How to improve egg quality

Name: Dr (TCM) Attilio D'Alberto
Brand: Dr (TCM) Attilio D'Alberto
SKU: hd-local-wokingham-rg-40
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1. Overview

Egg quality is one of the most important determinants of female fertility. It influences whether fertilisation can occur, whether the resulting embryo will develop normally, and whether miscarriage is likely. Yet despite its central importance, it is an area that most fertility clinics pay relatively little attention to before starting treatment.

The good news is that egg quality is not fixed. It can be meaningfully improved in the three months before a planned conception attempt or IVF cycle through targeted changes to diet, supplements, lifestyle and — in my clinical experience — acupuncture and Chinese herbal medicine. I am Dr (TCM) Attilio D'Alberto, a fertility specialist with over 25 years of clinical experience. This page summarises the evidence-based steps that I recommend to my patients to improve egg quality, and explains how traditional Chinese medicine (TCM) approaches the issue.

2. Why egg quality matters

Unlike sperm, which are produced continuously throughout a man's adult life, a woman's eggs are all formed before birth and stored in the ovaries from that point forward. Every month, a cohort of follicles begins to develop, and one dominant follicle matures to the point of ovulation. The quality of the egg released depends on a number of factors — primarily age, but also the woman's general health, nutritional status, hormonal environment, oxidative stress levels, and blood supply to the ovaries in the weeks and months leading up to that cycle.

Egg quality has two main components:

Chromosomal integrity — whether the egg contains the correct number of chromosomes. Chromosomally abnormal eggs are the leading cause of failed fertilisation, failed implantation, and early miscarriage. The proportion of chromosomally abnormal eggs increases significantly with age, particularly from the mid-30s onwards.
Mitochondrial function — the energy-producing capacity of the egg's mitochondria. Fertilisation, early embryo division and implantation all require enormous amounts of cellular energy (ATP). Eggs with depleted or dysfunctional mitochondria do not have the energy reserves to complete these processes successfully, even when chromosomally normal.

Both aspects of egg quality can be influenced by the interventions described below — and since the egg's final maturation takes approximately three months, beginning these changes three months before the intended conception or IVF cycle gives the best chance of meaningful improvement.

3. How long does it take to improve egg quality?

The development of an egg from a primordial follicle to a mature, dominant follicle ready for ovulation takes approximately 90–120 days. This is the key biological principle behind all egg quality advice: the egg being released today has been developing for the past three to four months, and its quality has been shaped by everything that happened to the woman's body during that window.

For this reason, I recommend that any woman wanting to improve her egg quality begins making changes at least three months before a planned conception attempt or IVF cycle. Starting earlier — four to six months before — gives more time to see the full benefit of treatment, and is especially important for women with low AMH, elevated FSH, or diminished ovarian reserve.

4. Diet and nutrition

Diet is one of the most important and modifiable influences on egg quality. The overall dietary pattern matters more than any individual food, and the evidence most consistently points to a Mediterranean-style diet as the approach most strongly associated with better fertility outcomes.

The Mediterranean diet

A Mediterranean diet — characterised by abundant vegetables, fruits, legumes, wholegrains, olive oil, oily fish and nuts, with moderate poultry and dairy and limited red meat and processed foods — is now well supported by research as beneficial for fertility. A prospective cohort study of 590 women undergoing IVF found that higher adherence to the Mediterranean diet was significantly associated with a greater number of embryos available for transfer, suggesting a positive effect on fertilisation and early embryo development.¹ A 2023 systematic review of preconception diet patterns found that the Mediterranean diet showed the strongest and most consistent association with improved clinical pregnancy rates of all dietary patterns studied.²

Key nutrients for egg quality

Protein

Adequate protein intake is essential for follicle development, hormone production and egg maturation. Aim for three meals a day with quality protein at each — eggs, fish, poultry, legumes, nuts, seeds and dairy. Seafood is particularly beneficial as it provides protein alongside omega-3 fatty acids, zinc, selenium and iodine, all of which support reproductive health.

Omega-3 fatty acids

Omega-3 fatty acids — found in oily fish (salmon, mackerel, sardines, herring), walnuts and flaxseeds — have been shown to support egg quality by reducing inflammation, improving the fluidity of cell membranes (which affects how well the egg can be fertilised), and supporting follicular development. Research suggests omega-3s may help to slow ovarian ageing and improve oocyte quality, particularly in older women.

Antioxidants

Oxidative stress — the accumulation of reactive oxygen species (ROS) in the follicular fluid surrounding the egg — is a major driver of poor egg quality. A diet rich in antioxidants helps to neutralise ROS and protect eggs from oxidative damage. Foods high in antioxidants include berries, leafy green vegetables (spinach, kale, rocket), tomatoes, red peppers, carrots, pomegranate, broccoli, nuts and seeds. Vitamin C (found in citrus fruits, peppers and kiwi) and vitamin E (found in nuts, seeds and avocado) are particularly important antioxidants for fertility.

