How to Optimize Egg Quality for Fertility (Episode 517)

Full Transcript: Episode 517

Lisa Hendrickson-Jack:

In today’s episode, we are taking a deep dive into optimizing egg quality. This is one of the topics that Lily and I dove deeply into when we were writing Real Food for Fertility. Arguably, following the instructions and following the protocols that we put forth in the book are going to improve egg quality anyways, but we take it much deeper into looking at why is egg quality important, how is the egg cell different from other cells in our body, and what are some of the specific steps that we can take to really optimize egg quality. So without further ado, let’s go ahead and jump into today’s episode.

So I think a great place to start is just with the question of why is egg quality important? I think that in some ways that question is obvious. The egg cell is really the start of human life. That’s where we all come from. And when we look at it from a scientific standpoint, it’s really interesting to think about the qualities of the egg cell itself. So, you know, the egg cell is unlike any other cell in the body. It is larger. It’s the largest human cell. It is the one cell that is visible to the naked eye. And so if you were to look at, if you, you know, were to look at a book or something like that, an egg cell is similar in size to what a period would appear to, you know, on a piece of paper. So, you know, that makes the egg cell unique. And I mean, why is it so large? You know, what is it? Why, what makes it so different?

So again, some interesting facts about the egg cell. The egg cell contains more mitochondria than any other cell in the body. And so if you think back to your junior high or high school biology class, I always think about this. So when we were learning about the cells, we would learn about plant cells and animal cells. You know, in animal cells, they would have the mitochondria. And when we would see the picture of these cells in our textbooks, there might have been one or two mitochondria in the cell. There’s different numbers of mitochondria in different cells in the body. So, you know, a liver cell or a heart cell may have a few thousand mitochondria. And so even that is interesting because I’ve never seen anything depicted like that. So I don’t really even have a visual in my mind for what that could possibly look like. But the egg cell has anywhere from 100,000 to 600,000 mitochondria.

And so that might give us a clue as to why it’s so large, why it’s so much larger than any other cell in the body. And I believe that that also speaks to the importance of the role of the egg cell, right? Because all of us started as an egg cell. And when you think about what mitochondria are doing, they are the energy source of the cell. That is what drives the cell. So of course, the egg cell would require more mitochondria than any other cell in the body. And of course, it would be the largest cell of all the human cells because it’s literally growing a human.

So when we think about that in context, the science helps that kind of common sense. Well, of course, the egg cell is important, but it really informs why it’s important. And also, it informs us a little bit more about what makes the egg cell different. And given just the sheer volume of mitochondria in the egg cell, it also leads us towards some of the things that we can be doing to really improve and optimize our fertility and optimize that egg quality. So a large part of what we need to do then is to support those mitochondria so that they are able to really thrive. And by supporting the mitochondria, we are also going to be improving the overall health of the egg cell.

So I think that’s a great place to start. You know, and there’s some other interesting information about eggs and quality that I always like to share with clients and practitioners. And we’ve all heard, or at least most of us have heard, that we are born with all the eggs that we are ever going to have. There’s talk here and there in the scientific community about stem cell research and the possibility that, you know, well, that might not exactly be true. But when it comes to natural conception, I mean, even if there was a possibility for these stem cells to be grown into new eggs and to give us possibilities that we wouldn’t have had previously, none of that is going to be done in the old-fashioned birds and the bees way. So, for what it’s worth, we are born with all the egg cells that we’re ever going to have.

And one of the big differences between male and female fertility is that although male fertility, you know, fertility does decline in men with age as well. So it’s not to say that, you know, an 80-year-old man is going to have the same fertility as a 20-year-old. I mean, the quality of the sperm, things are going to be very different. But men are fertile from puberty onwards, whereas women are fertile from puberty to menopause. So we definitely have an end date. And so one of the things that we’re going to talk about in today’s episode is the impact of age on fertility.

But getting back to just this concept that we’re born with all the eggs that we’ll ever have. So it’s estimated that when we’re born, we have anywhere from half a million to a million follicles. And there is a natural and gradual process of decline in these numbers as we get older. So when we start puberty, it’s estimated that this number decreases to about 400,000 follicles. And as we get up in age, when we’re in our late thirties, we’re estimated to have anywhere about 25,000 somewhere around there. And then when we actually hit menopause, and so menopause is the word for our last period, and that’s identified after you’ve gone one year without menstruation. So it’s estimated that we have about an average of 1,000 follicles at that stage when we have our last period.

