Told It Was Egg Quality? Why Your Twenties Aren't the Answer

After you're told it's egg quality, one of the first things you do is go backwards.

The drinking in your twenties. The stressful job. The years you didn't eat particularly well. Maybe you smoked. Maybe you didn't take a prenatal until you started trying to get pregnant.

And you wonder: did I do this?

I hear some version of that all the time.

Then comes the part that makes even less sense to you.

Because you're not living like that now.

You're eating well. You're taking the CoQ10, the prenatal, vitamin D, the omegas. You've stopped drinking. You're exercising. Maybe you're doing acupuncture. You've cleaned up your products and thrown out half the plastic in your kitchen.

And yet you retrieved eight eggs, had embryos developing on day three, and by day five there was nothing to transfer.

Your clinic says egg quality.

So now what?

Egg quality shouldn't be the end of the investigation

Age matters. I'm not going to tell a 40 year old that her eggs are biologically the same as they were at 28. They're not, and the research on ovarian aging is clear that oocytes accumulate oxidative and mitochondrial changes over time.

But that's different from deciding a failed retrieval is the accumulated consequence of everything you did in your twenties.

Your eggs were formed before you were born. They remain in the ovaries for years and they do age with you. The follicle that eventually produces the egg retrieved during IVF also goes through a long period of growth and development before that retrieval, and that stretch is influenced by the environment it's happening in.

That distinction is the whole thing. Your twenties are not a useful explanation for why this cycle failed. Neither is age on its own. Neither tells you whether there are modifiable factors affecting the follicular environment, and both partners' health, that have never been investigated before you repeat the same cycle.

What's actually happening before the egg reaches retrieval

Once we're looking at the months leading into a cycle, whether you drank too much at 24 stops being the useful question.

What we want to know is what's happening now.

How is your blood sugar? Not one fasting glucose from a panel two years ago. What are insulin and triglycerides doing, because those move long before anything shows up on an A1C.

What does the rest of your thyroid panel look like, not just TSH? Free T3, Free T4 and antibodies. Antibodies are the piece most commonly missing, and thyroid autoimmunity creates immune activity around the developing follicle even when TSH sits inside the lab range.

Are you absorbing the nutrients you're taking? This is the one that surprises people. Vitamin D that hasn't moved after months of consistent supplementation. Ferritin that stays flat despite taking iron faithfully. If the markers aren't moving, the supplements aren't reaching the follicle, and adding more of them won't change that.

Is there inflammation, or something in the gut that nobody has looked at? Bloating after most meals. Alternating constipation and loose stools. Constipation that's been present so long it reads as just how your body works. Those get mentioned at intake and never make it into the fertility picture.

And there's often a diagnosis that comes up partway through a call almost as an aside. Hashimoto's. Psoriasis. Celiac. Another autoimmune or inflammatory condition. That belongs in the investigation, not off to the side of it.

None of this proves what happened in your cycle. It tells us where to look, which is a different job.

See also: Egg Quality and Ovarian Signaling: Why Age Alone Doesn't Explain Outcomes

And what about him

If your embryos stopped developing, we don't want the entire investigation focused on you because his semen analysis came back normal.

A standard analysis measures count, motility and morphology. It doesn't assess DNA integrity. Research on ICSI cycles has found that as sperm DNA fragmentation rises, the rate of top quality day five blastocysts falls, and that association holds even when the basic parameters look fine.

His bloodwork is the other gap. Thyroid, blood sugar, testosterone, inflammatory markers, nutrient status. Very little of that gets run on the male partner, and his development window responds to the same inputs yours does.

He isn't the problem here. In our experience he wants this as much as you do, and no one has told him there's anything for him to do.

See also: Male Factor Fertility: The Overlooked Variable in Embryo Outcomes

The part of your history that does matter

We don't want to swing too far the other way and tell you the past is irrelevant, because some of it isn't. It just isn't the part you're blaming yourself for.

Not the drinking at 24. The decade you spent on hormonal contraception is a different matter.

That comes up on nearly every call, and it almost never comes up at the clinic. Ten, twelve, fifteen years on the pill, then coming off it in your mid thirties to start trying. And the first thing that happens is you find out your cycles are irregular, or your luteal phase is short, or your periods are heavy, and there is nothing to compare any of it against. Hormonal contraception does not produce a real cycle. It replaces one. So a decade on it is a decade with no data, which means whatever was developing underneath had no way of being noticed.

