mice suggested, intermittent fasting may temporarily shut down active fertility ‘freeing up energy that can be used to enhance maintenance, thereby preserving viability and fertility for when the period of famine has passed.’ (7)Certainly in some studies it appears that not only can this potentially help when it comes to keeping us fertile for longer. It could help with egg quality. Even showing benefits after the intermittent fasting period has stopped. (8)
FOUR: Folate (Folic Acid) and egg quality:So we have long known the benefits of Folate for preventing neural tube defects in children. However, research also suggests that it could also play a role in egg quality and therefore may be another reason to take it even ahead of conception.One study looking at IVF suggested that women who received a Folic Acid supplement prior to treatment had ‘better quality oocyte and a higher degree of mature oocyte compared to women who did not receive folic acid.’ (9)What is an oocyte? It’s basically an immature egg cell.
So where/how do we get more?
Folic Acid is the synthetic version of a B vitamin (B9) called Folate. It is found naturally in dark leafy green vegetables, beans, eggs, asparagus, avocado, nuts/seeds and citrus fruits. Also worth noting that Folate is relatively fragile. It does degrade during processing.
What does this mean?
Practically speaking fresh fruit and veg is key. Fresher the better and ideally eaten raw or steamed. Boiling can in fact cause the folate to seep into the water. So unless you’re having a soup its best to boil or steam.
It has also been added by government initiatives to certain foods/grains like breakfast cereals. You’ll probably labels saying ‘fortified’ with Folic Acid for example.
How much do you need and in what form?
As above – ensuring you have adequate intake is super important. Not only for a health pregnancy but also potentially for egg quality. However, research suggests that ensuring your body absorbs the right amount is important:
So what type is best (yes there are different types! Never simple... sigh!)
Folate is the form that we get from foods.
Folic Acid: is the man made synthetic form.
Of course eating a healthy balanced diet full of vegetables is a great starting point. During pregnancy however it is crucial to make sure that your body is getting the right amount.
Some people have a genetic difference: known as MTHFR. This means they cannot process folic acid. So, ideally you should go for Methylfolate supplements (5MTHF). This is the body’s most active form of folate (10) Our personal favourite is the one made by Cytoplan. However, the first port of call if you do have any questions on which supplement suits you best is of course your doctor. Always speak to them first when it comes to taking any supplement.
How much is ideal for egg quality?
The official recommendation is 400 micrograms (mcg) before, during pregnancy and whilst breastfeeding (11) For both egg quality and reduced chances of birth defects it is important to take it before pregnancy.
Some higher risk women (when there is a family history/diabetes) are advised to take 500 mcg. Research suggests that above that level is not necessary.
The tricky part comes when you look at lots of different prenatal supplements. Unhelpfully, the amounts of Folic Acid contained within can vary dramatically. We have seen anything from 400 mcg up to 2000 mcg! (12) That is also beforeany food intake (particularly fortified foods). So, if you’re eating a healthy balanced diet the chances are you’ll be getting more.
The tolerable safe upper limit for Folic Acid has been suggested to be 1000 mcg/day (12) so a 400 mcg supplement plus a good diet is absolutely fine.
FIVE: Myoinositol: and egg quality for people with Polycystic Ovarian Syndrome:Lots of women suffer with Polycystic Ovarian Syndrome (PCOS). It has been said 1/5 women (according to NHS data). At it’s core it is a hormonal imbalance which can impact the body’s ability to grow mature egg cells for ovulation. This can impact egg quality.One study looked at the use of Myoinositol with Melatonin and Folic Acid and found a ‘clear trend to better oocyte quality‘ (14). This was echoed by a second simply looking at Myoinositol on its own (13).
Firstly, what is Inositol?
It’s actually naturally occurring, a vitamin-like compound that belongs to the vitamin-B complex. There are as many as nine different types found in:
the body (which produces its own)
Fruits (principally citrus)
Can it really help with egg quality and even implantation?
One of the issues with PCOS is that the follicles don’t develop properly, which is why you can have issues with ovulation and egg quality.
