The quality of the eggs and the ovarian reserve
Studies show that the quality of the egg is the most important factor for the probability of having a successful pregnancy.
Some doctors say that the quality of the egg is a factor of age, and that there is very little that can be done to change this quality.
Age is indeed an important factor when it comes to fertility. The ideal period for a woman to conceive is between 25 and 35 years of age, and a man’s sperm quality is at its optimum when they are under 45 years of age.
The quality and quantity of eggs begin to decline from the age of 38 in most women, thus causing them difficulties conceiving. The success rate among women undergoing the various types of fertility treatments decreases with age. As a woman gets older, other complications also arise so even if they manage to get pregnant, it could lead to a high-risk pregnancy.
Backed up by studies, some doctors will tell you that the quality of the egg can be improved by taking certain nutritional supplements over a period of at least 3 months together with changing your diet and lowering your level of exposure to environmental hazards that can harm fertility, as described on this site.
This site lists the supplements you need to take to improve egg quality. The most important supplement is Coenzyme Q10/ubiquinol. Another important supplement that helps not only the quality but also the quantity of eggs is DHEA.
Studies show that only good quality eggs are more likely to develop into good embryos that are able to survive and become implanted in the uterus and culminate in pregnancy. It’s very important to maximize the number of good quality eggs so that they have the potential to turn into a healthy baby.
*Improving egg quality is also very critical for preventing miscarriages mainly because of the link between chromosomal disorders and miscarriages. As the woman gets older, the risk of ovulation of a chromosomally abnormal egg increases, resulting in lower fertility and the risk of miscarriage. If a low-quality egg is fertilized or the embryo is unable to implant or the embryo is implanted initially but is then unable to develop properly, it can end in a miscarriage. Although older women tend to have lower quality eggs, younger women may also have low quality eggs.
Ovarian reserve refers to the quantity and quality of eggs or the reproductive potential – and it affects the woman’s ability to conceive. As stated already, age plays a significant role in fertility and is directly related to reproductive aging.
Although female fertility decreases as age increases, it’s difficult to predict the overall rate of decline in fertility. A woman’s egg quality is at its highest in her mid-20s and up until her early 30s, representing the most fertile period of her life. From her early 30s, both the quality and quantity of the eggs begin to decline, resulting in a decrease in fertility potential, with the most significant decline occurring in her mid-30s and early 40s. The decrease in the quantity and quality of the eggs may be manifested in the longer time it takes for conception to occur. As a result, the probability of getting pregnant in one cycle begins to decline significantly from the early 30s, with a faster decline after the age of 37.
A common misconception is that regular menstrual cycles indicate a normal ovarian reserve and therefore it is possible to get pregnant. This is not always the case, as many women who have regular menstrual cycles can still face challenges if they have a diminished ovarian reserve (lower quality and quantity of eggs).
There are several screening tests to check the status of the ovarian reserve but there is no single, most reliable test to predict the potential of pregnancy occurring; therefore, the results of these tests should take into account the age of the woman and they can be best interpreted by a fertility specialist.
Below are common ovarian reserve screening tests:
On the 2nd or 3rd day of the menstrual cycle, an estimation of FSH (follicle-stimulating hormone) in the serum is done.
FSH is a hormone that is produced by the anterior pituitary gland in the brain and it stimulates a dominant follicle in the ovary to grow and secrete estradiol (estrogen). High levels of FSH may indicate that the brain is trying to compensate for older ovaries. In general, FSH levels can vary from month to month.
Testing the estradiol (E2) level –
High basal estradiol levels are usually caused by advanced follicular recruitment that can occur in older women or in case of a poor ovarian reserve. High estradiol levels can inhibit FSH secretion in the pituitary gland and thus result in falsely low FSH levels. Consequently, simultaneous measurement of both FSH and estradiol levels is required to prevent misinterpretation of falsely low FSH levels.
AMH (levels of the anti-molar hormone) –
The anti-müllerian hormone (AMH) is secreted by the small follicles (less than 4 mm) in the ovary. This test indicates the condition of the ovarian reserve, that is, the number of eggs in the ovaries.