So this brings about lots of interesting questions. And I think one of the questions I often get when I talk about this is, you know, well, if we’re on the pill for a while and we’re not ovulating, does that somehow preserve our eggs? And so in that description that I gave you, there was a decline in the estimated number of follicles from birth to puberty. And during that time, we’re not ovulating. So there is a process of, you know, follicular atresia — that’s how they talk about it in the research articles — but there is this gradual decline that happens over time kind of regardless as we get older.

And then also when we’re ovulating, so it’s estimated that we ovulate about four to 500 times over the course of our reproductive lives. So assuming that we’re not on contraceptives for 20 years or something like that. And so when you ovulate though, it’s not that you lose one egg. So this is an important part of understanding egg quality as well. When you’re ovulating, so let’s say this month, when I look at my ovulation that’s happening, that egg — well, I was born with that egg — and then it was in development for many months prior to ovulation.

And so the estimated development phase of these follicles, and so they’re there already, but prior to ovulation, there is this whole process of follicular development that goes on in the background. So the follicles, the estimated time is anywhere from seven to eight months, or possibly more, from when that follicle is brought through this developmental stage. And the most critical in terms of our nutrients and our preparation to optimize egg quality, the most critical time is that three-month period prior to ovulation. So if I’m releasing this episode in the month of April, then in the month of January, whatever I was doing in January or February, that is contributing to the egg quality of the egg that I’m going to ovulate now. But that process of development started even before that. I would have to count seven to eight months earlier than that of when this process initially began.

So that’s something really interesting to consider as well. When we’re looking to optimize our egg quality, it’s something that we really want to think about in that preconception phase. And this is why it’s really important when we can, when we have the ability to plan ahead for pregnancy. And this applies to both parties. So today’s episode is focused primarily on egg quality, but it’s equally important for men to also be thinking about sperm quality. And a similar time frame does apply because whatever you’re doing, you know, whatever sperm he’s releasing today is a printout of whatever he was doing three to four months ago. And in the very same way, the quality of our eggs today is a reflection of what was happening three to four months ago. So it really shows us how crucial that preconception period is.

And I should also mention that as I’m going through these points, if you’re wanting to dive deeper into this topic, if you’re wanting to take a look at the research and kind of dive into some of the research papers that went into these sections where, you know, the information I’m talking about — mitochondria or, you know, the number of eggs that we’re born with — if you’re interested in reading some of that original research, I would definitely point you to Real Food for Fertility. All of the topics that we’re covering are covered in the book. And in particular, I’m focusing on chapter 10 today, because that is our egg quality chapter. And of course, you can also review chapter nine, which is the sperm quality chapter. I put the sperm before the egg just to kind of illustrate that although the egg is essential, without healthy sperm, conception can’t happen, right? So we have to look at them as a team with each of them contributing 50% of the overall contribution there.

So I mean, that I feel like is a really good introduction to this topic. Now we know why egg quality is so important and a lot of the kind of important and key factors in egg quality. So something else I should mention when it comes to egg quality is that there’s parts of this equation that we can have an effect on and parts of it that we can’t. One of the factors that we don’t really have control over is the quantity of our eggs. So as I mentioned, as women, our reproductive lifespan, it does have an end point. And we do have this gradual decline of egg quality that occurs kind of regardless, or egg quantity that occurs.

And so one of the things when it comes to testing, and when we’re wanting to look deeper into our egg quality, that’s something that we should talk about, because many women are getting ovarian reserve tests — tests like AMH, anti-Mullerian hormone, FSH, follicle-stimulating hormone, and a variety of other hormone tests — and while these tests are important and helpful in their own way, what they’re really telling us more about is often the quantity of eggs.

