Beth Heller, MS, RYT
At the Moon we are constantly striving to increase our E.Q.I.Q. (Egg Quality I.Q.) and for years we have believed that nutrition can play a role in eqq quality. However, until recently there were few studies to support this claim so we needed to temper our recommendations with the phrase “but there isn’t any clinical evidence for this yet.” Now, several new investigations have shown that, yes, certain nutritional supplements may make a difference in egg quality. The goal of this blog is to summarize the latest clinical news, discuss the substances that are now showing potential benefits for women with poor egg quality and help you make choices about which supplements may be right for you. As with any supplement protocol, you should always consult your physician before starting.
1. Myo-inositol (MI)
Very recently two clinical trials were published that clarified a lot of the unknowns about myo-inositol, a product we use at PDtM under the name of FlowPro. Myo-inositol (MI) is a part of the B vitamin complex and is a known insulin-sensitizer. It has also been shown to improve both physical (hirsutism and acne) and reproductive (anovulation and amenorrhea) manifestations of Polycystic Ovarian Syndrome (PCOS). In addition, myo-inositol plays a role in cell growth and early studies indicated that higher levels of MI in the follicular fluid was associated with better egg quality.
Several exciting new studies have emerged that have shed new light on MI and its role in fertility, particularly Assisted Reproductive Technology. The latest study of interest demonstrated that treatment with 4 g per day of MI for three months prior to IVF improved egg quality in women who had failed a previous IVF due to poor egg quality. In this study the treatment also included 3g per day of melatonin, which I will talk about next.
But first, a note about inositol. For some time there has been a debate as to the efficacy of d-chiro vs. myo-inositol for fertility. We have chosen to use MI in our products because a) this is the form that has been used in all the clinical research we have seen to date on PCOS, egg and embryo quality and b) it is less expensive than the d- form. Now, a new study confirms that myo-inositol seems to be more effective than d-chiro for egg and embryo-quality. On another happy note, MI has also been shown to have a positive therapeutic effect on mood disorders that are responsive to SSRI’s (serotonin selective reuptake inhibitors) including depression, panic and OCD – a potential plus for the anxious, depressed fertility patient!
2. Melatonin
Melatonin is a hormone that is secreted by the pineal gland. It regulates our sleep/wake cycle as well as other hormones, in particular the hormones of the female reproductive cycle. New studies like the one above suggest that melatonin supplementation at a level of 3 mg per day may help to improve egg quality when taken with MI for several months prior to IVF.
There are caveats to the use of melatonin. Side-effects may include exacerbation of depression symptoms and patients who struggle with depression should make sure to discuss this side-effect with their physician. Melatonin should not be used with patients using thyroid medication as it can impact thyroid hormone levels. It can also suppress ovulation at high doses so in general we only recommend this supplement for women who will be using ART and a trigger shot to stimulate ovulation and/or retrieval.
Finally, melatonin should NOT be taken while pregnant or nursing. In general we do not recommend melatonin use for longer than 3 months without taking a break. It can also cause marked drowsiness and is best taken just before bedtime.
3. DHEA
DHEA (not to be confused with the omega-3 fatty acid DHA) is a hormone that serves as a precursor of steroid hormones testosterone and estrogen. Research indicates it may also stimulate follicular development. Several studies have shown supplementation with 75 mg of DHEA daily to improve egg quality and pregnancy outcome in women who were “poor responders” to IVF stimulation medication. Another study suggests that DHEA supplementation may reduce the risk of aneupoloidy.
DHEA should be used with caution as it is a pretty powerful hormone and when used at high levels and over a long term it may damage the liver. Women who are pregnant or nursing should not take DHEA, nor should women with PCOS as this could exacerbate the condition. Like melatonin, we recommend a three month treatment period.
4. CoQ10
CoQ10 is a naturally occurring fat-soluble nutrient that is essential for energy production. CoQ10 has potent antioxidant properties and cell membrane stabilizing effects that make it beneficial for egg and sperm quality, specifically sperm motility. CoQ10 works within the mitochondria (the cellular power stations) in the cells and is essential for energy production. Until recently, CoQ10 was not thought to be a nutrient that required supplementation, as all normal tissue manufactures its own CoQ10; however, this production decreases naturally with age and is also lowered by certain drugs, including statins. When CoQ10 levels in the cells are low, energy production may be reduced and oxidative stress increased as a result.
