Women are born with ovaries full of all the eggs they'll ever have, unlike men who produce sperm non-stop for most of their lives. It's been the popular belief up until recently that women's eggs age as they do, and somewhere between the 35 and 45 they lose much of their viability. But then, to our surprise, recent research has actually proven much of that to be wrong!
Chromosomal abnormalities and poor egg quality are no longer a pre-determined diagnosis for women of "advanced maternal age." We know now that there is much to be done to improve how our hormones and ovaries function, and therefore produce healthy eggs, even over the age of 40!
To explain why, let's start with how the ovaries work and how our eggs develop within them.
Oogenesis: a brief explanation
Even though we are born with all the eggs we'll ever have, meaning we never make new, "fresh" ones, they lay in a dormant state for most of their existence. This funny word, oogenesis, is the process by which egg cells wake up, divide several times, and ultimately become a genetically unique egg released during ovulation. The whole process takes about 3 months start to finish.
Compared to the rest of our bodies, our ovaries are bubbling, sensitive, and wildly active balls of cells. Most other parts of our bodies are made up of cells that are created, do their job for a long time, then get retired and replaced by another similar cell. In the ovaries, however, we are waking up several (usually more than a dozen) dormant eggs every month and sending them on that 3 month coming of age journey to prepare for ovulation.
Because our ovaries and the developing eggs within them are so active, they need a lot of nutrients and energy, as well as even blood sugar and hormone levels in order to divide and develop correctly. They are way more sensitive than other cells in our bodies, so the environment they develop in is of the utmost importance. In fact, much of the decline in egg quality that was once associated with age is now known to be caused by how the cells function in relation to the body they exist in, not an inherent defect with the eggs themselves.
In fact, providing the correct nutrients to the ovaries/eggs, balancing hormones, and reducing stress and inflammation can all improve egg quality. Just keep in mind, they don't work instantly! Because it takes 3 months for eggs to develop, most of the tools we have for improving egg quality must be employed at least 3 to 4 months before a substantial difference is noticed.
If you're ready to stop reading and give up right now, please don't! Even if you are in the midst of trying to conceive, even if you've already been trying for years, even if you are starting IVF next week, many of these tools can help you to conceive and stay pregnant. And, even if you don't conceive this upcoming cycle, if you continue trying then you may be glad 3 months from now that you made the changes you did now, rather than delaying any longer.
What can you do to improve egg quality?
Plain and simple, if you're not already, you should be taking a prenatal vitamin. It's the first thing I recommend to anyone trying to conceive, or even to those considering it in the next few years.
It should ideally be made of whole foods rather than synthetically manufactured vitamins, because the bioavailability of vitamins from food sources is so much better. I recommend MegaFoods Baby and Me or Garden of Life's Vitamin Code Raw Prenatal.
Prenatal vitamins are not just for when you're pregnant, they contain several nutrients that improve how the ovaries function and therefore can improve egg quality.
Ideally if your partner (or whoever is providing sperm, if you know them personally and are in a position to make nutritional recommendations) is 35 or older he should be taking a multivitamin specifically formulated for men.
Follow the dosage according to the label on the multivitamin you choose. It can be dangerous to increase the dosage of a multivitamin (unless instructed by your healthcare practitioner) because while it may mean you get lots of some vitamins, you're likely getting too much of others that may be toxic in high doses.
CoQ10 is an antioxidant coenzyme that improves the amount of energy our cells have, and I don't mean that in an Eastern medicine sense of the word energy or "Qi," I mean the biochemical reactions that fuel our cells to function. That's part of why CoQ10 has long been used by marathon runners and Olympic athletes, to improve cellular metabolism and boost energy stores in the body.
All cells run on a compound called ATP, it's a simple molecule our bodies make to fuel the chemical reactions in our bodies. The eggs of older women usually have lower reserves of ATP because the cells can't make it as well, which is believed to be responsible for irregular organizing of chromosomes during cell division, which leads to chromosomal abnormalities in embryos. CoQ10 improves how cell metabolism works so there's more available ATP in the eggs, thus improving egg quality. For similar reasons it can also improve sperm quality if taken by men.
There has been extensive research on CoQ10 and side effects have been shown to be quite minimal. Some people experience mild digestive upset, but that's quite a common side effect for any supplements across the board. A potentially beneficial side effect of CoQ10 is that it can improve blood sugar regulation. If you have diabetes, discuss CoQ10 with your doctor. In some cases patients are able to reduce the dosages of their diabetes medications after taking CoQ10 for several months.
For more information and dosages, I recommend reading It Starts with the Egg, by Rebecca Fett, chapter 6.
