If you’re my patient you’ve heard me say: it takes 3 things to have a baby: 1. Sperm 2. Fallopian tubes that are open and 3. Ovaries that are working…….If you know everything there is to know about these three things, then you can usually figure out why you aren’t getting pregnant and then can figure out the best treatment option for you.
But this is the thing: you can have perfectly normal testing that tells you that your ovaries are working (normal FSH, normal AMH, normal antral follicle count) and go through an IVF cycle and your doctor may tell you that the reason why you’re not getting pregnant is because you have poor egg quality. Who wants to hear that?! No one gets married to then say, “Can’t wait to have problems getting pregnant so I can meet Dr. Aimee.”
What does having “poor quality eggs” mean and what can you do about it?
You should know the following 5 things:
1. Just because someone tells you that you have poor egg quality doesn’t mean that you can’t get pregnant. Depending on the situation, it likely means it will be harder to get pregnant and in some situations means that you should consider using donor eggs. But again poor egg quality doesn’t automatically = can’t get pregnant.
2. Women are born with all the eggs we will ever have. You have a set number of runners (eggs) that try to win a race each month. Only 1 egg wins and ovulates, the rest die and you can never use them again. Every woman has a different potential number of runners that try to win the race each month. It doesn’t matter how old you were when you started your period or how many times you’ve been pregnant or how long you’ve been on the birth control pill – your ovaries will slowly run out of eggs over time. Every woman’s rate of egg loss is different and you can’t compare the number of eggs you could potentially have retrieved in an egg retrieval compared to your neighbor.
3. We know that the following conditions can negatively affect egg quality: endometriosis, history of prior ovarian surgery (during which portions of the ovary were removed), smoking, cancer treatment, and certain genetic conditions such as Turner Syndrome and carrying the Fragile X mutation.
4. There are things you can do to try to improve egg quality but no one can guarantee you pregnancy despite doing every posssible thing that I will describe below because ultimately, there is no such thing as “controlling your fertility.” You do your best to surround yourself with the best specialists and do all you can to lead a healthy lifestyle – fertility is just one of those things that no matter how hard you work, there is no guarantee that a pregnancy with your own eggs will take especially if you’ve been told that you may have poor egg quality.
5. Poor egg quality means that the eggs just don’t have what it takes to turn into a normal pregnancy. That’s the easiest way to think about it. Another way to think about ovarian aging is this: when you bite into an apple and let it sit out, what happens? It turns brown. and over time the apple will start to shrink. The apple reacts to oxygen in a way that makes the white part turn color. Antioxidants are one way to possibly prevent this “browning” in the apple or decrease the effects of aging in the ovary. For the most part, once an apple is brown and has shrunk in size, there is nothing that you can do to turn it into it’s original color, size and shape.
Without getting into too much detail, this is what I tell my patients to do:
1. Consider high dose antioxidants. You can buy a supplement similar to Total Fertility.
2. Consider acupuncture and hypnotherapy
3. Consider taking 7-keto DHEA 75 mg daily. 7-keto DHEA is different than DHEA because it doesn’t have the testosterone side effects that DHEA will have and you can’t find this in most vitamin stores. You have to buy it online.
4. Consider melatonin 3 mg per day. Only one Japanese study showing that there could be an improvement in egg quality as a result of taking it because it is such a potent antioxidant. Can’t hurt, may help.
5. Consider taking resveratrol.
6. Stop smoking and limit caffeine and alcohol intake.
7. Maintain a normal body mass index. You can calculate your BMI here: http://www.nhlbisupport.com/bmi/
8. Consider adding human derived growth hormone to your treatment protocol.
No one really knows what the right dose is for any of the recommendations I have listed above because there haven’t been enough studies done on the subject. I wish we were at the point where we could take human derived stem cells and inject them into ovaries to make them generate new eggs (the research is there in the mouse model but women will unlikely be able to benefit from this research for generations to come).
As always, I hope this helps!