CoQ10 has been shown to improve sperm quality and is now under investigation for potential use with women of advanced reproductive age undergoing ART to improve egg/embryo quality. The oocyte has among the highest concentrations of mitochondria of all body cells and uses immense amounts of energy in the process of maturation and ovulation. Researchers hypothesize that supporting the oocyte with CoQ10 may improve egg quality (Bentov et al. 2010).
The recommended dosage for overall health is 100-300 mg/day, or as directed by a nutritionist. The dosage under investigation in studies looking at egg quality is higher: 600 mg/day. CoQ10 appears to be a safe supplement: Studies have used supplementation of CoQ10 up to levels of 3,000 mg per day without adverse side effects. At present, the only risk to taking CoQ is the cost, as this supplement can be pricy, and no data currently exists on its usage in high doses during pregnancy.
5. Omega-3 Fatty Acid (EPA/DHA)
There is still no direct clinical evidence that omega-3 fatty acids improve egg quality but we are convinced they are a good bet and include them in our Egg Quality Protocol. Eicosapentaenoic acid (EPA) forms the backbone of many of the chemicals that halt inflammation in our body and also serves to support the health of our cell membranes. Docosahexaenoic acid (DHA) (not to be confused with DHEA above) is important for brain health and adequate stores of DHA are thought to be beneficial for the early cognitive development of the fetus. DHA may also be helpful for depression. Look for purity-tested products.
This is exciting news indeed but you should always speak with your physician before beginning a supplementation regimen of any kind. Of course, we would also be remiss if we didn’t mention that providing your body with the highest quality diet is also important for fertility. If you are specifically seeking to improve your egg quality you should also consider re-thinking your diet to limit inflammation, achieve good blood sugar control and get ample antioxidant nutrients from food sources. Our nutritionists at Pulling Down the Moon are specialists and will tailor their recommendations to your fertility diagnosis.
For more information about any of the supplements or info in this blog, please feel free to contact me at beth@pullingdownthemoon.com. These supplements and other fertility-related products are available at our online store.
I have more question about the egg controll
Lashonda, you can post your general questions here and if you have more specific needs you can contact our office to speak to one of our nutritionists. Thanks!
Do you recommend these supplements for women who are trying to conceive naturally (without IUI or IVF)?
Hi Faith, It would depend on age, diagnosis, etc. Have you seen a doctor or been given a reason why you’re not conceiving? In general we would recommend working with a nutritionist who can guide you to not only to the right supplements but also explain how diet choices can impact fertility. Melatonin should NOT be taken in high doses in women who are “trying naturally” as it may delay ovulation (obviously not great for fertility!). There’s no consensus of how high a dose of melatonin is required to delay ovulation so until there’s more clinical data we proceed with caution in natural cycles. Melatonin should also be avoided if you have depression, thyroid issues or are taking thyroid meds. DHEA should not be taken by women with Polycystic Ovarian Syndrome (PCOS) or by women who are pregnant. Because these supplements have contraindications would recommend that you get screened by a fertility doctor for these conditions before trying either melatonin or DHEA. Myo-inositiol has less potential for side-effects but, again, we recommend that you clear any supplement with your physician first.
I’m trying naturally after several months of clomid. I’m 40 with secondary infertility. I’m also on synthroid for hypothyroidism. Which supplements would you suggest?
