Have you ever wondered whether you can actually change your egg quality? Or is what you have simply what you have?
As a reproductive endocrinologist who has spent my career studying the ovary, I can tell you that egg quality is not a fixed characteristic. It is a biological process that unfolds over time, and the final 60 to 90 days before an egg is ovulated are especially important. During this window, the developing egg is responsive to its nutritional and hormonal environment, inflammation, mitochondrial health, sleep, stress, thyroid function, and blood sugar.
This does not mean you can reverse age-related changes. Age matters, and no diet, supplement, or lifestyle change can guarantee that an egg will be chromosomally normal. But age is not the only factor that matters. There are meaningful ways to influence your egg and ovarian health during the months when an egg is preparing to ovulate.
I call this period “trimester zero.” It is the time before conception that medicine has largely left unclaimed, when the egg that could become a future pregnancy is completing its final stages of development. Whether you are trying to conceive, preparing for IVF, freezing your eggs, or simply thinking about your future fertility, you deserve to understand what is happening during this window and which factors may be within your control.
In this week’s episode of the As a Woman podcast, I’m breaking down what egg quality actually means, how an egg develops, and where to focus your energy during those critical three months.
You were born with all the eggs you will ever have. In fact, you had the greatest number of eggs while you were still developing inside your mother. At approximately five months of gestation, the ovaries contain around 6 to 7 million eggs. By birth, that number has fallen to roughly 1 to 2 million. By the time you have your first period, around half a million remain. Yet most women will ovulate only about 400 eggs throughout their reproductive lives.
I often describe the ovary as a vault. Most of your eggs remain stored inside as microscopic primordial follicles, but over time, groups of follicles begin moving toward the surface of the vault. They grow from primordial follicles to primary and secondary follicles before becoming antral follicles, which are the small follicles we can see and count on an ultrasound. This development takes approximately two months. The follicles then enter the menstrual cycle in which one is typically selected to become dominant and ovulate. When we look at the entire process, we arrive at that 60-to-90-day developmental window.
“The egg that you’re going to ovulate in a few months from now is being shaped at this minute.” - Dr. Natalie Crawford
If you are undergoing IVF or freezing your eggs, medications encourage multiple follicles from that group to continue developing so that more than one mature egg may be retrieved. This is why I want you to think about preparation before the treatment cycle begins. The eggs retrieved during an IVF or egg-freezing cycle did not suddenly begin developing when you started injections. They were already growing and responding to their environment for weeks before that.
Egg quantity and egg quality are not the same thing.
Egg quantity refers to the number of eggs remaining in your ovaries. Tests such as AMH and an antral follicle count can help estimate ovarian reserve, although neither test can tell us precisely how many eggs remain or whether an individual egg is healthy.
Egg quality describes how well an egg functions. Can it complete maturation? Can it accept sperm? Can its chromosomes divide correctly? Does it have enough energy to support the earliest stages of embryo development? Chromosomal normality is an essential part of egg quality, but it is not the entire definition. Egg function also depends on mitochondrial health, the cells surrounding the egg, the hormones produced by the follicle, and the environment in which the egg is developing.
You cannot create more eggs or refill the ovarian vault. But that does not mean there is nothing you can do for the eggs that are already growing.
My field has done women a disservice by reducing egg quality to only age. Age is an essential part of the conversation, but treating it as the only factor takes away your agency and does not reflect the full biology of the ovary. I sit across from patients going through IVF who have evidence that their eggs are not functioning as well as we would like. Their eggs may not mature normally, fertilize, divide correctly, or become chromosomally normal embryos. In some cases, we make changes to the environment surrounding those eggs and see a difference in a later cycle. We cannot reverse everything, but we should not pretend that nothing matters simply because age matters too.
Inside each egg, the chromosomes are held in a precise stage of cell division by proteins called meiotic spindles. Imagine asking a classroom of kindergartners to stand in alphabetical order and remain perfectly still. The longer they have to stand there, the greater the chance that someone will move out of place. That is part of what happens with age. Time creates wear and more opportunities for errors when the chromosomes eventually separate.
Now imagine sending puppies, kittens, and other distractions into that classroom. Maintaining perfect order becomes even harder. This is how I want you to think about excess inflammation. Normal life creates some inflammation, and no one can eliminate it completely. Chronic inflammation, however, may place additional stress on the proteins, mitochondria, and cellular systems involved in egg development.
