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
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
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 3mg 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!
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.
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
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.
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 email@example.com.
These supplements and other fertility-related products are available at
our online store.