So AMH, for example, anti-Mullerian hormone, it is a hormone that is released by our follicles. And so as we move toward ovulation, each time we move towards ovulation, it’s not just, like I said, it’s not just one egg that we release. It’s a group of follicles that are all developing at the same time. There’s a little pool of follicles towards the beginning of that menstrual cycle. And out of that pool of follicles, one of those follicles is chosen for ovulation. And the rest of those follicles are essentially reabsorbed. Again, that concept of follicular atresia. So that just means that they are reabsorbed. They are not ovulated, and they are not preserved for another round. That’s it for them. So that’s kind of the end of their journey.

So the majority of our eggs actually don’t end up being ovulated if we’re ovulating an average of four to 500 times in our reproductive lifespan. The majority of those eggs end up reabsorbed. But going back to that little pool of eggs, when we’re, you know, soon after puberty, you know, when we’re earlier in that journey of our reproductive lifespan, then that pool is larger. So each time we go to ovulate, there’s a larger pool of follicles that is developing each time, and then we ovulate from that pool. And as we get older, that pool, it gets smaller and smaller.

And what the researchers found was that there was this correlation between the AMH levels, because they’re released by those developing follicles, and our reproductive lifespan. Now, for anyone who went, you know, who did like a stats course or something, they always say correlation is not causation. But there is this correlation. And so if you were to measure the AMH levels of women in their 20s, women in their 30s, women in their 40s, you would see that on average, those numbers are going to decline. And so it’s actually more useful to compare what would be normal for a 20-year-old or for a 25-year-old or for a 30-year-old, as opposed to just looking at AMH levels overall. Because within each age cohort, you would have a different category or a different frame of reference for what’s normal in that stage.

So with that in mind, what happens, and if you are listening to this episode because you have been told that you have a low AMH level or diminished ovarian reserve — often what happens, and what’s happened with many of my clients and practitioners and their clients, is that when we are getting these parameters back, when we’re doing this testing and the numbers are low, we’re being told that it has an impact on our ability to conceive naturally. So we’re being told that if you have a low AMH, which again is reflective of the quantity of eggs, not necessarily the quality, you are being told that that means you won’t be able to get pregnant naturally. I’ve had clients who were told that it means that they’re going to go into menopause immediately. And what’s interesting is that when we look at the research, the research doesn’t indicate that.

So again, this is something that we covered in Real Food for Fertility at length. But when you look at what the data says, the ovarian reserve parameters are actually most effective and useful at predicting IVF — not even the overall IVF outcome, but how many eggs will be retrieved. So if a woman has low AMH, it means that that little pool of follicles that develops towards the beginning of each cycle is smaller. And so the smaller that follicular pool in her ovaries — again, and that’s what the AMH level numbers are reflecting — then the less likely she is to get a really significant quantity of eggs out of that.

So if someone’s going to do IVF, obviously they have to stimulate the ovaries, and then they try to develop as many eggs as possible. And so when those ovarian reserve numbers are lower, then there’s less eggs to develop. And so naturally that means that there would be less of a possibility of having a higher number of eggs at the end of the stimulation process. So what’s interesting is, you know, across the board, meta-analyses, you know, many, many studies, they come to the same conclusion — that the most effective use of these ovarian reserve parameters is to predict how many eggs are going to be coming out of this retrieval process. And what they consistently show as well is that these numbers don’t necessarily correlate with women’s chances of conception.

So just because you have a low AMH, or have been told you have a diminished ovarian reserve, the research tells us that it doesn’t mean that you won’t be able to conceive naturally. I don’t think it means we should ignore the numbers. I think that if you have the low AMH numbers or the diminished ovarian reserve numbers, it does tell us that we should really double down and focus on the quality, overall quality of eggs. And I have had clients who have, by following some of these suggestions and by optimizing the dietary factors, supplemental factors, reducing nutrient deficiencies, focusing on some of the key nutrients that we know support egg quality, I have had some clients who improved their AMH levels overall. And of course, their chances of conception and optimizing their quality.

But so it’s not to say we should just totally ignore these numbers, but we should really be looking at what the research tells us that they mean. And so again, if you are thinking of, or have it in the back of your mind that you may move forward with artificial reproductive technology, I think that it’s helpful to know that that’s where those ovarian reserve parameters are the most predictive. And not necessarily, and again, like whether you’ll get pregnant or not, but specifically to the number of eggs that you may retrieve.