A healthy lifestyle cannot stop aging or guarantee chromosomally normal eggs. But when age is something we cannot change, it becomes even more important to pay attention to the parts of the ovarian environment that we may be able to influence.
Mitochondria provide the energy a cell needs to function, and an egg has enormous energy demands. It needs energy to mature, organize and divide its chromosomes, fertilize, and support an embryo through its earliest stages of development. The mitochondria inside an embryo come from the egg, which means the mitochondria inside your egg could eventually provide the energy that fuels every cell in a future child. It is kind of wild when you think about it.
Chronic inflammation and oxidative stress are associated with mitochondrial damage and poorer mitochondrial function. This is one reason nutrition, antioxidants, sleep, movement, and metabolic health repeatedly come up when we discuss egg quality. Mitochondrial health is not simply a wellness buzzword. It is part of the basic biology of how an egg functions.
An egg also develops inside a follicle, surrounded by cells and follicular fluid. The cells around the follicle help produce estrogen, and after ovulation, that follicle becomes the corpus luteum, which produces progesterone and helps regulate the implantation window. Researchers studying follicular fluid collected during IVF have found associations between inflammatory markers, certain endocrine-disrupting chemicals, and poorer reproductive outcomes. This does not mean one exposure determines the fate of an egg, but it does tell us that the follicle is not isolated from the rest of your body.
Nutrition is foundational. I have a nutrition degree, and I have always been fascinated by how food provides the building blocks our bodies use to make hormones, maintain cell membranes, produce energy, and manage inflammation. Medicine has dismissed the role of nutrition for too long, especially when it comes to the ovary.
Here is what I recommend prioritizing:
Fruits, vegetables, and fiber. These foods provide vitamins and antioxidants, while fiber supports the gut microbiome and helps improve insulin sensitivity. Include a variety rather than becoming preoccupied with finding one perfect “fertility food.”
Healthy fats. Fat and cholesterol are involved in the production of steroid hormones, including estrogen and progesterone. Olive oil, nuts, seeds, avocados, and eggs can all provide useful fats and nutrients.
Plant-based protein every day. Beans, lentils, tofu, and other legumes give you protein and fiber together. You do not have to eat an exclusively plant-based diet, but plant protein should be a regular part of what you eat.
Thoughtfully sourced animal protein. Eggs can be a nutrient-dense option, while fish also provides omega-3 fatty acids. You do not have to eliminate other sources of animal protein, but pay attention to quality and sourcing when possible.
Fewer ultra-processed foods and added sugars. These foods can make it harder to maintain stable blood sugar and insulin sensitivity. Focus on building most meals from foods that provide fiber, protein, healthy fats, and the nutrients your body needs.
Supplements may help fill specific gaps, but they should be added to this nutritional foundation rather than used as a replacement for it.
Supplements can support specific aspects of egg development, mitochondrial function, antioxidant protection, and metabolic health. But the dose matters, and a product labeled for “egg quality” may not contain the amounts commonly used in fertility care. Always review your complete supplement list with your physician, especially if you take medications or are preparing for treatment.
Here are the supplements I discuss in the episode:
Omega-3 fatty acids. DHA is incorporated into cell membranes, including the egg’s cell membrane. I often recommend at least 1 gram of omega-3 fatty acids in addition to a prenatal vitamin or multivitamin. Check the actual amount on the label because many prenatal vitamins do not provide this full dose.
Coenzyme Q10. CoQ10 is an antioxidant involved in mitochondrial function, and the body’s natural levels decrease with age. Supplementation has been associated with better egg and embryo outcomes in some fertility studies. For patients trying to support egg quality, I commonly recommend 600 mg per day. Many combination supplements contain significantly less, so pay attention to the dose rather than relying on the product name.
Vitamin D3. Vitamin D receptors are present throughout the reproductive system, including the ovaries and endometrium, and low levels have been associated with poorer egg-quality and implantation outcomes. I prefer checking a vitamin D level and supplementing based on the result. In the episode, I discuss at least 1,000 IU of vitamin D3 per day as a common starting amount, but check your prenatal first because it may already contain vitamin D.
Melatonin. Melatonin is involved in sleep and also acts as a potent antioxidant. Some IVF studies have found an association between melatonin supplementation and improved embryo quality, including among women who report sleeping well. More is not better. I typically recommend starting with 1 mg and using no more than 3 mg, taken approximately 30 minutes before bed.
