Vitamins and Supplements to Improve Egg Quality and Quantity
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Vitamins and Supplements to Improve Egg Quality and Quantity
We’ve all heard the stories before…
A woman might in her late-30’s – who was told that none of her eggs were likely to be good – decided she wasn’t ready to get any donor eggs or search for surrogate.
Instead, she took a cocktail of supplements and three months later she got pregnant naturally and gave birth to a healthy baby.
Of course, we know this isn’t always the outcome.
However, curious minds can’t help but ask…
“Which supplements did she take?”
(67 year old “Ma” just gave birth to a baby girl and they can’t hide their happiness.)
- help women with similar circumstances (i.e., same age, same treatment plan, etc.)?
- What do the clinical studies actually reveal (i.e., greater oocyte yield, higher fertilization rate, increased chance for live birth)?
Keep an open mind, but don’t be afraid to be critical. Supplements aren’t a magic bullet… and just because one combination of supplements worked for one woman, doesn’t mean it’s guaranteed to work for another. And remember, age will always be the best predictor of egg quality, so that has to be taken into consideration with the bigger picture.
Another important consideration when choosing supplements is cost. It probably goes without saying, but the cost of supplements can quickly add up, which is why it’s extra important to do your homework. Of course, it’s also extremely important to speak to your fertility specialist before taking a bunch of new fertility supplements.
CoQ10
Mitochondria are organelles located in the cells of the body, are the “powerhouse of the cell”, and are responsible for utilizing oxygen to move electrons and generate energy (which is the creation of adenosine triphosphate or ATP). Coenzyme Q10 (CoQ10) is an antioxidant and aids in the process of creating ATP via the electron transport chain in the mitochondria. It is part of the mitochondrial inner membrane. When CoQ10 levels are higher, the electron transport chain can more efficiently function to create energy. When more energy is produced by the mitochondria, cells with a higher metabolic requirement (such as eggs and sperm) can more effectively function and develop.
Oxidative stress (free radical damage of cells and DNA) is a proposed mechanism which decreases female fertility. Levels of CoQ10 naturally decrease as you age. Taking anti-oxidants such as COQ10 can help reduce this damage and improve outcomes.
Vitamin D
Vitamin D (also called “calciferol”) is a fat-soluble vitamin which is naturally present in few foods and is available to take as a dietary supplement [through D2 (ergocalciferol) and D3 (cholecalciferol)]. It is also produced in the body (endogenously) through the conversion of sunshine on the skin (through ultraviolet (UV) rays), which triggers the Vitamin D synthesis pathway. Vitamin D which is obtained through sun exposure and supplementation is biologically inactive and must undergo several physiologic changes (hydroxylations) to convert Vitamin D to 25-hydroxyvitamin D called 25(OH)D (called calcidiol) in the liver, and then to 1,25-dihydroxyvitamin D called 1,25(OH)2D called calcitriol. This is the active form of Vitamin D in the body. This active form of Vitamin D promotes calcium absorption in the gut, regulates bone remodeling and mineralization, and maintains proper serum levels of calcium and phosphate.
Vitamin D deficiency is very common in most countries. A systematic review has shown that 25(OH)D concentrations below 50 and 25 nmol/L during pregnancy were reported in 64% and 9% of Americans, and 57% and 23% of Europeans, and is highest during the winter months (Pilz). There is data suggesting that low blood levels of Vitamin D may negatively impact fertility, pregnancy outcomes, and lactation (Pilz).
Melatonin
Melatonin is a hormone produced in the brain, in a small tissue called the pineal gland. It plays an important role in nocturnal maintenance of the circadian rhythm and regulating the sleep-wake cycle (,when to go to sleep and when to wake up). Melatonin protects against age-related mitochondrial oxidative damage. Similar to CoQ10, the action is in the mitochondria, helping to reduce the risk of mitochondrial oxidative damage by free radicals in the ovaries. Also similar to CoQ10, Melatonin supplementation has been shown to have a beneficial effect on fertility rates through improving egg quality.
Acai Berry
Acai powder is rich in antioxidants, which can help reduce free radical damage to the ovaries and to eggs, improve egg quality, and can improve outcomes. Acai can be obtained through acai bowls or through supplementation.
NAD
NAD+ (nicotinamide adenine dinucleotide) is an enzyme consisting of adenine and nicotinamide. Most importantly, it is involved in critical steps of the electron transport chain in the mitochondria (like CoQ10) responsible for generating energy (ATP). It also is an important signaling molecule which can effect cellular transcription of proteins and DNA repair. As we age, egg quality decreases in step with declining levels of NAD+. Proposed benefits of NAD+ supplementation (often through the metabolic precursor nicotinamide mononucleotide or NMN) include improving egg quality, restoring fertility potential, and rescue reproductive capability.
Dehydroepiandrosterone (DHEA)
DHEA is a hormone which is naturally produced in the body by the adrenal glands and can also be taken as a supplement. Through several reactions, DHEA is converted to Estrone and Estradiol (Estrogen), which is important in follicle/oocyte development.
One of the proposed benefits for DHEA is in patients with Diminished Ovarian Reserve (DOR). When encountering DOR, it is recommended to take an aggressive approach with maximizing anti-oxidant supplements as well as available supplements/treatments to improve oocyte quality and improve chances of a successful outcome. Proposed benefits include increase egg count, egg quality, and improving pregnancy outcomes.
Vitamin C (Ascorbic Acid)
Ascorbic Acid, also called Vitamin C, is a water-soluble vitamin essential for the formation of collagen (famously to help prevent scurvy!) and is an anti-oxidant with many uses in the body. It is used to maintain and repair tissues, produce neurotransmitters, and functions as a critical cofactor in many enzymatic reactions. Most animals can synthesize their own Vitamin C, but humans and apes are unable to, and must obtain Vitamin C from dietary sources (eat your citrus!). It is also available as a generic, over-the-counter supplement, and is obtained in most multi-vitamins.
Specifically pertaining to fertility and IVF, Vitamin C has several proposed used, including the protection of oocytes from free radical cellular damage. There have been several studies looking at pregnancy outcomes when supplementing with oral Vitamin C at different stages of the IVF process.