And so just to give another example of that, since those numbers are reflecting that pool of eggs in the ovaries as you’re moving towards ovulation, women with PCOS — polycystic ovary syndrome — tend to have a higher pool of follicles. I mean, that’s what it means, polycystic ovaries. And if you were to look at the ovaries of a woman who has PCOS, but also specifically has that kind of classic string of pearls presentation in her ovaries, you would see it looks like a little sack of marbles, you know, lots and lots of these little follicles in there. So women with PCOS tend to have high AMH because they have a larger group of follicles developing, and that’s because of the issue of PCOS. The classic PCOS symptoms include insulin resistance, and that interferes with the natural process of ovulation and results in this larger number of immature follicles that are not moving toward ovulation in a timely fashion. And this is why that condition is characterized by long and irregular cycles.

So in that situation then, these women have high AMH, and does that mean that they have way more eggs in their reserve than the rest of us? Or does that mean that it’s a sign of ovulatory dysfunction? And so for those women who have a high AMH level, who have multiple small follicles in their ovaries beyond what is optimal, then they are at a higher risk to overstimulate — meaning that when they’re going through the IVF process and they’re trying to stimulate the ovaries to make eggs, they’re at a higher risk of stimulating too much, and that condition could even be fatal in some cases, in some severe cases, and can cause extreme discomfort and pain when you have this ovary that is producing just way too many eggs.

So I hope that that’s helpful as well, because when it comes to egg quality, this is something that is not as easily measured. If we think about, if we go back to just the idea of sperm quality and sperm quantity, I mean, men can provide a semen sample. So they can, we can take that semen and look, analyze those sperm, we can look at them under the microscope, we can identify what the quality is like. It’s a lot easier to do that. But with egg quality, it’s not as easy to just extract a bunch of eggs or see how many we have or that kind of thing.

So when it comes to ovarian reserve parameters, they are always an indirect estimate of the remaining reserve. And those ovarian reserve parameters again are looking at the quantity, how many, and it’s always an estimate. No one’s going in, pulling out the ovary, cutting it in half, and counting the remaining follicles. So it’s always an indirect estimate of what we’re having. And then the quality is a bit more difficult to measure as well, because again, we would have to be extracting. And so fortunately — and this is something that we argue in Real Food for Fertility — we argue that a healthy menstrual cycle sets the stage for optimal fertility.

And so when we think about the menstrual cycle as a vital sign, what we’re saying is that, although we’re not going to go and pull out your eggs and look at them one by one to identify the quality of them, what we can do is we can indirectly look at your menstrual cycle. And the overall quality of the menstrual cycle is reflective of your egg quality and your follicular development. So even for example, everything is so intimately connected. If you were to look at the development of a follicle, I mean, they can measure the follicle, they can measure the size, and we know what an optimal-sized follicle would grow to.

So, for example, if you are having a normal healthy menstrual cycle, you have good, healthy, strong follicular development, the follicle is growing to a good size, then that is indirectly going to be reflected in the amount of estrogen that you’re producing. The length of your cycle, when ovulation is happening, and the amount of estrogen that you’re producing, for example, in that follicular phase prior to ovulation, is going to then have an effect on your cervical fluid production. It’s going to have an effect on the development of your endometrial lining. Estrogen is directly responsible for rebuilding the functional layer of the endometrium after you’ve had your period. And so the health and strength of that follicle is going to have a direct impact on these other signs of your menstrual cycle that we can observe.

So although we’re looking at this often in an indirect way, we can look at the menstrual cycle as an indirect kind of reflection of how your eggs are developing. And similarly, we can look at the luteal phase, because what happens when we ovulate is that that egg is released from that ovarian follicle, and once that happens, the remaining follicle — the remaining egg sac, if you will — on the ovary is what turns into the corpus luteum. And so the health of that follicle has a direct impact on the health of that corpus luteum, and that is reflected by the quality of our luteal phase and our ability to produce progesterone.

So there’s indirect ways for us to assess egg quality in that respect by taking a look at the menstrual cycle. And I think this is also an interesting approach when we’re looking to support and improve egg quality, because then we want to be supporting and improving the menstrual cycle, because these things are intimately connected. Again, it’s the follicle, the health of that follicle that determines our hormone levels and whether our hormones are balanced, how much estrogen and progesterone we are producing — it’s a direct result of the health of our follicle.

