The Importance of Egg Quality
Producing an egg every month is the first step in conceiving, next the egg has to be of good quality. Factors that can influence egg quality include hormone balance, oxidative stress and maternal age.
How is egg quality determined? Is there a test for egg quality?
Egg quality is a judgement call that takes into account embryo implantation success, maternal age, and ovarian reserve. There is no way to look at an egg and decide if it’s a good egg or a bad one and no test specifically for egg quality.
What if my doctor says I “have to use donor eggs”?
What your doctor is really saying is that your odds of success (without naturopathic support) would be better with donor eggs. I have had several patients in exactly the same boat, who conceived and had healthy pregnancies with their own eggs, because naturopathic medicine can address some or all of the factors that influence egg quality.
Factors that influence egg quality
Hormone balance: Studies on follicular fluid hormone levels have shown that those eggs that matured in a higher progesterone and estradiol environment were more likely to have normal fertilization and a normal pregnancy respectively, than those with lower estradiol, progesterone and/or higher testosterone. Obviously, the hormonal environment bathing the developing egg influences the quality of the egg and it’s receptivity to fertilization. There are a number of factors that will influence your hormone balance: diet, vitamin and mineral status, stress, exercise and herbs.
Oxidative stress: Oxidation is an aging process. Think of biting into an apple and putting it down. When it turns brown, that’s oxidation and in the human body, that process is not conducive to healthy eggs or sperm. We eat foods rich in antioxidants and we can take supplements to combat oxidative stress. Insulin resistance increases oxidative stress, so addressing blood sugar and insulin issues can help reduce oxidation. One study concluded that the reason that older women struggle with fertility is due to increased oxidative stress with increasing maternal age. Another has elucidated the role that melatonin plays in reducing oxidative stress in eggs.
Maternal age: Much as we’d all like to turn back the clock numerically, we can’t, we can however undo some of the effects of age on developing eggs. Oxidative stress increases with age, so we can use antioxidants. Hormones change with age, so we can rebalance. Our bodies accumulate more environmental pollutants over time, we can help the body purge these and reduce additional exposures. Mitochondia are the batteries of each cell. With age, these batteries slow down. There are natural treatments that increase mitochondial function, such as Coenzyme Q10, and reducing insulin resistance can improve mitochondrial function.
Thyroid Function: In women with a normal TSH, the presence of TPO antibodies can have a negative impact on embryo quality. Women with high-normal to high TSH can also lower quality embryos, particularly in the presence of TPO antibodies.
Improving Egg Quality Research
Electroacupuncture can improve high quality embryo rates, which may be related to its effect in increasing serum and follicular fluid stem cell fluid levels. Source: Yang BZ, Cui W, Li J. Effects of electroacupuncture intervention on changes of quality of ovum and pregnancy outcome in patients with polycystic ovarian syndrome. Zhen Ci Yan Jiu. 2015 Apr;40(2):151-6.
L-carnitine supplementation has the potential to improve the quality of vitrified human oocytes and embryos during assisted reproduction treatment. Source: Moawad AR, Xu B, Tan SL, Taketo T. l-carnitine supplementation during vitrification of mouse germinal vesicle stage-oocytes and their subsequent in vitro maturation improves meiotic spindle configuration and mitochondrial distribution in metaphase II oocytes. Hum Reprod. 2014 Oct 10;29(10):2256-68. doi: 10.1093/humrep/deu201. Epub 2014 Aug 11.
Treatment with the Chinese medicine Erzhi Tiangui Granule correlated with regulating the AMH levels in the serum and the follicular fluid, adjusting the androgen level, and improving the pathophysiological changes of PCOS patients. Source: Lian F1, Zhao S. Effects of Shen invigorating and Chong-channel regulating method on anti-Müllerian hormone and oocyte quality in polycystic ovarian syndrome patients. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2012 Jan;32(1):9-12.
Oxidative stress and mitochondrial dysfunction are responsible for poor oocyte quality of insulin-resistant mice, and may provide novel targets to improve low fertility in females with insulin resistance. Source: Ou XH, Li S, Wang ZB, Li M, Quan S, Xing F, Guo L, Chao SB, Chen Z, Liang XW, Hou Y, Schatten H, Sun QY. Maternal insulin resistance causes oxidative stress and mitochondrial dysfunction in mouse oocytes. Hum Reprod. 2012 Jul;27(7):2130-45. doi: 10.1093/humrep/des137. Epub 2012 May 3.
Via the free radical scavenging activity of melatonin and its metabolites, oxidative stress is reduced in all reproductive organ cells ensuring their optimal function. Enhancement of oocyte maturation and preservation of oocyte quality may be major functions of melatonin. Oocyte damage reduces successful fertilization and the development of a healthy fetus. Source: Reiter RJ, Tan DX, Tamura H, Cruz MH, Fuentes-Broto L. Clinical relevance of melatonin in ovarian and placental physiology: a review. Gynecol Endocrinol. 2014 Feb;30(2):83-9. doi: 10.3109/09513590.2013.849238. Epub 2013 Dec 9.
Molybdenum affects oocyte quality possibly through regulating ovarian oxidative stress in a dose-dependent manner. It appears that molybdenum may improve ovarian function at a suitable concentration, and might be a candidate for the treatment of female infertility. Source: Zhang YL, Liu FJ, Chen XL, Zhang ZQ, Shu RZ, Yu XL, Zhai XW, Jin LJ, Ma XG, Qi Q, Liu ZJ. Dual effects of molybdenum on mouse oocyte quality and ovarian oxidative stress. Syst Biol Reprod Med. 2013 Dec;59(6):312-8. doi: 10.3109/19396368.2013.826296. Epub 2013 Aug 16.
TPO antibodies affect embryo quality in euthyroid women with low-normal TSH≤2.5 μIU/mL. In women with high-normal TSH levels, increasing TSH levels, and possibly TPO antibodies, appear to impair embryo quality. Source: Weghofer A, Himaya E, Kushnir VA, Barad DH, Gleicher N. The impact of thyroid function and thyroid autoimmunity on embryo quality in women with low functional ovarian reserve: a case-control study. Reprod Biol Endocrinol. 2015 May 15;13:43. doi: 10.1186/s12958-015-0041-0.
Progesterone levels were higher in cases of normal fertilization compared to failed fertilization. B quality embryos came from oocytes immersed in follicular fluids with higher estradiol values vs C quality. Source: Carpintero NL, Suárez OA, Mangas CC, Varea CG, Rioja RG. Follicular steroid hormones as markers of oocyte quality and oocyte development potential. J Hum Reprod Sci. 2014 Jul;7(3):187-93. doi: 10.4103/0974-1208.142479.