Can Ovarian Reserve Be Improved?

Ovarian reserve refers to the quantity of a woman’s remaining eggs. It’s mostly important for anyone undergoing ovarian stimulation (i.e. egg freezing or IVF) but in some cases can be a helpful marker to evaluate ovarian health. While it’s normal for ovarian reserve to naturally decline with age, it feels as though I’m diagnosing diminished ovarian reserve (DOR) more and more frequently in my office. Many of my patients often as if there are steps they can take to improve their egg reserve. So let’s get into it!

Understanding Ovarian Reserve

Let’s start with how we test ovarian reserve.  Assessing ovarian reserve often involves blood tests, primarily Anti-Müllerian Hormone (AMH) blood test and an ultrasound to measure your antral follicle count (these are fluid filled sacs, each containing an egg, that have left the resting stage and are now ready for stimulation). An AMH of 1-3 ng/ml is within normal range; >4ng/ml is above average and indicates a large quantity of eggs; <1 ng/ml is considered DOR. AMH usually correlates with your antral follicle count (AFC), and serves to provide more concrete numbers of eggs that we can expect to retrieve during IVF or egg freezing. In essence, a high ovarian reserve means more eggs remain in the ovaries, while a lower reserve suggests a dwindling supply. It’s important to know, these measurements are not definitive predictors of whether someone can get pregnant but rather indicators that can help guide decisions regarding treatment dose.

Can Ovarian Reserve be Improved?

Ovarian reserve is influenced by many different factors including genetics, lifestyle, and environmental exposure (including in utero exposure when you were just a little fetus). There are things that can temporarily reduce ovarian reserve including:

• Prolonged use of hormonal contraceptives
• Pregnancy
• Rapid, significant weight loss
• Recent pelvic surgery

Usually these will only temporarily reduce your AMH and follicle count, and they can bounce back over time. Often with pregnancy and hormonal birth control, it’s the ovarian suppression that causes the drop in AMH which can recover months after delivery or discontinuation of your contraceptive.

Outside of these exceptions, decline in ovarian reserve over time is natural and often irreversible. However, there are ways to support overall reproductive health, in order to optimize ovarian function and egg quality. While lifestyle changes can’t turn back the biologic clock on egg count and egg quality, they may enhance fertility potential by supporting the health of the remaining eggs. Here are the top things you can do to optimize your reproduction whether you’re actively trying to conceive or know you may want to in the future:

1. Lifestyle Modifications

·       Diet: A diet rich in antioxidants, vitamins, and minerals can have a positive impact on egg quality. Incorporate foods high in antioxidants, like fruits and vegetables, and consider nutrients like omega-3 fatty acids (from sources like fish and flaxseeds) and folate. These nutrients are associated with better reproductive health and may help protect eggs from oxidative stress.

·       Exercise: Moderate, regular exercise helps improve metabolic health as well as hormonal balance. However, it’s essential to avoid over-exercising, since we know excessive physical stress (without adequate nutrition) may negatively impact ovarian function and ovulation.

·       Stress Management: Chronic stress can elevate cortisol levels, which can interfere with reproductive hormones and affect ovarian function. Mindfulness practices, yoga, or therapy can be beneficial for managing stress and supporting overall reproductive health.

2. Supplements and Antioxidants

· Coenzyme Q10 (CoQ10): Some research suggests that CoQ10, a powerful antioxidant, may help support mitochondrial function in eggs, potentially enhancing their quality. It’s something I often recommend to my patients.

· Vitamin D: Vitamin D deficiency has been associated with poorer reproductive health outcomes- though the data remains controversial here. Either way we know Vitamin D is incredibly important to overall health. Ensuring adequate vitamin D levels through sunlight exposure or supplements may improve ovarian health, especially if there’s a deficiency.

· N-Acetylcysteine (NAC): NAC boosts the production of glutathione, one of the body’s most potent antioxidants, helping to neutralize free radicals and protect ovarian cells

3. Optimizing Hormonal Health

· Adequate Sleep: Poor sleep can lead to hormone imbalances, including increased cortisol and disruptions to reproductive hormones such as FSH, LH, estrogen and progesterone. Aim for consistent, quality sleep to support normal hormone signaling in the hypothalamic-pituitary-gonadal axis (aka the communication between the brain and gonads).

· Limit Environmental Toxins: Exposure to environmental toxins, like phthalates and bisphenol A (BPA), can disrupt endocrine function. These are just some of the long list of toxins that we know negatively impact egg quantity and quality! Limiting plastic use and choosing glass or stainless-steel containers for food and drinks is one easy place to start. I often encourage my patients to also prioritize getting produce from the local farmer’s market (how lucky we are in Southern California to have access to this year round!), minimize processed foods and wash your produce really well.

4. Consider Fertility Preservation

While lifestyle changes may help support reproductive health, they cannot reverse the natural decline in egg count over time. If you’re concerned about your ovarian reserve or wish to delay family planning, fertility preservation options such as egg freezing or embryo banking could be worth considering.