There is no doubt about it, infertility rates for both men and women are rising. Researchers estimate that about 15% of female infertility is due to Premature Ovarian Insufficiency (POI).  Premature ovarian insufficiency occurs in women under the age of 40 when the ovaries are no longer functioning normally. When this happens, the ovaries do not produce adequate amounts of hormones and ovulation does not occur regularly. There is a decline in the number, quality and health of the eggs.

The goal is to catch POI early

From a naturopathic perspective, it’s important to identify early signs of POI before it’s fully progressed into irreversible ovarian failure. There are often early warning signs that the ovaries are not functioning well and starting to decline. This is the time to intervene. At this stage, natural therapies offer so much to preserve ovarian functioning, improve egg quality and promote fertility.

Signs of early stage POI:

• Failure to achieve pregnancy in women with normal menstrual cycles
  • In a women under age 35:  one year of trying without success
  • For women over age 35: failure to achieve pregnancy with 6 months of trying.
• Irregular cycles or long cycles (> 40 days)
• Lab findings: Slightly elevated FSH (over 9),  high normal estrogens (over 45), low antral follicle counts (< 6 follicles)  and AMH <1.

If you are having trouble getting pregnant or have irregular or long cycles, consider seeing a practitioner to start a workup and to identify any potential problem early.

My workup often includes:

• Full hormone workup: FSH, Estradiol (estrogen), Progesterone (luteal), Full thyroid panel (TSH, FT4, FT3 and thyroid antibodies)
• Nutrient evaluation: B12, Vit D, folate, ferritin, homocysteine
• Routine screening labs such as a complete blood count, fasting glucose, HbA1c, and cholesterol panel
• I may also run an AMH and refer for pelvic imaging and an antral follicle count.

Causes of POI and declining egg quality:

As a woman, you are born with all the oocytes (immature eggs) that you will ever have. Over the course of your life, the number of these eggs continues to decline and eventually you will run out (this is menopause). As you age, all the cells in your body experience damage to some extent, the same happens to your eggs. As you age, your eggs age and they are likely not as healthy as they were when you were 20.

Experts estimate that only 25% of POI cases have a known cause. Some cases are due to genetic reasons. Other times the follicles in which the eggs mature are damaged. Some things that can cause this damage are:

• Chemotherapy and radiation
• Autoimmune conditions- Women with autoimmune conditions are more likely to experience ovarian decline.
• Latent viral infections (in a small number of cases)
• Factors that increase oxidative stress and damage the egg’s mitochondria:
  • Lifestyle factors such as poor diet, too much stress, and inadequate sleep
  • Environmental toxicants – This is likely to explain many of the “unexplainable” cases of POI. Toxins that affect reproductive health include BPA, phthalates, parabens, heavy metals, cigarette smoking and environmental pollution.

Natural ways to improve the health of your eggs:

If you are over 35 and having trouble conceiving, have signs of menstrual irregularity or are diagnosed with premature ovarian insufficiency, these nutrients have been shown to improve egg quality and increase live birth rates. Women under 35 do not typically need to consider these nutrients, unless there are signs of early POI.

The goals of the natural therapies are to decrease oxidative stress in the ovaries and eggs, improve mitochondria functioning in the eggs and optimize hormone levels.

1. Myoinositol – found in meat, citrus fruits and legumes, this B vitamin enhances development of mature eggs and improves egg quality. Studies have shown this nutrient to increase pregnancy rates, increase number of high quality eggs, and increase number of retrieved eggs in women undergoing IVF.  It also helps induce ovulation in women with PCOS.
2. Melatonin – is a hormone secreted by the pineal gland. It is well known for promoting sleep. Melatonin is also an excellent antioxidant that helps protect eggs from damage. Studies have shown it to support healthy maturation of eggs and embryos. It works synergistically with Myoinositol to support egg health.  Studies done in women undergoing IVF showed a significant increase in number of mature oocytes, increased pregnancy rates and successful IVF
3. COQ10 – is a naturally occurring antioxidant in the body which naturally declines with age. It is a key player in the health of your mitochondria and the ovaries are rich in these energy powerhouses.
4. Antioxidants –  anti-oxidants in general support the health of eggs and protect them from harmful substances in the environment. Supplementing with Alpha lipoic acid or N-acetyl-cysteine is indicated for some women. Vitamin C and Vitamin E are also great antioxidants that can be found in a prenatal vitamin. The best way to get more antioxidants is from food – brazil nuts, berries, walnuts, green leafy vegetables, dark chocolate, green tea and spices (turmeric, ginger, rosemary, oregano, basil).
5. DHEA  is another commonly recommended hormone used to support egg health. The data is split however as to whether it is helpful or safe. Some studies say yes and others say no.  The doses used in studies (25g 3x/day) often cause intolerable side effects and can even be harmful to reproductive health.  I find DHEA is best used in much lower doses and only when body levels of DHEA or testosterone are low.

In addition to the above nutrients, low levels of testosterone can lead to decreased ovarian function and low egg quality. I often test levels. If testosterone is low, the plant medicines Maca and tribulus are helpful.

Don’t forget the basics – diet and lifestyle

Never discount the impact that healthy lifestyle and diet has on fertility.  Studies are clear – lowering stress, getting adequate sleep and eating a healthy diet increase pregnancy rates. Eat a Mediterranean based diet that is rich in vegetables and fruit. Keep sugar low and avoid white refined foods. Avoid alcohol and limit coffee to 1 cup per day

An egg quality support plan takes time to work, give it at least 3 months. If you are planning to do IVF, start an egg support plan 3 months prior.  

Editor’s Note: The information in this article is intended for your educational use only. Always seek the advice of your physician or other qualified health practitioners with any questions you may have regarding a medical condition and before undertaking any diet, supplement, fitness, or other health program.