Supplement Guide

The best supplements for improving egg quality are:

  • A good quality prenatal with at least 800 mcg folate (not folic acid)
  • CoQ10

In certain circumstances, other supplements such as melatonin, myo-inositol, alpha-lipoic acid, n-acetyl cysteine, or DHEA may be needed, as discussed in the book.

The Best Prenatal Supplement for Egg Quality:

Garden of Life Vitamin Code Raw Prenatal.

  • It has 800 mcg of folate (rather than the synthetic form, folic acid, which must be converted to folate in the liver using the DHFR enzyme. The efficiency of this enzyme varies greatly between different people).
  • It has the active forms of vitamin D and B12, and good amounts of thyroid-supporting zinc, iodine, and selenium.
  • It is also very well tolerated, with few side effects.

View Garden of Life Prenatal on Amazon

The natural folate in Vitamin Code Raw Prenatal is derived from lemon peel.  The manufacturer has not characterized the precise form of folate in the end product, but research indicates that a significant proportion of the folate in citrus is in the form of methylfolate.  Even so, if you have a history of recurrent miscarriage, or a known MTHFR mutation, you may want to consider a prenatal specifically labelled as containing methylfolate, as explained here: Alternative Folate Supplements for MTHFR

Men Need Prenatals Too !

I also recommend the Garden of Life Vitamin Code Multivitamin for Men as the most important supplement for improving sperm quality. It has folate rather than folic acid, a good amount of selenium and zinc, and added mixed carotenoids and tocopherols (which are antioxidants in the same family as vitamin A and E). For couples with a history of recurrent miscarriage, new research suggests that men should instead take a methyl-folate based supplement. I recommend Designs For Health Twice Daily Multi.

CoQ10 for Egg Quality

CoQ10 is another important supplement for boosting egg quality. As discussed in the book, CoQ10 appears to improve egg quality by supporting energy production in the mitochondria of developing eggs. Energy production is vital to the ability of immature eggs to develop into mature eggs with the right number of chromosomes.

CoQ10 is found naturally in almost every cell in the body, but levels decline with age. Supplementing with CoQ10 is therefore a key strategy to address age-related infertility and potentially prevent chromosomal abnormalities (study).

What is the best type of CoQ10 supplement?

CoQ10 is quite a large and sticky molecule that can be difficult to absorb.  It also exists in two forms: ubiquinone, which is the standard form most commonly found in supplements, and ubiquinol, which is the active form.  Taking CoQ10 in the form of ubiquinol may have two advantages:

  1. It is more readily absorbed than most ubiquinone supplements.
  2. It is already in the active form, ready to act as an antioxidant and support energy production. (Ubiquinone is the oxidized form that has to be converted first. Most people perform this conversion well, but the ability to do so may decline with age).

For these reasons, it may be advantageous to supplement with CoQ10 in the form of Ubiquinol.  I recommend Jarrow Formulas QH-Absorb and Doctor’s Best Ubiquinol with Kaneka QH.

As discussed in the book, the standard dose of ubiquinol for age-related infertility or diminished ovarian reserve is 200-300mg per day (although some IVF clinics are now recommending even higher doses).

If cost is a significant concern, you can also take a standard ubiquinone supplement at a higher dose (200mg, 3 times per day). Some newer formulations of ubiquinone appear to be very well absorbed and for these supplements a higher dose may not be required. (Study). The best form of ubiquinone is likely Pharma-Nord’s Bio-Quinone Gold (MyoQuinon in Europe). It is absorbed as well, if not better than ubiquinol and was used in a recent clinical study showing significant benefit for egg quality. (It can be even more expensive than ubiquinol though).

Additional Egg Quality Supplements 

There are many other supplements with the potential to improve egg and sperm quality, but not every supplement is right for every situation, as explained in the book.(And you should always discuss your supplement plan with your doctor.) If you decide to add a particular supplement, the following are good-quality brands to choose.

Alpha-lipoic acid:  Doctor’s Best Stabilized R Alpha-lipoic acid

Myo-Inositol:  Jarrow Inositol Powder

DHEA:  Fertinatal, Life Extension DHEA,  Pure Encapsulations DHEA

If you and your doctor are considering adding a DHEA supplement, it is useful to have your level checked first, by a simple lab test.  (The test measures the level of DHEA-S in your blood, which is more accurate than simply measuring DHEA itself).

Knowing your DHEA-S level can help to determine whether you need the full dose used in clinical studies, or whether a lower dose may be sufficient.  Checking your DHEA-S level every couple of months while taking a DHEA supplement will also help to ensure you are taking the right dose.

DHEAS Blood Tests for Fertility

In most areas, you can order a test yourself through Life Extension (US) or Medichecks (UK).

What is the Optimal DHEA Level for Fertility?

The scientific research does not yet provide a clear answer as to this, but we do know that DHEA levels naturally decline with age.  Until more is known, clinics that recommend supplementing with DHEA typically aim for the high end of the normal range for young women, which would be around 250-300 mcg/dL.

Normal DHEA-S Range:

18-29 years: 44-332 mcg/dL
30-39 years: 31-228 mcg/dL
40-49 years: 18-244 mcg/dL

See also: Normal Ranges for AMH, FSH, Estrogen, Testosterone 

A new edition of It Starts with the Egg will be released in February/March 2019!

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