Egg quality watch points, signs & symptoms – An IVF doctor’s Q&A

If you’re trying to conceive (TTC) or are having fertility treatment right now, you’ve probably heard the term ‘egg quality’ – whether that’s from your clinic, or online on social media or fertility forums. 

We know from personal experience that it can be easy to get a bit obsessed with egg quality, especially when we’re over the age of 35. It all feels a little bit elusive, and a quick look at page one of Google tells us that we’re not alone in this.

But are there really any noticeable signs of bad egg quality? And what should we should be looking out for, if we’re having IVF in particular?

This kind of specific topic calls for real, scientific directive, so we’ve picked up with fertility specialists from The Prelude Network® – the largest and fastest-growing network of fertility clinics in the United States and Canada – for their expert perspective. 

Offering the best in treatment options, science, and patient care, The Prelude Network lives up to its name – it’s the beginning of something meaningful, laying the groundwork for what lies ahead, for each and every family and family-building goal. 

Together, we’ll delve deeper into what egg quality actually means, why it matters, and the doctor-approved watch points to be aware of as you plan your journey, with an IVF focus.

Let’s get into it.

Q: What do we mean by egg quality? 

The term egg quality is often loosely used to describe a person’s ability to conceive and maintain a healthy pregnancy. 

While it may sound like a broad evaluation of all eggs within the ovary, that’s not quite how it works from a clinical perspective.

Dr. Shannon Alexa from Main Line Fertility explains:

“In medicine, we use this term to refer to the overall potential for a single oocyte or egg to be fertilized when exposed to sperm and result in a chromosomally normal embryo. 

Here it is used to refer only to the potential of a single egg instead of a general statement about all of the eggs within the ovary. 

There are of course more definitive criteria in a laboratory setting that embryologists use to classify the physical traits of eggs, but this is only applicable in an in-vitro fertilization (IVF) lab setting.”

Q: Why does egg quality matter? 

In a nutshell, egg quality plays a key role in determining the best fertility treatment path for you. The characteristics linked to egg quality help doctors shape your care plan and assess potential outcomes.

As Dr. Alexa notes, “It is important to remember that this is not a tangible value. You cannot test for egg quality. Instead, it is presumed to be high, normal or low based on the outcome of fertilization and pregnancy. 

The value placed on egg quality, regardless of which treatment is recommended, is used as a tool to counsel you on your expected results, as well as your risk of poor pregnancy outcomes.”

Q: What are some of the top predictors of egg quality? 

One of the strongest indicators of egg quality is age.

According to Dr. Alexa, “Increasing age, particularly over age 35, has been shown to correlate significantly with a higher percentage of poor pregnancy outcomes and therefore assumed poor egg quality.”

Other factors that can impact the quality of eggs are: 

• other medical conditions like Type II Diabetes and Polycystic Ovary Syndrome (PCOS)
• lifestyle choices, like smoking or vaping 
• genetics

For those undergoing IVF, the clinical team can gain insights into egg quality based on the percentage of eggs that fertilize, how many develop into embryos, and how many embryos are genetically normal following preimplantation genetic testing (PGT-A).

Q: Are there any signs or symptoms of poor egg quality that we can look out for?

According to Dr. Alexa, there are no real external signs of bad egg quality outside of IVF, where fertilization and embryo development rates are monitored in the lab.

“Outside of other known medical conditions, increasing age is the strongest predictor of egg quality, however, some conditions like PCOS, Premature Ovarian Insufficiency (POI) and perimenopause may be associated with a lower egg quality, each with different symptom profiles.”, she explains.

Q: Does endometriosis mean poor egg quality? 

Not always, but endometriosis can impact egg quality. Dr. Eli Reshef from Advanced Fertility Center of Chicago explains:

“Women with endometriosis often have lower-quality eggs, which can lead to poorer fertilization rates and risk of recurrent losses. The extent of endometriosis does appear to correlate with poorer egg quality and advanced endometriosis is associated with more significant negative effects compared to milder forms.”

He adds that severe cases may result in fewer eggs retrieved, as well as fewer mature eggs.

Q: Are slow growing follicles considered poor quality​? 

Not necessarily, says Dr. Reshef. “Some follicles, though growing slower than the lead follicles, may well contain good-quality, mature eggs.”

The goal during IVF stimulation is to retrieve as many mature eggs as possible, even if some follicles develop at a slower pace during that process.

Related read: For more on this, dig into what Prelude Network experts have to say about follicle size and its role in IVF here.

Q: If suspected, how would egg quality issues typically be identified and addressed in-clinic?

Egg quality is primarily assessed during IVF in the lab, by evaluating the eggs collected.

The specific, chromosomal health of each egg can only be indirectly assessed by fertilizing eggs, creating embryos, and conducting preimplantation genetic testing (PGT).

This is often easily confused with the test for ovarian reserve, which looks at the quantity of eggs left. This number also declines with age, and therefore a lower reserve may also be seen with presumed lower egg quality if you’re over the age of 40.

Dr. Reshef outlines several bloodwork approaches used in-clinic on Day 3 of your cycle to assess egg quantity, including:

• AMH (Anti-Mullerian Hormone): Often preferred for assessing ovarian reserve. AMH is produced by developing follicles in your ovaries.
• Follicle Stimulating Hormone (FSH): Provides insight into egg reserve, though less accurately than AMH
• Luteinizing Hormone (LH): Helps assess ovarian function and conditions like PCOS
• Estradiol (E2): High levels may indicate poor ovarian response.

In addition to bloodwork, a transvaginal ultrasound is performed to:

• measure the ovaries and uterus
• identify abnormalities like uterine fibroids, polyps, and unusual ovarian cysts
• conduct an antral follicle count (AFC), which helps predict ovarian response to stimulation
• assess the accessibility of your ovaries to transvaginal removal of eggs

The results of Day 3 testing, combined with your age and medical history, are what will help your fertility specialist determine the most appropriate treatment plan for you – egg quality concerns, or otherwise.

Key takeaways (& next steps)

So, what should our key takeaways be, when it comes to egg quality? 

Dr. Reshef sums it up, explaining that while there are no guaranteed methods to improve egg quality, taking certain supplements containing CoQ10 and inositol can help bring you peace of mind, and avoiding harmful lifestyle factors like smoking can support better outcomes.

Whilst egg quality can be a tricky and much made of topic, understanding the factors involved and looking to trusted experts for insight can help you navigate your fertility journey with greater clarity and confidence.

Whether you’re single, partnered or identify as part of the LGBTQ+ community, The Prelude Network’s inclusive approach and focus on fertility education for all makes it simple. 

Want to learn more about the specifics we’ve covered above, or speak with a fertility specialist, heading into 2025? The Prelude Network currently has locations in California, Florida, Georgia, Illinois, Indiana, New York, Pennsylvania, Tennessee, and Texas in the US, as well as Alberta and British Columbia in Canada. 

Find your closest clinic here, and connect with their team to request an appointment.