Hi Beth, it’s difficult to make a specific recommendation without a full nutrition intake. In general we recommend what we call our “Core Five for Fertility” – a good prenatal (like our Prenate Pro), an omega-3 supplement that has >700 mg EPA and >500 DHA, a probiotic to support the immune system, the gut and detoxification processes, Vitamin D for good hormonal function and CoEnzymeQ10 to support mitochondrial function in the developing eggs. In addition we have specific protocols for Egg Quality, PCOS and hormonal imbalances. Our nutritionists would have to look at your diet, your gut function, symptoms and menstrual cycle before making specific changes. You probably already know to limit soy (especially processed soy) as it can interfere with thyroid function. I highly recommend a nutrition consultation with one of our specialists – they are available in person in Chicago or the DC Metro area or via phone. We offer two tracks. Our Therapeutic Nutrition Track is for women working on a specific issue like egg quality, poor response, endometriosis or PCOS. This may or may not be combined with our ART Recovery/Prep Program, a healing “cleanse” program that we often use in cases of failed cycles, miscarriages and unexplained infertility. I wish you the best of luck and hope #2 comes quickly.
! Peace, Beth
What do you suggest for women who are pre-menopausal (POI, POF) who still ovulate pretty regularly? I do take DHEA and have for awhile. I am going to be 40 soon, and have had 2 successful pregnancies and 3 miscarriages.
Carrie, thanks for your question. I’m sorry to hear that you’ve experienced so many losses but also heartened to hear of your successes. You don’t specifically mention that you’re trying to conceive again but I’m assuming that is your goal as I respond to your question.
Without a full history it’s hard to be specific but here are some general thoughts. With POI we usually start with the diet, and work with strategies that improve nutrient intake, limit inflammation and oxidative stress and promote hormonal balance. In some cases that means our nutritionists will eliminate dairy, gluten and soy but that will depend on a patient’s individual case, digestion, medical history, etc. Regarding supplements, we do use DHEA in some cases but we do not like women to take it for longer than 3-6 months at a time. We would definitely take a look at how long/how much DHEA you are using and how you feel it is helping your cycles before deciding whether or not you should continue. Beyond DHEA there is emerging data that myo-inositol may play a role in the maturation process of eggs so this is a supplement you may want to try. We also believe CoQ10 and fish oil (EPA/DHA) may also support the hormonal milieu and eqq quality.
In some cases we will use a product called Reprocleanse. This is a non-soy phytoestrogen supplement that is NOT appropriate for women using medical fertility treatment. In women trying naturally we will sometimes use it for two weeks to a month after a miscarriage or in cases of high estrogen or other elevated hormones. Anecdotally we have seen benefits. Of course, we recommend you clear all supplements with your physician prior to starting.
If you want more specific guidelines, our nutrition consultations are available in person in Chicago and Rockville, MD and by phone from anywhere else. It’s an in-depth, personalized process that may not only enhance your fertility but may also improve your general health.
Best of luck! Peace, Beth
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Hi there! I am excited to have stumbled onto your site as it seems filled with excellent information!
I am wondering if you can speak at all to the supplementation of only Myo-inositol? Is it only effective when paired with Melatonin or is there reason to believe that seeking this out independently may offer some improvement as well? Perhaps paired with CoQ10 (with Omega-3)?
I am 32, have 1 failed IVF (zero fertilization; eggs luteinizing) and 1 ectopic pregnancy (have since had bilaterial tubal removal) and am preparing over the next 4 months for my 2nd IVF. Eqq quality MAY be an issue and I am hoping to do what I can to increase my odds!
Any advice you can offer would be greatly appreciated! Thank you.
Thanks so much for your comment. We use myo-inositol in several different contexts – in women with PCOS, in women with a history of hyper-stimulation during IUI and IVF and as part of the melatonin/myo protocol described by Unfer et al. Because melatonin can interfere with thyroid meds, we will sometimes use myo-inositol by itself in women who are poor responders and/or have egg quality issues. In fact, we are actually hoping to conduct some research looking at myo-inositol without melatonin to support egg quality. Of course you should always clear any nutritional supplement regimen with your physician.
What would you suggest for someone who’s eggs are 2 small. I was told my eggs should be bigger at this point of time in my cycle. Is there any vitamins or herbs that can help with the size?
Thanks.
There are no supplements proven to increase egg size/quality, however, there are several protocols under investigation for potential benefit. You may want to ask your Reproductive Endocrinologist about DHEA, myo-inositol, melatonin and CoQ10 with your next cycle if this one is not successful. We do not recommend taking these supplements without doctor’s approval.
Let’s hope this cycle works, though…Best of luck!
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