Inositol. Inositol may improve insulin sensitivity, particularly for people with insulin resistance or PMOS. In the episode, I discuss at least 1 gram for patients with known insulin resistance. Your individual needs may differ, so this should be considered alongside your metabolic health and treatment plan.
Supplements can fill gaps, but they cannot replace adequate nutrition, strength training, sleep, metabolic health, or a thoughtful fertility evaluation. The goal is to use them intentionally as part of the larger picture.
You do not need a family history of diabetes for insulin sensitivity to matter. When you eat, food is broken down into glucose, which provides fuel for your cells. Insulin helps move that glucose inside. I like to think of insulin as a salesperson knocking on the cell’s door. When the cell responds normally, the door opens and glucose enters. With insulin resistance, the cell becomes less responsive, so the pancreas releases more insulin. Now the salesperson has to bang harder on the door.
Higher insulin levels can contribute to inflammation, affect hormone signaling, and promote the accumulation of visceral fat. Improving insulin sensitivity may therefore be an important part of supporting the environment in which your eggs are developing.
To improve insulin sensitivity, focus on:
Eating fiber, healthy fats, and protein together to create a steadier blood-sugar response.
Choosing lower-glycemic foods more often and reducing refined carbohydrates, ultra-processed foods, and added sugars.
Giving your body a consistent overnight break from eating. This does not mean extreme fasting. It may be as simple as avoiding habitual late-night eating and keeping most meals within the daytime hours.
Building muscle. Muscle can use glucose with less reliance on insulin. I recommend strength training approximately three times per week when medically appropriate.
Getting enough sleep. Inadequate sleep can worsen insulin sensitivity and interfere with the hormonal signals your ovaries rely on.
Movement can also help your body respond to stress. When cortisol rises, the liver releases stored glucose so you have the energy to react to a threat. But most modern stress does not require you to physically run away. A walk, some squats, a few push-ups, or another form of movement gives your body somewhere to use that fuel.
Experiencing stress does not mean you caused a fertility problem. The useful question is whether there are realistic ways to reduce the chronic load on your body and help it recover more effectively.
Endocrine-disrupting chemicals can interfere with hormone communication and contribute to inflammation. Some have been detected in follicular fluid and associated with egg, embryo, and fertility outcomes.
You cannot eliminate every chemical exposure from your life, and trying to do so can quickly become overwhelming. Focus first on repeated exposures inside your home, where you spend the most time.
Here are three places to start:
Remove plastic from your kitchen when practical. Replace plastic food-storage containers, cups, and water bottles with glass or stainless steel. Avoid heating food in plastic because heat can increase the transfer of chemicals into food. You do not have to replace everything in one day. Begin with the items you use most frequently, particularly those that come into contact with hot food or drinks. Consider replacing nonstick cookware as well.
Find out what is in your water. Look up the water-quality information for your ZIP code and identify the contaminants found in your local supply. Then choose a filtration system designed to address those specific substances. Different filters remove different contaminants, so buying any filter without checking its capabilities may not solve the problem you are concerned about.
Choose fragrance-free products. Fragrance can be a source of phthalate exposure in personal-care products, cleaning products, detergents, candles, and air fresheners. Look specifically for products labeled fragrance-free. An unscented product may still contain fragrance chemicals used to mask another odor.
You do not need to create a perfectly toxin-free home. Start with the exposures that happen repeatedly, make changes as products need to be replaced, and focus on what is realistically within your control.
If this feels like a lot, begin with five priorities during the 90 days before conception, IVF, or egg freezing:
Build most meals around plants, fiber, healthy fats, and quality protein.
Review your prenatal and supplement doses with your physician.
Strength train approximately three times per week when medically appropriate.
Protect your sleep and pay attention to blood-sugar regulation.
Reduce repeated exposure to plastic, nonstick cookware, contaminated water, and fragrance.
You do not need to implement every possible recommendation at once. Start with the factors most relevant to your health, then repeat the changes you can realistically sustain. Focus on what you can control.
If this helped you understand what to focus on when trying to improve your egg quality, share it with someone who is preparing for pregnancy, IVF, or egg freezing. Listen to the full episode of the As a Woman podcast wherever you get your podcasts—listen now on Spotify or Apple.
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