So when we look at then, what are some of the factors that impact egg quality, potentially in either a positive or negative way. Unfortunately, the biggest factor that plays a role in egg quality is our age. And so we can look at that either as a positive or negative. The reality is that as we get older, our egg quality naturally declines. And again, this also applies to men. As men get older, the quality declines. And this can be a result of issues with mitochondrial function. We talked about the importance of the mitochondria. So as we get older, the quality of our mitochondria can suffer. And also our exposure to oxidative stress or response to.

So oxidative stress is — I mean, it’s a fancy word for damage due to oxygen. And I always like to use the example of peel a banana, leave it out, it starts to turn brown. So that’s an example of oxidative stress. And so as we get older, we are more susceptible to oxidative stress. And so those are two big factors that kind of come into play. As we get older, most of us have heard that we are at a greater risk of having chromosomal abnormalities or DNA integrity issues. And this plays into our ability to reproduce. Because of course, in that process, it’s essential that the chromosomes are duplicating, replicating properly, and all of that, but yet we are at a higher risk of that.

So I think the key takeaway as we get older — so as we get into our mid-30s and beyond, you know, mid to late 30s, early 40s — if we’re looking to optimize our chances of conception, if we’re looking to optimize egg quality, the first thing is that just by being in that age category, it’s something that we should really be aware of. We should be taking some steps to kind of mitigate some of those impacts of age. And as I mentioned, one of the key ways to do so is to support our mitochondrial health. And then of course, another would be to look to finding ways to reduce that oxidative stress to the best of our ability. And so how do we do that? We do it through a combination of diet, lifestyle factors, and smart supplementation. Those are the key things that we can do to optimize our egg quality.

And so, you know, some of the factors that are really key to supporting egg quality — I think, you know, the first one that we mention in that section of our egg quality chapter is being aware of the impact of high refined carbohydrate consumption. So we know that consuming a large amount of highly refined carbohydrates is associated with ovulatory dysfunction. There was an interesting study that found that women who had the highest intake of refined carbohydrates were at a 78% greater risk of ovulatory infertility compared to women with the lowest intakes. And often when we think about this effect of carbohydrate consumption, we might think of women with PCOS and assume that they’re the ones that are really being affected. You know, for these women, when they consume carbohydrates, it causes ovulatory disruption, they may experience long and irregular cycles. So we can really see how it affects their cycle, but I think the mistake is to think it only affects those women. It doesn’t affect me, you know, because my cycles are fairly regular, it doesn’t have an impact.

And so, you know, what the research tells us is that it does have an impact even on the quality of our eggs and potentially the mitochondrial function. So maintaining a balanced blood sugar, consuming a balance of protein, fat, and carbohydrates, as we talk about in the book, is one of the first things that we can do, one of the first steps we can take to optimize egg quality.

I mean, there’s other factors that can have a negative impact, whether it’s dietary — if we’re not consuming enough omega-3 fatty acids, if we’re consuming too many of those inflammatory foods out of balance. If we have poor metabolic health in general, and so whether that is related to insulin resistance, high blood pressure, significant weight gain, women with metabolic syndrome have been found to have to take a longer time to conceive. So that concept of just overall health is really crucial to egg quality.

Something else to consider that we talk about a lot — I know I talk about this a lot with clients — is, again, related to food. If you’re not eating enough, this is huge. So this is where menstrual cycle charting can play a really significant and useful role in helping us to evaluate the quality of our menstrual cycle, which then is an indirect reflection of the quality of our eggs. So for women who are inadvertently not eating enough food — so whether that’s skipping meals, skipping breakfast, intermittent fasting, or working out a lot and not necessarily eating a sufficient amount to offset their energy expenditure — so that’s huge.

