When it comes to fertility, there are many factors at play. However, one lesser known impact is the role of egg quality on fertility outcomes.
If you are exploring your fertility or reproductive health options, then you have likely heard of egg quantity, or the number of eggs you have. However, egg quality, or the potential of an egg to become a viable pregnancy, is an equally important player in fertility outcomes.
In fact, your reproductive health is intrinsically linked to the quality of your eggs. Understanding the factors that influence egg quality, from age to diet, can empower you to make informed decisions about your reproductive journey and know how to better support your overall fertility picture. So, let’s get into it.
WHAT’S THE DIFFERENCE BETWEEN EGG QUANTITY AND QUALITY?
Egg quantity is the number of eggs that a woman has. Since women are born with all the eggs they will have, egg quantity undeniable declines over time and there is little we can do to influence this.
Egg quality, on the other hand, describes the potential for that egg to become fertilized or a viable pregnancy. It is predominately determined by chromosomes (more on that later) and unlike egg quantity, lifestyle choices can influence the quality of egg cells.
OKAY SO WHAT’S AGE GOT TO DO WITH IT?
Let’s be clear, it is an undeniable truth that ovarian reserve declines with age. And in so many ways, this is largely outside of our control – environmental exposures and genetic factors make it so that as the body accumulates stress over time, the quantity and quality of a woman’s eggs decline. And while there is not much we can do to actually boost egg quantity, we can start to influence egg quality by limiting environmental and lifestyle factors that add stress to the body.
HOW DOES EGG QUALITY DEVELOP?
The development of egg quality is a fascinating and intricate process that starts before a woman is even born. Inside her ovaries, millions of tiny structures known as primordial follicles create her ovarian reserve. As she enters her reproductive years, a selected group of these follicles mature during each menstrual cycle, with one dominant follicle eventually releasing a fully developed egg (hello, ovulation!), ready for a potential fertilization.
This growth process of the egg occurs approximately three to four months before ovulation, during which time the egg undergoes essential changes to prepare for a potential pregnancy. This means we have about a 12 week window where our dietary and lifestyle habits can significantly impact developing eggs, maximizing the chances of a successful pregnancy.
SO HOW IS EGG QUALITY IMPACTED?
When it comes to egg quality, we are primarily talking about ways we can support chromosomal health. Chromosomes are essentially strands of DNA that determine the viability of an egg to become an embryo. If you remember from high school bio, we each have 46 chromosomes – 23 from mom and 23 from dad. When looking at egg quality, we are predominantly looking at whether an egg cell has this correct number of chromosomes. Too many, too little, or missing pieces of chromosomes (i.e. abnormalities in chromosomes) can pose significant challenges and complications during conception, fertilization and implantation. In fact, the chromosomal health of an egg is a primary indicator of miscarriage risk. In other words, chromosomal health is pivotal for successful pregnancies and the birth of healthy babies, with high-quality eggs possessing undamaged DNA and a correct number of chromosomes.
So why do some eggs have abnormal chromosomal health? Well, during that 3-4 month window of egg development, the egg undergoes an energy intensive process of dividing, replicating and segregating chromosomes. In many ways, by supporting the energy powerhouse of the cell, called the mitochondria, we can support egg development, maturation, chromosomes and quality.
So what damages egg quality? Well certain conditions and disorders can impact DNA, such as endometriosis, cancer, ovarian surgery, and eating disorders like anorexia nervosa. Chronically high blood sugar, hyperinsulinemia, or the overproduction of insulin that is often associated with PCOS or conditions of elevated androgens, can also negatively impact chromosomal health, egg quality, and thus overall fertility.
Additionally, environmental and lifestyle factors can play a crucial role in determining egg quality. Consuming a nutrient-rich diet and maintaining a healthy nutritional status can optimize ovarian reserve. On the other hand, chronic stress, exposure to endocrine disruptors, and poor dietary habits can facilitate the decline of egg quality. Various factors, from antibiotic use, alcohol consumption, sedentary behavior, high-glycemic-index foods, etc. can all negatively impact mitochondrial function, impacting egg quality and fertility.
ARE THERE TESTS FOR EGG QUALITY?
Short answer: no.
While there are no tests to directly measure egg quality, there are tests available to assess egg quantity, which is a part of the overall ovarian reserve. Two common tests for evaluating egg quantity are the Antral Follicle Count (AFC) and the Anti-Mullerian Hormone (AMH) test. AFC involves using ultrasound to count the number of antral follicles in the ovaries, providing an estimate of a woman’s ovarian reserve or the total number of eggs available for potential ovulation. The AMH blood test, on the other hand, measures a hormone produced by the developing follicles in the ovaries, giving insight into the remaining egg supply. But again, this is only one piece of the puzzle!
