Definition of low egg count
First, how is this low egg count assessed? Ovarian ageing or a so-called low egg count is evaluated by several markers, a decrease in Anti-Mlüllerian hormone, an increase in follicle-stimulating hormone and a decrease in the antral follicular count (AFC). Even though the relevance of these tests is still subject to debate (May-Panloupe et al. 2016) .
Before going deeper into these hormones, the antral follicular count is observed through an ultrasound. You need to know that all the follicles in the ovary start off as primordial follicles and these cells are just 25 micrometers - 0.025 millimeters. It is impossible to see them with the naked eye. Can you imagine how difficult this must be to see with an ultrasound? Once a follicle reaches a certain stage you can recognize it on an ultrasound. For example on day 2, 3 and 5 of your cycle these are better visible. Still it is a reflection of the state at a certain moment in time.
These primordial follicles are “awakened” by hormones. Even if there aren’t that many follicles visible in this moment, it can be a matter of creating the right environment for your hormones. The right hormonal balance can slow down or increase the amount of follicles to be released and can stimulate the maturation process of them.
Hormone levels affecting fertility
Let’s take a deeper dive into hormones. Anti-müllerian hormone’s (AMH) role is to counteract the recruitment of primordial follicles that are triggered by FSH. When you get older FSH levels are likely to go up. This is because the ovaries need to work harder to release follicles. So more of this trigger hormone is necessary. AMH is protecting the follicular pool by making sure just a selection of follicles is prepared for maturation. We need sufficient levels of FSH though for the maturation process of follicles but too much can also cause an over release of follicles. It is a fine balance between these two hormones. A recent study shows that diet and lifestyle play a significant role in addition to age and genetics affecting AMH levels.
Diet, lifestyle and fertility hormones
A study among 2414 women (age 20 - 50) in Tehran showed that certain food groups can stimulate AMH levels. The most important foods that have this effect are dairy products, fermented dairy, fruits and berries. The study implies that dairy can reduce the decline of AMH and might therefore preserve the ovarian reserve. The importance of dairy products on fertility is underscored by Ayurveda as well. From an Ayurvedic viewpoint it is important though how you combine these foods and if you can digest them. One of the Ayurvedic rules on food combinations is that the intake of dairy and fruit at the same time can cause fermentation. Eat first your berries and after about half an hour take your bowl of yoghurt.
Fertility and mitochondria
We have seen that dairy products increase the production of AMH which means that it is more likely that our follicular pool preserves. But what happens during the process of maturing follicles, called folliculogenesis? In this process an immature follicle is duplicating the genetic material belonging to its mitochondria, known as mtDNA. This process requires energy which is generated by mitochondria themselves. Our egg cells (oocytes) are the richest cells of the body in mitochondria and depend largely on them for fertilization and embryonic development.
Mitochondria help to keep follicles alive and prevent apoptosis (death of cells) so it plays a role in follicular atresia (disintegration of follicles). This organelle is prone to mutations because it lacks protection and lays in close proximity to where reactive oxygen species (ROS) are generated. This can affect our fertility in two ways: it can reduce the amount of mature follicles and it can cause abnormalities when genetic material is duplicated during folliculogenesis.
High levels of ROS is a sign of oxidative stress and can be caused by diet, certain toxins in our environment and lifestyle factors. In my fertility program we elaborately discuss this topic.
Diet, mitochondria and fertility
Our reproductive health depends on age, genetics, the competence of our mitochondria and our diet. As this Tehran study shows dairy products can increase levels of AMH which counterbalances high FSH levels which occurs generally among women after age 37. The competence of our mitochondria is crucial in protecting our follicles and aiding their development. One of the factors that inhibits mitochondria from doing their job is oxidative stress. From an Ayurvedic perspective your digestive health is the foundation of it all. The better you know which food groups you can digest the less you expose your body to oxidative stress caused by diet. Fertility depends on more than just age. It is the result of how we live, what we do, what we ingest and what we believe.