When we look at what the research has to say about not getting enough to eat, if you are underfueling yourself, there is even an interesting sweet spot where, before it starts to create overt issues with your menstrual cycle, there was a study where the women in the study, they had two groups. One of them was eating what they call a eucaloric diet. So they were eating a sufficient amount to offset their energy expenditure, and this was one of those kind of controlled feeding studies. So they actually were measuring, like weighing their food and comparing it to how much they were working out. So it was very kind of controlled. And so you had the one group that was getting a eucaloric, sufficient amount for their activity level. And the other group was eating anywhere from 20 to 30% less than their expenditure.

And what was interesting about that study was that none of the women stopped getting their periods. You know, the cycles were not overly disrupted, but there were kind of subtle changes that you may observe when you’re charting. But when they were measuring the blood levels of these women, of their hormones — estrogen and progesterone — they found that even though they were regularly cycling, their estrogen and progesterone levels significantly decreased, even though they didn’t have overt cycle disruption.

So again, what we talked about earlier was that the level of hormones that you’re producing during the menstrual cycle is a direct reflection of the quality of that egg. If that follicle is getting to that right sweet spot, that good size, that has an impact on how much estrogen it’s going to be putting out, how much progesterone the corpus luteum is going to be putting out, because that corpus luteum is developed from the remaining follicle after ovulation takes place. When we see that the hormone levels are decreasing by that much, it really shows us that we should be aware that if we’re not fueling our bodies sufficiently, it is having a negative impact on that follicular development. And that is why it goes on to cause these cycle issues.

So I mean, there’s a number of factors that impact egg quality. If you think about any of the kind of lifestyle pieces — things that we know aren’t necessarily great for us — things like smoking, or heavy alcohol use, or excessive caffeine consumption, exposure to toxins — none of these factors are optimal to support our egg quality. So we do want to be looking at some of those lifestyle factors. And of course, we want to be paying attention to our diet.

I always give an honorary mention to hormonal contraception because we do know that when a woman is on birth control pills or other types of hormonal contraceptives that are suppressing ovarian function, they do have a specific negative impact on those ovarian reserve parameters. While women are on contraceptives, they have a lower AMH, a lower antral follicle count, lower ovarian volume. And that’s because these contraceptives are essentially making our ovaries dormant during that time. And what the research shows us is that it can take anywhere from six to seven months after coming off these contraceptives, and I would argue that half a year to a year based on some of the things I’ve seen clinically, for those ovarian reserve parameters to normalize, to fully normalize. So that’s something to keep in mind as well.

In addition to optimizing diet, so in Real Food for Fertility, we outline the optimal diet for fertility based on what the research has to say, what key nutrients are needed, and what foods to prioritize in order to get there. So it’s not about being overly restrictive, it’s about what are we adding in. And some of the key foods that we always want to consider adding in include, you know, liver and organ meats, fish and seafood as a source of omega-3 fatty acids, as a source of zinc and other key nutrients, eggs as a source of choline and folate, and fermented foods to support overall gut health. So there’s a number of specific foods that we really want to be adding in.

And in addition to that, when it comes to supporting egg quality, there are a number of key nutrients and supplements that have been shown to support egg quality. One of the best studied is coenzyme Q10, because of its role in supporting mitochondrial health. Again, going back to how the egg has more mitochondria than any other cell in the body. So coenzyme Q10 is another nutrient that has been well studied for supporting sperm quality. Because if you think about the important role of mitochondrial health in sperm quality, I mean, just the motility — motility is one of the key factors that tells us about the health and quality of sperm. And of course, the role of the mitochondria is essential. So, not only has coenzyme Q10 been well studied for egg quality, but also sperm quality, and again, because of its ability to support mitochondrial health.

I mean, other nutrients include vitamin A, vitamin D. Vitamin A is essential for reproduction in so many ways. We go into it a lot more in the book. I would highly encourage you to read more about vitamin A if you’re not aware of the key role it plays in reproductive health. And this is one of the reasons that incorporating liver, cod liver oil, natural sources of vitamin A is so important. Vitamin D is essential for optimal fertility. Really optimizing those levels can’t be understated. It’s essential for overall menstrual cycle health, hormonal health, fertility, ovulatory function, ovulation, egg quality. And there’s even interesting studies that have been done on vitamin D supplementation and its ability to improve AMH levels over the course of several cycles. So there’s a lot of important takeaways there.