Research has shown that myo-inositol plays a role in follicular development with higher concentrations = more mature follicles and better egg quality (15, 16) as well as improving the chances of implantation.
What is best to take and how?
Well first and foremost (yep, we will say it again). As always you MUST consult with your doctor before taking this or any type of supplement. It is also important not to use this as a substitute for improvements in diet and lifestyle.
You do not actually need a prescription and you can take myo-inositol or in combination with d-chiro-inositol in powder form from either a pharmacy or a health food store.
As with any supplement, it is best to start taking it several weeks to months before trying to conceive to get the most out of it. (15, 17)
Once again it is very important to follow the recommendations of the manufacturer as of course there are lots of different brands. So, different dosage depending on the brand so some things for context:
Myo-inositol doses of 400mg daily throughout pregnancy has been shown to be well tolerated with limited side effects. Higher doses (up to 1200mg daily) can lead to side effects like nausea, flatulence and diarrhoea.
Always better to start off with lower levels and see how you get on. Remember however to always follow the instructions of the manufacturer and consult with your doctor however. (18)Footnotes:
- XU Y, NUSENBLAT V, WANG S: Pretreatment with Coenzyme Q10 improves ovarian response and embryo quality in low-prognosis young women with decreased ovarian reserve: a randomised controlled trial. Reproductive Biology and Endocrinology: 2018: 16: 29
- GIANNUBILO S, TIANO L, MAZZANTI L: Amniotic Coenzyme Q10: Is it Related to Pregnancy outcomes? Antioxidants & Redox Signalling. 2014 Oct 10: 21(11): 1582-1586
- OZCAN P, FICICIOGLU C, ESREFOGLU M: Can Coenzyme Q10 supplementation protect the ovarian reserve against oxidative damage? Journal of Assisted Reproduction and Genetics. 2016 Sep: 33(9): 1223-1230
- EVANS M, BAISLEY J, BARSS S, GUTHRIE N: A randomised, Double-Blind, Crossover Trial Comparing the Bioavailability of Two CoQ10 Formulations: Journal of Functional Foods: 2009 65-73
- RCOG: Royal College of Gynaecology and Obstetricians: https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-healthy-eating-and-vitamin-supplements-in-pregnancy.pdf
- WIENS D, DeSOTO CM: Is High Folic Acid Intake a Risk Factor for Autism? A Review: Brain Science: 2017 Nov: 7(11): 149
- Unfer V, Carlomagno G, Rizzo P, Raffone E, Roseff S. Myo-inositol rather than D-chiro-inositol is able to improve oocyte quality in intracytoplasmic sperm injection cycles. A prospective, controlled, randomized trial. Eur Rev Med Pharmacol Sci. 2011; 15(4):452-7. Unfer V, Facchinetti F, Orru B, Giordani B, Nestle J. Myo-inositol effects in women with PCOS: a meta-analysis of randomised controlled trials. Endocr Connect 2017; 6(8):647-658
- Chiu TT, Rogers MS, Law EL, Briton-Jones CM, Cheung LP, Haines CJ. Follicular fluid and serum concentrations of myo-inositol in patients undergoing IVF: relationship with oocyte quality. Human Reproduction 2002; 17(6): 1591–1596.
- Artini PG, Di Berardino OM, Papini F, Genazzani AD, Simi G, Ruggiero M, Cela V. Endocrine and clinical effects of myo-inositol administration in polycystic ovary syndrome. A randomized study. Gynecol Endocrinol 2013; 29(4):375-9.
- Papaleo E, Unfer V, Baillargeon JP, De Santis L, Fusi F, Brigante C, Marelli G, Cino I, Redaelli A, Ferrari A. Myo-inositol in patients with polycystic ovary syndrome: a novel method for ovulation induction. Gynecol Endocrinol. 2007; 23(12):700-3.
This article is for informational purposes only. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice. The information on this website has been developed following years of personal research and from referenced and sourced medical research. Before making any changes we strongly recommend you consult a healthcare professional before you begin.
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