Planning

The Relationship of Poor Egg Quality and Infertility

7 min read

Key Points

  • Egg quality can determine the ability to conceive and carry to full term
  • Egg quality drives fertility
  • Choice treatment is specific to each person's cause of infertility and current health
  • Decisions around fertility are personal and require the understanding of options available to each woman TTC

 

Article Written by: Jess Kimball

Poor egg quality can make or break whether or not a pregnancy can make it to full-term. It is typically caused by a 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. 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 anti-Mullerian hormone (AMH), 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 fertilize. 

 

 

Average Egg Count by Age:

American College of Obstetricians and Gynecologists

20 weeks' gestation 6 to 7 million
Birth 1 to 2 million
Puberty 300,000 to 500,000
37+/-25,000+/-
51+/-1,000+/-

There is no clear consensus on the average egg count for those with diminished ovarian reserve. 

 

What are the signs of poor egg quality?

  1. Trouble conceiving
  2. Late or absent menstrual periods
  3. Shorter menstrual cycles than average, with the average being 28 days.
  4. Heavy menstrual flow
  5. Miscarriage

 

Miscarriage

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 Diminished Ovarian Reserve (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 embryos 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. An 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:

  1. Tubal Disease
  2. Endometriosis
  3. Prior Ovarian Surgery
  4. Chemotherapy
  5. Radiation Therapy
  6. Smoking
  7. Pelvic infection
  8. Genetic abnormalities i.e., fragile X syndrome
  9. Autoimmune Disorders

 

Genetic or Chromosomal Abnormality

Poor egg quality can lead to chromosomally abnormal pregnancies. It can also increase the risk of a 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 are damaged, egg quality is poor. Nutrition and lifestyle factors play a role in egg quality. 

 

IVF

IVF, or in vitro fertilization, allows the best egg to be handpicked. 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...”

 

 

Testing 

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). 

 

Tips to improve egg quality and maximize fertility:

  1. Quit smoking
  2. Lessen alcohol intake
  3. Improve nutrition
  4. Exercise moderately
  5. Take fish oil
  6. Take Co-Enzyme Q10 (Coq10)
  7. Take Vitamin A

 

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 a 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 a 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. Interviewing multiple physicians until you have found the best fit for you is highly advised. 

 

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 has declined. 

 

Understanding your egg quality is an important step in trying to conceive and determining when you plan to try to conceive. Someone with a low ovarian reserve may choose to freeze their eggs if they want to have children later, 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:

  1. Is ovarian reserve testing right for me?
  2. Are there other tests you recommend?
  3. When should I think about egg freezing?
  4. Do you have a fertility specialist you recommend?
  5. When should I consider scheduling a consultation?

 

 

 

References

 

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 cause 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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