Because FSH levels vary from cycle to cycle, AMH in a serum is a more reliable indicator, with minimal variability during the menstrual cycle and between menstrual cycles, and therefore can be checked at any point in the menstrual cycle. The AMH level reflects how many potential eggs there are in the follicle. It decreases gradually with age and can be an early indicator of decreased ovarian functioning, making it one of the best indicators of ovarian functioning. During the IVF cycle, AMH is one of the best signs for predicting a diminished or excessive ovarian response to stimulation, and it is also correlated with the number of aspirated eggs.
The higher the level of the hormone in the woman’s blood, the greater the number of follicles and eggs. The test does not help to understand what the quality of the eggs is, only their quantity. Pregnancy can occur even if the levels of AMH are low.
The antral follicle count –
The antral follicle count is a test that measures your ovarian reserve. This test is performed at an early stage of your menstrual cycle and, in the test, your doctor visually counts the number of follicles that contain eggs and are developing in both your ovaries. The test is done using a vaginal ultrasound.
The antral follicle count can vary from month to month and is also correlated with the number of eggs aspirated after an IVF cycle.
Diminished ovarian reserve
A diminished ovarian reserve refers to a decrease in the quality of the egg, the number of eggs, and the reproductive potential, and can therefore be the cause of infertility.
A high level of FSH on the second or third day, a low AMH level, a low antral follicle count, and a history of a poor response during stimulation within an IVF cycle indicate that there is a diminished ovarian reserve. It’s important to point out that evidence of a diminished ovarian reserve does not necessarily translate into an inability to conceive. In most cases, the cause of a diminished ovarian reserve is unknown, with reproductive aging being the main known cause.
Other factors that can affect the ovarian reserve include:
- Basic medical conditions
- Previous ovarian surgery
- Systemic chemotherapy
- Pelvic radiation
- Certain genetic disorders
There are no agreed criteria at all for diagnosing a diminished ovarian reserve. It therefore may be difficult to diagnose someone with a diminished ovarian reserve as the diagnosis may predict a reduced response to ovarian stimulation in the IVF cycle, but not necessarily the overall pregnancy rate.
It’s important to remember that there is an iron-clad rule: all it takes is one good quality egg. And yes, it’s harder to get pregnant like this but it’s definitely possible.
Specific toxins harm fertility and egg quality:
- Studies show that one of the toxins that harms fertility is bisphenol A (BPA), a chemical used in the plastics industry.
It’s very important to reduce exposure to this toxin. And how do you do that?
- By replacing plastic utensils in the kitchen that come in contact with hot food or beverages
- By using a stainless-steel water bottle
- By reducing the use of canned food and highly processed foods
- By preparing more foods at home using natural and whole ingredients
- Paper receipts that you get from stores contain this substance so you should wash your hands with soap and water when you get home
Studies show that infertile women can have higher levels of BPA than fertile women, and that these high levels of BPA are linked to infertility in women undergoing IVF treatment.
- Phthalates and other toxins
This group of chemicals, which are intended for use in the plastic manufacturing industry and in care products, has been proven to harm fertility and health in general.
Phthalates can be found in a wide range of products: pesticides, building materials, personal care products, medical devices, detergents, fragrance products, packaging, toys for children, wax, paints, printing inks and coatings, food products, textiles, food containers and wrappers. Personal care items that may contain phthalates include perfume, eye shadow, moisturizer, nail polish, liquid soap, and hair spray.
When purchasing such products, read the details of the composition of the product on the label. It’s recommended to avoid products that contain DBP in care products and DEHP in PVC plastic.
To reduce exposure to these chemicals, it is recommended:
- To avoid using conventional perfume, hair spray, nail polish, and fabric softeners.
- To start using herbal hair and skin products.
- Exposure to toxins and radiation
Exposure to chemicals, such as pesticides, air pollution, excessive use of cell phones, etc.
It’s important to note that a total avoidance of chemicals is not feasible but their use can certainly be significantly reduced and thus improve the condition of fertility.