Folate

Folate (vitamin B9) is essential from before conception and through early pregnancy to prevent neural tube defects in the developing embryo. It is also required for DNA synthesis and repair in the egg itself. Good dietary sources include dark leafy greens, legumes, fortified cereals, asparagus and avocado. A supplement providing 400–800 mcg daily of methylfolate (the active form) is recommended for all women trying to conceive.

Iron

Iron deficiency is common among women of reproductive age and has been associated with impaired ovulation and poor egg quality. Prioritise non-haem iron from plant sources (lentils, spinach, pumpkin seeds, tofu) alongside haem iron from lean red meat. Consuming vitamin C-rich foods alongside plant-based iron sources improves absorption.

What to eat less of

Processed foods, refined carbohydrates, sugar, trans fats, and excessive alcohol all generate oxidative stress and promote systemic inflammation — both of which are damaging to egg quality. A high glycaemic diet has also been associated with hormonal disruption and impaired ovarian function. Limiting these foods is as important as increasing the beneficial ones.

5. Supplements

While a good diet is the foundation, certain supplements have an evidence base that makes them worth considering for women seeking to improve egg quality, particularly those with diminished ovarian reserve, those undergoing IVF, or those over 35.

Always discuss supplements with a healthcare professional before starting, as some interact with medications or are contraindicated in certain conditions. Dosages and combinations should be personalised.

Coenzyme Q10 (CoQ10)

CoQ10 is an antioxidant and essential component of the mitochondrial electron transport chain — the biological mechanism by which cells generate ATP (cellular energy). Egg cells are among the most metabolically demanding cells in the human body, and their mitochondrial function declines with age. CoQ10 production also naturally declines with age, coinciding with the age-related decline in egg quality and ovarian reserve.

Research has found that CoQ10 supplementation can improve fertilisation rates, embryo maturation rates and embryo quality, particularly in women aged over 31 undergoing IVF.³ A 2024 systematic review found that CoQ10 increased oocyte retrieval rates and live birth rates for women with poor ovarian response, and improved pregnancy rates in women with poor ovarian response and PCOS.⁴ A 2023 systematic review from the Reproductive BioMedicine Online journal concluded that DHEA and CoQ10 together resulted in significantly higher clinical pregnancy rates than controls, and recommended both as pre-treatment supplements for women with poor ovarian response.⁵

The typical recommended dose is 200–600 mg daily, ideally as ubiquinol (the reduced, active form), which is better absorbed than ubiquinone. CoQ10 should be started at least two to three months before IVF stimulation or a planned conception attempt.

DHEA (dehydroepiandrosterone)

DHEA is a precursor hormone produced by the adrenal glands that supports ovarian function by maintaining androgen levels — which are required for healthy follicle growth. DHEA levels decline with age and are particularly low in women with diminished ovarian reserve. Research has shown that DHEA supplementation for at least six to eight weeks before IVF can improve ovarian response and the number of eggs retrieved in women with poor ovarian reserve.⁵ DHEA should only be used under medical supervision, as it can affect hormone levels.

Methylfolate (active folate)

As noted above, 400–800 mcg of methylfolate daily is recommended for all women trying to conceive, ideally starting at least three months before conception. Women with the MTHFR gene variant may not convert folic acid to its active form efficiently, making methylfolate the better choice.

Vitamin D

Vitamin D deficiency is highly prevalent in the UK and has been associated with poorer IVF outcomes, impaired ovarian reserve and increased miscarriage risk. A vitamin D blood test is recommended for all women trying to conceive; if levels are low, supplementation with 1000–2000 IU daily is appropriate.

Omega-3 (fish oil)

If dietary intake of oily fish is low, an omega-3 supplement providing at least 1000 mg of combined EPA and DHA daily is a reasonable addition to support egg quality and reduce inflammation.

Myo-inositol

For women with PCOS, myo-inositol supplementation (typically 2–4 g daily) has been shown to improve insulin sensitivity, reduce androgen levels, restore more regular ovulation, and improve oocyte quality. The evidence for myo-inositol specifically in improving egg quality in non-PCOS women is less clear.

Melatonin

Melatonin is a powerful antioxidant that accumulates in follicular fluid and protects eggs from oxidative damage during the critical final stages of maturation. Research has found some favourable effects of melatonin supplementation on IVF outcomes, particularly oocyte quality. However, melatonin should only be used under medical guidance as it can affect sleep and hormonal rhythms.

