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Egg quality - What is Egg Quality?

Medically reviewed by Norbert Gleicher, MD, FACOG, FACS - Written by CHR Staff - Updated on Apr 28, 2020

What Is Poor Egg Quality?

When women have failed IVF cycles or are considering undergoing IVF at an advanced maternal age, they are often told that they likely have poor-quality eggs. But what does that mean, and why is it so important for success in infertility treatment?

The answer comes down to the simple fact that high-quality eggs produce high-quality embryos: 95 percent of embryo quality comes from the female ovum. Embryos must be strong enough to survive the early stages of development in order to result in a successful pregnancy, and that’s why egg quality is crucial in the success of fertility treatments.

Embryo quality has been assessed in IVF labs all over the world for many years, and there is an established criteria for quality assessment. However, somewhat inexplicably, eggs have been lagging behind in this regard. In recent years, CHR’s physicians and embryologists have started paying close attention to indicators of the quality of a woman’s eggs, and have found that egg quality measures can have more accurate predictive value than embryo quality measures when it comes to assessing each patient’s likelihood of IVF success. Based on these measurements, adjusting stimulation and timing the egg retrieval to maximize egg quality for IVF cycles have become a routine process of continuous quality improvement at CHR.

Why is egg quality important?

Dr. David H. Barad discusses why fertility specialists consider the quality of a woman’s eggs so important in achieving a successful pregnancy.

What Causes Poor Egg Quality?

Age is the most important factor. As a woman ages, her ovaries’ ability to produce high-quality eggs starts to diminish; this is particularly true if she has low AMH levels. This is a condition known as diminished ovarian reserve (DOR) and is the most common cause of infertility for women over 40. Younger women can also suffer from diminished ovarian reserve (in a condition called premature ovarian aging, POA), and have problems with the quality of their eggs. PCOS is another condition that has some impact on egg quality, though its effects can vary depending on the age of the patient and the type of PCOS.

Women with poor egg quality (and resulting poor embryo quality) have difficulty conceiving on their own. Success rates of fertility treatments are also lower for these women, who are often refused treatment at fertility centers unless they are willing to use donor eggs.

At CHR, however, we specialize in helping women over 40 and those with POA become pregnant with their own eggs. We use treatment plans geared toward improving the number and quality of eggs, taking into account various individual clinical circumstances of our patients with low ovarian reserve.

Determining Egg Quality: How to Know if You Have Poor Egg Quality

While egg quality is very important when it comes to a woman’s likelihood of conceiving, there are no established industry-wide standards for it as of yet. Many fertility centers, CHR included, conduct a blood test as a proxy. Especially at the beginning of a patient’s fertility journey, AMH and FSH are the two hormonal tests used to estimate egg quality.

Though embryos are routinely scored and graded for quality with similar criteria across the IVF field, evaluation of the actual eggs for quality is still relatively rare. There are not yet any set-in-stone guidelines for evaluation across the field, either, like normal egg size for pregnancy, etc. CHR has, however, developed a standardized scoring system that allows our specialists to evaluate and identify good-quality eggs versus poor-quality eggs.

The criteria CHR has developed includes the overall size of each oocyte, morphological factors like the size of the components inside each oocyte, how smooth the ooplasm is, and so on. In the most recent study conducted at CHR, the size of the oocyte had a significant impact on the resulting embryo’s quality. While egg quality in IVF is still an evolving area of study, we believe it can lead to new developments in techniques, tools, and treatments to improve egg quality that result in a more successful cultivation of good-quality embryos.

Poor Egg Quality Symptoms

Unfortunately, there is no set of easily recognizable symptoms of poor egg quality from the patient’s point of view. As described above, since age is the number one factor that affects eggs, it can be considered a risk factor for poor egg quality. Having difficulty conceiving without a clear reason is also a potential sign that the quality of the eggs may be a problem, especially for younger women with no anatomical problems like blocked tubes.

While poor egg quality doesn’t usually have obvious symptoms, competency of eggs is also bound to decline with time. Furthermore, when a woman has DOR, the quality of her eggs--along with her ovarian reserve--can decline quite rapidly. That is why time is always of the essence when weighing expert consultation and fertility treatment.

Your doctor or fertility specialist will be able to explain what affects the quality of your eggs, and how to test for egg quality and fertility. Fertility is not solely dependent on oocyte quality, but having good-quality eggs for IVF is important.

Egg Quality Test

When a patient comes to CHR for help conceiving, we always run an extensive array of tests to better understand the reason why they have not been able to become pregnant and devise an appropriate treatment plan. As part of these tests, we will conduct a blood test to get a sense of the patient’s egg quality, in addition to various other hormonal and physiological factors present in the body. Later on, we will evaluate her eggs based on the scoring system described above. According to this fertility test and our IVF egg quality grading system, we will be able to make further recommendations for the patient to improve the quality of her eggs, fertility, and the likelihood of conception with her own eggs.

Treating Poor Egg Quality: IVF, Timely Diagnosis and Pre-Cycle Treatments

Whether women have poor egg quality at 35, 40, after 40, with or without signs of poor egg quality, IVF is usually the first treatment. In vitro fertilization (IVF) not only allows the patient’s fertility specialist to encourage development of more than one egg per cycle, but also lets the embryologist help improve the chances of a successful pregnancy by selecting better-quality eggs for fertilization.

Even more importantly, at CHR, patients receive individualized treatments leading up to the actual stimulation cycle that are designed to condition the ovarian environment so the ovaries can develop a larger number of better-quality eggs for retrieval. With these specialized treatments, it is often possible for older women and women with POA to produce better-quality eggs for IVF and ultimately become pregnant without the use of donor eggs.

Norbert Gleicher, MD, FACOG, FACS

Norbert Gleicher, MD, FACOG, FACS

Norbert Gleicher, MD, leads CHR’s clinical and research efforts as Medical Director and Chief Scientist. A world-renowned specialist in reproductive endocrinology, Dr. Gleicher has published hundreds of peer-reviewed papers and lectured globally while keeping an active clinical career focused on ovarian aging, immunological issues and other difficult cases of infertility.