What to Know About Poor Egg Quality
Poor egg quality can make or break if a pregnancy can make it to term. It is typically caused by low ovarian reserve.
Every menstruating human has some abnormal eggs. At age 20 about 20% of eggs are considered abnormal, but by 40 that number has risen to 80%.
By age 35 only 6% of a person's total eggs remain!
Knowing about poor egg quality may be important if you are struggling to conceive and want to know what to expect or what to ask your doctor about. It may also be important if you are deciding to have children now or later. There are many reasons why it may be important to improve your egg quality.
It may be vital for you to improve egg quality if you are over 35, you have a diminished ovarian reserve, you have low AMH (anti mullerian hormone), your cycle is getting shorter, or you have had a failed round of IVF.
Egg quality drives fertility. Eggs with abnormal DNA (aneuploidy) are not likely to even fertilize.
There is no clear consensus on average egg count for those with diminished ovarian reserve.
What are the signs of poor egg quality?
Poor egg quality causes a fertilized egg to either not implant or only partially implant. If it does implant it usually will not develop properly. This typically leads to miscarriages or birth defects.
Research has shown the rates of biochemical pregnancy, clinical pregnancy, and embryo implantation in young people with DOR are significantly higher than in older people with DOR. Young people with DOR have ovarian hypo-response and low numbers of acquired eggs and embryos, but the possibilities of high-quality embryo and good clinical pregnancy are higher once eggs are acquired, according to research published in 2018.
Biochemical pregnancy is where the egg implants, but is miscarried in the first 2-3 weeks after conception. Clinical pregnancy is a pregnancy confirmed by HCG (Human Chorionic Gonadotropin) levels. Embryo implantation is described as an embryo implanting in the uterus. Embryo is used to describe a developing fetus before the eighth week, when we typically describe it as a fetus.
Low Ovarian Reserve
Low ovarian reserve or diminished ovarian reserve (DOR) is used to refer to the number of eggs someone has. About 10% of people with ovaries experience this, according to the Center for Human Reproduction. Treatments do not exist, but recommendations to live a healthier lifestyle can be made. Those recommendations boost fertility and improve conditions for the egg that will be released in ovulation. It is important to improve these conditions three months before ovulation.
Causes of Low Ovarian Reserve Include:
Poor egg quality can lead to chromosomally abnormal pregnancies. It can also increase the risk of genetic disorder in the baby. Most chromosomal errors occur three months before ovulation when either a chromosome doesn't separate and pair up again properly in meiosis, or chromosomes break, become inverted, or get deleted due to chemicals and viruses. Changing the conditions of the egg three months before ovulation can improve that egg's quality and decrease the chance of chromosomal abnormality. Mitochondria is responsible for the energy used to produce a good quality egg. If mitochondria is damaged, egg quality is poor. Nutrition and lifestyle factors play a role in egg quality.
IVF, or in vitro fertilization, allows the best egg to be hand picked. Meaning, while those with poor egg quality may not have as many good embryos they can still get pregnant through IVF. InGenes says, “Patients with poor egg quality have a higher rate of structural genetic abnormalities; however, by transferring chromosomally normal embryos, this technique maximizes the chance of embryo implantation..."
A blood test to measure a patient's follicle stimulating hormone (FSH) and estradiol blood levels are performed on day 3 of their cycle to determine ovarian response and egg quality. You can also take an at home ovarian reserve test.
Other forms of testing may include, AMH (anti mullerian hormone) blood level testing and antral follicle count, an ultrasound that looks at the number of visible antral follicles to predict primordial follicles (microscopic follicles that each contain an immature egg).
How can you improve egg quality and maximize fertility:
New Research and Fertility Medications for Better Egg Quality
The Center for Reproductive Health believes early diagnosis is important for those with diminished ovarian reserve (DOR). 33% of their patients with DOR have successful pregnancies with their own eggs.
Dehydroepiandrosterone (DHEA), a mild androgen as proven success for those with DOR.