6. Lifestyle factors

Sleep

Sleep is the primary period during which cellular repair, hormone regulation and tissue regeneration occur. Inadequate or poor-quality sleep disrupts cortisol and melatonin rhythms, impairs the hypothalamic-pituitary-ovarian (HPO) axis, and generates oxidative stress — all of which negatively affect egg quality. Aim for seven to nine hours of quality sleep per night, with a consistent sleep schedule. Avoiding screens in the hour before bed and keeping the bedroom dark support melatonin production.

Exercise

Regular moderate exercise improves blood flow to the reproductive organs, supports healthy weight, reduces inflammation, and helps regulate insulin sensitivity — all beneficial for egg quality. Walking, swimming, yoga and cycling are all suitable. Excessive high-intensity exercise, however, can suppress the HPO axis and increase oxidative stress, and is counterproductive for fertility in both men and women.

Stress management

Chronic stress elevates cortisol and disrupts the hormonal environment of the ovary. High cortisol levels interfere with the LH surge and progesterone production, and have been shown to impair both egg quality and implantation. Stress management practices — whether acupuncture, meditation, yoga, therapy or simply adequate rest — are an important component of egg quality improvement, not an optional extra.

Healthy body weight

Both being underweight and overweight affect egg quality and ovarian function. Excess body fat promotes elevated oestrogen, insulin resistance and systemic inflammation, all of which disrupt follicle development and reduce egg quality. Being underweight reduces the energy available for reproductive function and impairs hormone production. Achieving and maintaining a healthy body weight improves hormonal balance, ovarian response and egg quality.

Avoiding heat

The gonads are temperature-sensitive. While this is better established for sperm (which is why the testes are external), excessive heat — from prolonged hot baths, saunas or tight restrictive clothing in women — can impair the microenvironment of the ovaries and developing follicles. Moderate warmth, such as that used in moxibustion on specific acupuncture points, has a different and beneficial effect.

7. What to avoid

Smoking — smoking is one of the most potent toxins to egg quality. It accelerates the depletion of the ovarian reserve, increases chromosomal abnormalities in eggs, and is associated with earlier menopause. Stopping smoking is the single most impactful lifestyle change a woman can make for her egg quality.
Alcohol — alcohol generates oxidative stress and disrupts oestrogen metabolism. There is no established safe level of alcohol consumption for women trying to conceive; reducing intake or stopping entirely for the three months before conception is advisable.
Excessive caffeine — high caffeine intake has been associated with delayed conception and increased miscarriage risk. Limiting intake to one to two cups of coffee per day (or equivalent) is a reasonable precaution.
Environmental toxins — endocrine-disrupting chemicals (EDCs) found in certain plastics (BPA), pesticides, non-stick cookware coatings, and some personal care products can interfere with ovarian function and egg quality. Choosing organic produce where possible, using glass or stainless steel food storage, and choosing fragrance-free personal care products all help to reduce exposure.
Excessive dieting or caloric restriction — severe caloric restriction signals to the body that resources are insufficient for reproduction, reducing the energy available to developing follicles and impairing egg quality. Eating regularly, with adequate protein and healthy fats at each meal, supports follicular development.

8. Egg quality in Chinese medicine

In traditional Chinese medicine, egg quality is fundamentally governed by the Kidney, which stores the body's fundamental reproductive essence — jing. Jing is the constitutional resource that determines reproductive vitality, the quality of eggs and sperm, and the ability to sustain a healthy pregnancy. Kidney jing declines naturally with age, but the rate of decline is influenced by lifestyle, diet, chronic illness and constitutional factors.

From a TCM perspective, poor egg quality most commonly reflects one or more of the following patterns:

Kidney yin deficiency

Kidney yin nourishes and moistens the developing follicle, supporting egg maturation through the follicular phase of the cycle. Yin deficiency manifests as insufficient nourishment to the egg: a thin uterine lining, reduced fertile-quality cervical mucus, night sweats, a feeling of heat in the palms and chest, and a dry, reddish tongue with little coating. In biomedical terms, this pattern is often associated with low AMH, elevated FSH and diminished ovarian reserve. Treatment focuses on enriching Kidney yin and nourishing blood to improve the follicular environment and support egg maturation.

Kidney yang deficiency

Kidney yang provides the warmth and activating energy that drives follicular growth and triggers ovulation. Yang deficiency presents as fatigue, cold lower abdomen, low libido, frequent urination, pale complexion, and delayed or absent ovulation. Treatment warms Kidney yang to strengthen the ovarian response and support the luteal phase.

Blood deficiency

The blood is the physical substance that nourishes the uterine lining and delivers nutrients to the developing follicle. Blood deficiency — commonly seen in women with scanty periods, light or short cycles, pale complexion, hair loss or dizziness — leads to poor follicular nourishment and reduced egg quality. Treating blood deficiency is a central element of improving egg quality in TCM practice.

