Do you remember the fable about the goose with the golden eggs? This wondrous waterfowl lays an egg of precious metal on the daily. The owner eventually gets dissatisfied with only one of these at a time. In typical Aesop fashion, there’s a death to teach us that a) geese don’t keep a store of gold in their bellies and b) don’t get greedy. For most of my life, I thought the egg was a symbol of power or wealth. But on reflection, I think it could be pointing to how precious the oocyte is. And egg quality is at the root of its value.
Quality matters. Yet when we talk about the ovaries, the focus is usually on egg quantity. We emphasize a woman’s ovarian reserve and go into detail about how our treatments will increase mature eggs released or harvested. Don’t get me wrong: the number of eggs matter, too (we are born with all of our eggs and that number decreases over time). But I believe egg quality is equally, if not more, important than the sheer number in the ovaries.
What does egg quality even mean?
The egg is a complex cell, frozen in the midst of a chromosome division (meiosis I, for all you fellow science nerds) since before we are born. It only completes that chromosome division once it’s ovulated, which may be many decades later. The process of cell division is complex, utilizing many moving parts, including machinery to pull the chromosomes apart. I think of poor quality as rusty machinery, pulling the chromosomes apart in ways we don’t want it to. This is important because the egg’s chromosomes help comprise the embryo’s genetic code. And random chromosome errors in the embryo are a leading cause of first trimester miscarriage. Another theorized way egg quality may decrease is through exposure to free radicals or to inflammation.
So, how can I test my egg quality?
Here’s the crux: there is no test for egg quality. We presume it based on a woman’s age. Like other cells in the body, the accumulation of cell damage may eventually overwhelm the DNA repair mechanisms that our body has in place.
But herein lies the opportunity. Studies show that the egg undergoes its final readiness phase in the few months before it lines up for the ‘race to ovulation’, where it either is chosen to be released or, if not released, to dissolve away. This timeframe leading up to this race is when the effects of free radicals and inflammation may be counteracted by anti-oxidants and strategies to minimize inflammation.
What is the root cause that may be addressed?
Inflammation is one of those responses that has the Goldilocks effect: you don’t want too little or too much, but just the right amount. It’s designed to aid in the healing process and is composed of activation of different immune cells and substances (like cytokines) to stimulate blood flow, call in immunologic reinforcements, and repair tissue.
But chronic inflammation is too much of a good thing that can lead to tissue damage and harm to various organs. This happens through the nonstop activation of the immune system, new blood vessel formation, tissue fibrosis and its eventual destruction.
What lifestyle strategies can help?
Food is medicine. As such, there are clear diet patterns to support a lower state of inflammation.
- Decrease processed foods. This is the one change with likely the greatest impact.
- Consume a diet rich in:
- omega-3 polyunsaturated fatty acids (wild salmon and walnuts, for example).
- monounsaturated fats (keep the extra virgin olive oil flowing)
- vegetable and seed fiber (brussels sprouts or kale are powerhouse veggies)
- legumes (soybeans)
- whole grains
- lean protein (grass fed and organic is best)
- spices (like turmeric and cinnamon)
What supplements may be helpful for the eggs?
- mitochondria support
- Coenzyme Q10 is a supplement that most fertility patients on. But why that is isn’t always described. It’s a critical cofactor to mitochondria, which are the cell’s energy powerhouse.
- Mitochondria are unique because their DNA code is outside of the cell’s nucleus. Unfortunately, it doesn’t have the same repair mechanisms or the interweaving with histones that also protect nuclear DNA. So mitochondria are vulnerable.
- Animal studies support that damage to or aging of the mitochondria may be associated with negative egg and embryo effects.
- Studies also support CoQ10 as effecting at preventing or reversing these effects in mice. The data in humans is more sparse but one short-term study suggested benefit.
- Counteract the chromosome-damaging effects of free radicals.
- N-acetyl cysteine is the precursor to glutathionine, one of the most potent antioxidants. It’s been shown in studies to be associated with benefit in endometriosis and PCOS.
- Alpha lipoic acid also exerts its effects through glutathione.
- Resveratrol is a plant polyphenol that may explain the health benefits of red wine.
- Ginger is renowned for its inflammation-fighting properties.
- Turmeric (and its active component, curcumin) has also been shown in studies to have benefit against inflammation.
- androgen balancing
- The right balance of male hormones to the female hormone estrogen is critical for proper egg maturation in the follicle microenvironment.
- Male hormone levels decline with age.
- This isn’t for every patient (and certainly baseline male hormone levels should be assessed to best tailor your response), but using male hormones may be helpful in pregnancy chances.
Fertility issues may seem more like a frenzied game of duck, duck, goose as opposed to the daily endowment of a gilded egg. But small changes in our behaviors may truly yield the gift of something even more precious!
I am a USC-trained Reproductive Endocrinology & Infertility physician with a boutique practice in Orange County, CA. I am also a Fellow in Integrative Medicine at the Andrew Weil Center at the University of Arizona, a FEMM Fellow at the Reproductive Health Research Institute, and serve as Associate Clinical Faculty at UC Irvine. My goal is to radically reimagine my field by focusing on whole body methods to identify the root cause and heal reproductive issues, like fertility, miscarriage, and abnormal cycles. I do this through integrative medicine practices coupled with traditional REI techniques, all while avoiding aggressive procedures. I’m grateful to have been selected for multiple years running as a Southern California Super Doctor and Rising Star, Orange County Physician of Excellence, and Top Doc in Pasadena. I am a Healthcare Task Force member for Life Perspectives, a leader in education, research, expertise and support after reproductive loss; serve on the Advisory Board for Pre-Health Shadowing, a non-profit that makes discovery of different medical specialties accessible to students; and have been an invited guest at multiple conferences and podcasts as well as an author of book chapters and multiple articles. I am excited to use an integrative medicine lens to educate about women’s issues!