To accurately interpret test results and develop a personalized plan for family planning or fertility treatments based on individual circumstances, it is essential to consult with a healthcare provider or fertility specialist.
WHO SHOULD BE FOCUSING ON EGG QUALITY?
In many ways, all women! Taking care of our egg health often also means taking care of our body. If you are considering pregnancy or actively trying to conceive, whether through in vitro fertilization (IVF), egg retrieval, or egg freezing, the quality of your eggs matter. While we should ideally always be supporting our egg healthy, dedicating at least least 3-4 months prior to that ovulation cycle or procedure to support lifestyle habits is key to support egg quality and fertility.
Additionally, if you’re a woman within your reproductive years and notice signs like a shorter menstrual cycle (<25 days), hot flashes, or vaginal dryness, it may be a good idea to consult with your doctor to learn more about the quality of your eggs and overall ovarian reserve. Being proactive about your reproductive health can make a difference in your journey to starting a family.
And to note – it’s not just women who need to focus on their reproductive cell’s vitality; men also play a significant role since sperm quality affects fertility and the baby’s health.
WHERE SHOULD I START IN SUPPORTING EGG QUALITY?
Explore all available options:
If you’ve been trying to conceive, consider working with a specialist, changing lifestyle choices, or food intake to support egg quality and give yourself 3-4 months of this consistent change. You may also want to consider interventions such as in IVF, egg retrieval or freezing. Oocyte cryopreservation (i.e. egg freezing) is particularly advantageous for women under 30, offering the opportunity to preserve egg quality and provide future family planning options. Looking for more support? Check out our egg retrieval course.
Timing is critical in preserving and optimizing egg quality. Approximately three to four months before pregnancy, egg retrieval, or freezing, focus on enhancing your lifestyle habits. Improve your eating patterns, incorporate regular exercise, and minimize exposure to harmful substances.
Reduce oxidative stress:
Oxidative stress, which negatively impacts fertility, can be addressed by reducing exposure to lifestyle-related factors and incorporating antioxidants into your diet. In an effort to limit oxidative stress, try to be mindful of processed and packaged foods and deep fried options. These food options tend to contain excess sugar along with trans-fats which can negatively impact egg quality. Similarly, start to question your relationship to alcohol, smoking or various medications or substances.
Support your health context:
As discussed above, various conditions can impact egg quality. Outside of endometriosis or PCOS, conditions like insulin resistance and diabetes can also impact egg quality by driving oxidative stress and impaired mitochondria function. If you know you are facing a hormone or health related condition, be proactive – work with a dietitian or healthcare provider to implement dietary and lifestyle steps that can support your body and needs.
Both the quantity and quality of your diet influence fertility. A well-planned, balanced diet can support your egg quality and fertility outcomes, including the effectiveness of assisted reproductive techniques. Focus on a diet rich in plant-based foods, low glycemic index carbohydrates (think quinoa), antioxidants, fiber, vitamins, minerals, poly- and mono-saturated fatty acids, including omega-3, and adequate protein. These dietary choices contribute to reducing insulin resistance and increasing your chances of pregnancy.
Embrace gentle movement:
Lifestyle modifications, including regular exercise, can positively impact egg quality by reducing chronic stress levels and supporting better blood sugar regularity. Incorporate gentle movement into your daily routine to further support your reproductive health.
Minimize exposure to toxins:
Environmental toxins, from smoking to BPA, can all impact egg quality. By minimizing exposure to these harmful substances and reducing chronic stress, you can protect and preserve your eggs’ health. So swap out the plastic and let go of the non-stick.
A FEW OTHERS THINGS…
Understanding the significance of egg quality and its influence on fertility is crucial for women to take charge of their reproductive health. While age and the natural decline of egg quantity and quality are inevitable, proactive steps can be taken to optimize egg health. By considering available options, planning, reducing oxidative stress, improving nutrition, incorporating gentle movement, and minimizing exposure to toxins and chronic stress, you can maximize your chances of a healthy pregnancy and regain control of your reproductive well-being. Talk to your health care professionals about how you can improve your reproductive health and if you are curious about your ovarian reserve then, talk to your doctor about getting an AMH test or an ACF transvaginal ultrasound. And of course, reach out should you need any assistance or support.
Written By: Jamila Crawford, MS, RYT, CPT ; Edited By: Amanda Wahlstedt, RDN