Liver qi stagnation

Chronic stress causes Liver qi to stagnate, disrupting the smooth flow of qi and blood through the body. This impairs the hormonal transitions of the menstrual cycle, reduces blood flow to the ovaries, and creates internal heat (from stagnation) that can directly damage developing eggs. This is one of the most common patterns I see in clinical practice, particularly in women who are working at high intensity while trying to conceive.

9. How acupuncture improves egg quality

Acupuncture supports egg quality through several well-documented mechanisms:

Increasing ovarian blood flow

Acupuncture has been shown to significantly increase blood flow to the ovaries, delivering more oxygen, nutrients and hormones to the developing follicles. Better perfused follicles produce higher-quality eggs with stronger mitochondrial function. Research using Doppler ultrasound has demonstrated measurable improvements in ovarian blood flow following acupuncture treatment.

Regulating the HPO axis

Acupuncture modulates the hypothalamic-pituitary-ovarian axis, normalising the hormonal environment in which the egg matures. This includes improving the FSH:LH ratio in women with elevated FSH, regulating oestrogen production, and supporting the mid-cycle LH surge.

Reducing oxidative stress

Oxidative stress in the follicular fluid is a major cause of chromosomal abnormalities and mitochondrial dysfunction in eggs. Acupuncture has antioxidant effects — reducing markers of oxidative stress and increasing the production of endogenous antioxidant enzymes — that help to protect the egg during its final maturation phase.

Reducing the impact of stress on ovarian function

By reducing cortisol levels and activating the parasympathetic nervous system, acupuncture counteracts the direct negative effects of chronic stress on egg quality. This neuroendocrine effect is one of acupuncture's most important contributions to fertility treatment.

Treatment should ideally begin three months before IVF stimulation or a planned conception attempt, and continue throughout the follicular phase of each treatment cycle. I offer fertility acupuncture at my Wokingham, Berkshire clinic and provide online fertility consultations for patients who cannot attend in person.

10. Chinese herbal medicine for egg quality

Chinese herbal medicine is one of the most powerful tools available for improving egg quality. Formulae are tailored specifically to the patient's TCM pattern — whether Kidney yin or yang deficiency, blood deficiency, Liver qi stagnation, or phlegm-damp — and are adjusted as the treatment progresses and the pattern changes. This individualised, dynamic approach is fundamentally different from taking a single supplement and is one of the reasons that Chinese herbal medicine can produce significant improvements in egg quality even in women who have not responded to conventional supplements.

Chinese herbs are prescribed as pharmaceutical-grade granules, manufactured by Sun Ten (Taiwan) to stringent quality and safety standards. They are easy to take — dissolved in hot water and taken twice daily — and can be safely combined with conventional fertility treatment.

Herbs frequently used to support egg quality include formulas that tonify Kidney yin (to nourish the developing follicle), nourish blood (to support the follicular environment), warm Kidney yang (to improve ovarian response) and move qi and blood (to improve circulation to the ovaries and reduce the effects of stress). The specific formula prescribed will depend on your individual diagnosis.

Chinese herbal medicine is available in person at my Wokingham clinic and via online herbal consultation for patients throughout the UK.

11. Frequently asked questions

Can egg quality be improved after 40?

Yes, to a meaningful extent. While the proportion of chromosomally abnormal eggs does increase with age and cannot be entirely reversed, the mitochondrial function of eggs, the quality of the follicular environment, ovarian blood flow, and the hormonal regulation of the cycle can all be improved at any age through the interventions described above. Many of my patients over 40 have achieved successful pregnancies after a dedicated period of preparation.

How do I know if my egg quality is poor?

There is no single test that directly measures egg quality. Indirect indicators include low AMH, elevated FSH, poor embryo development in IVF cycles, repeated early miscarriage, and poor blastocyst development rates. Age is the strongest predictor of egg quality decline. A full fertility assessment — including AMH, FSH, antral follicle count, and in some cases more detailed hormonal testing — is the best starting point if you have concerns about egg quality.

Does low AMH mean poor egg quality?

AMH (anti-Müllerian hormone) measures the quantity of the remaining egg reserve, not the quality of individual eggs. A woman can have low AMH but still have good-quality eggs — and vice versa. Low AMH is a reason to act promptly and to begin an egg quality improvement programme immediately, but it does not in itself mean that conception is impossible.

How long should I take supplements before IVF?

Given that the egg takes approximately 90–120 days to mature, beginning supplements at least three months before IVF stimulation is ideal. For women with low ovarian reserve, starting four to six months in advance and combining supplements with acupuncture and Chinese herbal medicine where appropriate gives the best opportunity for improvement.

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