A 2010 study showed that 23.1% of the participants who took DHEA supplements had a live birth, those who didn’t take DHEA had a 4% live birth rate.
In 2012 a review concluded that more research on DHEA is needed.
Coenzyme Q10 (CoQ10) is an antioxidant powerhouse that can increase egg quality. In a human trial, supplementation with CoQ10 led to higher fertilization rate and more high-quality embryos. CoQ10 also has increased the number of ovarian follicles and improved ovulation.
Research, published in the journal Nature, has found boosting levels of a common metabolic coenzyme may help improve egg quality and chances of conception naturally and through IVF.
Researchers from the University of Queensland’s Center for Clinical Research found that the quality of a woman’s eggs is significantly dependent on nicotinamide adenine dinucleotide (NAD+). NAD+ is a chemical found in every cell of the body. NAD+ is involved in hundreds of metabolic processes and declines with age.
Research showed that boosting NAD+ in mice returned their eggs from 40 year old quality to 30 year old quality.
Using donor eggs is another option for those with poor egg quality.
Choice of treatment is specific to each person, their medical history, and their fertility goals. It is always best to consult with your provider about your options. If you feel that your provider is not best for you, you can always consult with more providers until you find the best fit.
Can you preserve egg quality?
Cryopreservation is a technique to preserve egg quality. It is the process of freezing your eggs. Frozen eggs do not lose their quality with age and can be used later when your fertility and egg quality have declined.
Understanding your egg quality is an important step in trying to conceive and determining when you plan to try to conceive. Someone with low ovarian reserve may choose to freeze their eggs if they want to have children later, in order to preserve their quality. Someone else may choose to have children earlier. Decisions around fertility are personal and require a lot of thought. A confident decision is made when someone has all of the information and has asked all the questions they need to. Here are some questions you may want to ask your provider as a start:
Bolton, R. (2021, October 19). The facts about egg quality. Plan Yourself Pregnant. Retrieved February 2, 2022, from https://www.planyourselfpregnant.com/the-facts-about-egg-quality/
Camargo, F. (2020, March 26). Poor quality eggs causes and treatment to conceive a baby. Ingenes. Retrieved February 3, 2022, from https://www.ingenes.com/international/are-you-a-candidate/female-infertility-causes/poor-egg-quality/
Chang, Y., Li, J., Li, X., Liu, H., & Liang, X. (2018). Egg Quality and Pregnancy Outcome in Young Infertile Women with Diminished Ovarian Reserve. Medical science monitor : international medical journal of experimental and clinical research, 24, 7279–7284. https://doi.org/10.12659/MSM.910410
CNY Fertility (2022, January 28). How to improve egg quality after 40. CNY Fertility. Retrieved February 3, 2022, from https://www.cnyfertility.com/how-to-improve-egg-quality-after-40/
Contributor, S. C. R. C. (2017, July 25). How to improve egg quality for pregnancy or IVF. How to Improve Egg Quality for Pregnancy or IVF. Retrieved February 3, 2022, from https://blog.scrcivf.com/how-to-improve-egg-quality-pregnancy-ivf
Ferguson, S. (2019, February 26). Diminished ovarian reserve: Overview, causes, and treatments. Healthline. Retrieved February 3, 2022, from https://www.healthline.com/health/diminished-ovarian-reserve#treatment
Rasool, S., Shah, D. Fertility with early reduction of ovarian reserve: the last straw that breaks the Camel’s back. Fertil Res and Pract 3, 15 (2017). https://doi.org/10.1186/s40738-017-0041-1
Tsirtsakis, A. (n.d.). Metabolic coenzyme shows promise for improved egg quality. NewsGP. Retrieved February 3, 2022, from https://www1.racgp.org.au/newsgp/clinical/metabolic-coenzyme-shows-promise-for-improved-egg
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Jess Kimball is a Full Spectrum Doula and Certified Lactation Counselor trained in Ayurvedic and Chinese medicine.