My AMH is so low. Can supplements like CoQ10 or DHEA really improve my egg quality?
A few days ago, I saw a woman preparing for her first egg freezing cycle. She had already spent hours reading online forums and scientific articles. Her AMH was very low, and she arrived with a long list of supplements she had been taking for months.
The first thing I told her was that AMH and egg quality are not the same thing.
A low AMH tells us that there are fewer eggs remaining in the ovaries. It doesn't tell us whether those eggs are healthy. Egg quality is determined primarily by age, not by the AMH level.
That's important, because many women spend months trying to "improve their AMH", when in reality there is no convincing evidence that any supplement can increase ovarian reserve.
That doesn't mean supplements have no role at all.
In recent years, dozens of vitamins, antioxidants and nutritional supplements have been promoted as ways to improve egg quality. A recent study looked at the evidence for 66 different micronutrients. Despite the impressive number, the authors found convincing evidence for only one: coenzyme Q10 (CoQ10).
The available evidence suggests that CoQ10 may improve the environment in which an egg completes its final stages of development, particularly in women with a poor ovarian response. Some studies have reported more mature eggs, a higher number of eggs retrieved and, in certain groups of patients, improved pregnancy and live birth rates. But these improvements are modest, and CoQ10 cannot make an older egg biologically younger.
DHEA has traditionally been used in women with diminished ovarian reserve in the hope of improving the ovarian response to stimulation — that is, helping the ovaries produce more eggs. But retrieving more eggs doesn't necessarily mean retrieving better eggs. It mainly increases the number of opportunities to find a healthy one.
So, do I recommend supplements?
Sometimes, yes. In my own practice, I often recommend ubiquinol, the biologically active form of coenzyme Q10, because it has the strongest biological rationale and the best clinical evidence we currently have. But I also explain that it is not a miracle treatment. It may help optimise the function of the eggs you still have, but it cannot create new eggs or undo the effects of ageing.
If there is one message I hope women remember, it is this: don't spend months looking for the perfect supplement while postponing an important decision. If egg freezing is something you're seriously considering, freezing younger eggs will almost always have a greater impact than any supplement we can prescribe later.