Another category of nutrients that is essential for supporting egg quality are the antioxidants. So, you know, vitamin C, vitamin E, selenium, folate — all of these different antioxidants are, again, going back to the brown banana concept. As we get older, we really need to kind of mitigate that oxidative stress, because again, we’re more susceptible to this oxidative damage as we get older. It’s part of aging. I mean, that’s why the banana turns brown because it’s getting older, right? It’s aging. But one of the ways that we can combat this is to really learn more about some of these key nutrients, supplements, and dietary practices to optimize our overall egg quality.

So I mean, this is really just the tip of the iceberg. I wanted to jump in and share some of the key takeaways with you, because I know this topic is an important one, and I know many of you have questions. And of course, many of you are tuning in specifically because we want to improve our overall egg quality.

One thought that I want to leave you with, and I’ve been hinting at it throughout this whole episode, is that egg quality is an important factor to conception, obviously. We really want to be optimizing our egg quality and especially as we’re getting older, we want to make this a priority. But by no means is it the only factor. I would never recommend that you, as the female part of the equation, are the only one who is doubling down on preconception nutrition and optimizing egg quality. Just keep in mind that it is equally important for your partner to do the same with his sperm quality. It cannot be understated. Our egg quality doesn’t entirely make up for his lack of sperm quality. Male factor infertility is on the rise and plays a part in 50% of infertility cases. That’s half.

And if you have been trying to conceive for a year or more, and you know something about timing — so you’re having sex at the right time in the cycle and it hasn’t been happening — then it is statistically much more likely that his sperm is not optimal. So from that standpoint, for any couple who’s been trying to conceive for a year or more and it hasn’t been happening, when they do research studies and look at the sperm parameters of men who’ve conceived within a year and compare it to the couples who have not conceived within the one-year or the two-year mark, the semen parameters of those men are overall, on average, lower. So keep that in mind as well.

One of the things I strive to do with this fertility conversation is to stop making it all about women. And I always make the joke that, you know, with all three of my children, I carried them for nine months, I went through labor, you know, pushed them out, all the things, and they came out looking just like their dad. And so I think it’s really important for us to just never forget that contribution that he’s making.

It is possible that you could do everything. You’re standing on your head, you’re eating all the things, you’re eating all the things that you’re quote supposed to and not eating the things you love, right? Like, so you’ve made all these changes, you’re doing all these things, and the pregnancy’s not happening, you’re trying to do more and more and more and more. And it’s possible that for many women in that situation, no one’s even looking at the partner. And it could be him — it could fully be him. I’ve had clients who haven’t been able to conceive for quite some time, and they have to fight with their medical provider to get him tested, to get a semen analysis done. Because they’re kind of like, “No, no, he’s fine.” But they didn’t even test him. So you never know.

So this is an important side note to this, where we do want to focus on egg quality. We want to do that. But I feel like most of my fertility clients know that. They already know that, they’re already on board, they’re already willing and able. I just have to provide them with the information and they’re like doing it. But what we’re not always doing is looking at the male as well. So we want to be doing these things simultaneously.

And if you are in that preconception phase where you’re thinking about starting to try for a baby within the next year, or two years, or three years, when you are ready to double down on your preconception nutrition, we recommend an absolute minimum of three months, but ideally it would be six months to a year. You both want to do it. It’s not just you. It’s not just about the egg. It’s about the sperm and the egg together as a unit.

So as I mentioned, if you’re wanting to dive deeper into this topic, I highly recommend that you grab your copy of Real Food for Fertility. You can grab your copy over at Amazon — just do a quick search and you’ll find the book. If you wanted to grab the first chapter for free, you can head over to our website, realfoodforfertility.com, and get the information there. If you already have your copy of the book and you’re wanting to grab the complete reference list — over 2,400 different citations, who knows how many actual studies are in there, probably over 3,000, because sometimes we have multiple citations listed under each note — you can also find that information at realfoodforfertility.com.

If you think this episode could help somebody, if you have a friend in mind who would just absolutely love this information, you can share this episode. The share link is fertilityfriday.com/517. And of course, I hope you have a wonderful week or weekend or whenever you’re tuning into the show. And of course, as always, until next time, be well and happy charting.