A hormone precursor, dehydroepiandrosterone (DHEA) is a popular supplement among women with Diminished Ovarian Reserve (DOR) because it helps to boost estrogen and testosterone levels in the body. DOR happens when women's ovaries begin to wake up fewer and fewer eggs for oogenesis each cycle, which can be particularly difficult when undergoing IVF and the goal is to retrieve as many eggs as possible. Some women with DOR have IVF success rates as low as 2-4%. DOR becomes more and more common for women in their mid to late 30s, and is considered nearly universal for women over 40 years old. In some more rare cases, it can effect young women for no known reason.
On that bummer note, the good news is the DHEA may be able to help! Women undergoing IVF who take DHEA for at least 4 months have showed increased numbers of eggs and embryos, and higher pregnancy rates! In some studies the rates of live births are remarkable, jumping from 4% in the control group to 23% in the group taking DHEA.
Because DHEA effects our hormones, it's not appropriate for all women, especially those with PCOS or who are at risk of certain types of cancers. I highly recommended you check with your healthcare practitioner before starting on it, especially if you are about to or currently undergoing IVF, ask your fertility doctor (your Reproductive Endocrinologist) if DHEA is right for you.
For more information and dosages, I recommend reading It Starts with the Egg, by Rebecca Fett, chapter 9.
Whenever diets are studied to find which foods best support fertility, one of the most important factors is high levels of anti-inflammatory and antioxidant rich foods to battle oxidative stress.
Oxidative stress is the equivalent of when you cut open an apple and it browns the longer it's exposed to air, or when you leave a metal rake out in the rain and it gets all rusty. That happens on a cellular level inside our bodies if we don't have enough antioxidants to fend it off, and our eggs are particularly susceptible to oxidative stress.
Pollution, poor diet, and emotional stress can all make oxidative stress in the body worse, but it can be battled with plenty of antioxidizing compounds found in food. Non-starchy fruits and veggies (especially ones that are brightly colored,) fresh animal products like grassfed dairy and beef as well as wild-caught fish, and many nuts and seeds are all full of antioxidants.
In general, processed flours, sugars, and refined fats are considered the most pro-inflammatory foods with the least benefit of any added nutrients, thus they are recommended to be avoided as much as possible. This includes foods such as breads, sweets, candy, pastries, snacks and "junk" foods, fried/battered foods, foods with processed fats, especially if hydrogenated or partially hydrogenated.
Learn more in my article: Anti-inflammatory vs. Pro-inflammatory Foods.
Keep blood sugar balanced
Balancing blood sugar is the other important dietary factor that effects hormonal regulation and egg quality, since high or low blood sugar levels can negatively effect how the ovaries function and therefore how eggs develop within them.
Avoiding high glycemic foods like processed sugar, refined grains and flours, and even white potatoes can help to keep blood sugar levels from spiking. You don't have to avoid sugar and carbohydrates entirely, but try to get them from more wholesome sources, such as whole grains, winter squash, and fruit, so they carry the added benefits of vitamins, antioxidants, and fiber.
Eating balanced meals with plenty of protein also helps to set you up for even blood sugar levels for the next few hours. That doesn't have to mean animal protein at every meal, there are lots of plant-based protein options.
Also, avoid going long stretches without eating or skipping meals, that can get your blood sugar levels too low. Carry healthy snacks in case you have an unpredictable schedule or tend to get hungry between meals.
Unfortunately, our modern day world contains a slew of toxins that are not fertility friendly. BPA, phthalates, and pesticides are all common offenders that are well known to disrupt hormone levels in our bodies.
Whenever you can, eat organic, avoid plastic food containers, avoid canned foods, avoid cleaning products and cosmetics that are full of chemicals, ditch perfumes or products with artificial fragrances and make the switch to organic essential oils.
For more information on hormone-disrupting toxins, sign up for my free e-course: Happier Hormones in 30 Days!
Acupuncture & Herbal Medicine
I specialize in women's reproductive health and have seen some amazing responses in women's fertility with Chinese medicine, even for women over 40.
I can't tell you how many times my patients get pregnant the cycle before they are scheduled to start IVF, a nice problem to have! Or how many of my patients have been told they could never conceive, even with the use of IVF, only to prove their doctors wrong.
Acupuncture and herbal medicine are so effective for a number of reasons, they can balance hormones, improve circulation to the uterus and ovaries, reduce stress and inflammation, and curb side effects of hormonal medications. Unlike many other treatments, acupuncture and herbal medicine are completely customized to each individual patient, to best address what their body needs.
For example, in addition to issues with egg quality, some women have trouble conceiving because they aren't ovulating, some have short cycles, while others have thin uterine linings. It doesn't help to throw a one-size-fits-all treatment at every patient, because one woman needs help regulating ovulation, one needs to lengthen her luteal phase, and another needs to nourish blood to thicken her endometrium.
If you are undergoing IVF, acupuncture has been proven to increase success rate when performed in the weeks leading up to egg retrieval, as well as improving success rates of embryo transfer when performed the same day. Read more about it in my post: The Connection between Acupuncture & IVF.