Some women come off it and feel it immediately. Acne that was never there before. Cycles that don't come back for months. Hair shedding. Bloating and digestive symptoms that started around the same time and never quite settled. That cluster gets called post birth control syndrome online. It's worth saying plainly that it isn't a formal medical diagnosis and you won't find it in a clinical guideline. What is documented is the underlying pieces.

Long term hormonal contraceptive use is associated with lower status of several nutrients, including B vitamins, magnesium, zinc and selenium. Those are the same nutrients that thyroid function, methylation and follicular development depend on. If you came off the pill already depleted and then started IVF, nobody measured the starting point.

There is also a gut connection, and this is the one that surprises people. A meta-analysis of oral contraceptive use and inflammatory bowel disease found that women who had used the pill had a higher risk of developing Crohn's disease, with the association strongest among current users. That is not a claim that the pill causes gut disease. What it points to is a plausible effect on the gut barrier and the microbiome, which is exactly the environment that determines whether you absorb anything you're taking now.

Whether long term contraceptive use has any relationship to a diminished reserve diagnosis years later is not something anyone can answer with confidence, and I'm not going to pretend otherwise in either direction. The research does not settle it. What I will say is that it belongs in the conversation rather than being waved off. On a case where a woman spent fifteen years on the pill and then got a DOR diagnosis in her thirties, we want to look at what else that period may have set in motion.

Antibiotics belong in the same conversation. Most women have had multiple courses over a lifetime, often for acne through the teens and twenties, sometimes for recurrent UTIs or sinus infections. Each course reduces the diversity of the gut microbiome, and diversity is what recovers slowly, if at all, when nothing has been done to rebuild it. A less diverse microbiome affects the gut barrier, and the barrier affects absorption and how much inflammatory signalling gets through. That is the same chain of events that determines whether the iron and the vitamin D you're taking are reaching anything.

We see the downstream findings constantly.

See also: Told donor eggs after failed IVF? The gut pattern your clinic did not test

Then there's the autoimmune diagnosis you've had for years that has never been connected to your fertility. One autoimmune condition raises the likelihood of a second.

That is a history worth investigating. It is not a history to feel responsible for. It's the difference between asking what did I do and asking what is still going on, and only one of those has anything you can act on.

Failed IVF and miscarriage, with no explanation

Nicole's first retrieval produced almost twenty eggs and one healthy embryo. She got pregnant. She miscarried at around nine or ten weeks, and no one could tell her why.

Her second cycle produced no healthy embryos at all.

She had one insurance covered cycle left. That is the point where most women are told to go again quickly, and it is the point where she decided she wanted to know she had looked at everything first.

That's when she came to us. Individualized functional testing. Full bloodwork. Nutrition, targeted supplements, lifestyle changes and nervous system support. We looked past the IVF protocol at the parts of her health that had never been part of the fertility conversation.

Nicole is now mom to a healthy baby boy.

She tells it better than we do. Here she is in her own words, on what changed and why she believes looking deeper mattered.

Every situation is individual. Nicole's story is her own experience and it doesn't predict what will happen for anyone else. What it shows is what one more cycle looks like when something has actually changed underneath it.

Shared to illustrate process, not to predict outcomes.

What we'd want to know before another retrieval

Four areas, expanded by case rather than run as a menu. Inflammation and immune history. Metabolic and hormonal health. Nutrients and gut health. Both partners.

Underneath all four sit sleep, nutrition, movement and nervous system regulation. Testing comes in where the history supports it. We don't guess. We test. The body is not a silo.

We're not manufacturing ovarian reserve and we're not going to suggest otherwise. No diet, supplement or gut protocol produces ten follicles where there were three. The work is different. With the reserve you have today, what can we identify that's modifiable in the environment those follicles are developing in, and how prepared can both of you be before the next decision.

Sometimes another IVF cycle is absolutely the next step. Sometimes donor eggs are. Egg quality just shouldn't be where the investigation ends.

The questions people ask after an egg quality diagnosis

Did drinking or stress in my twenties cause my low AMH? There's no way to trace a specific number back to a specific decade, and nobody can tell you that honestly. Age is the strongest known influence on ovarian reserve. What's more useful now is what's modifiable in front of you rather than what isn't.

Did being on the pill for years affect my fertility? This is one where what we see does not match what women get told. The standard answer is that cycles come back and everything resumes. What comes up on calls is different. Cycles that stay irregular for months or longer. A luteal phase that never lengthens. Periods that come back heavier or more painful than they were before. And no baseline from the previous decade to compare any of it against.

What is documented is nutrient depletion and an effect on the gut environment. Whether long term use has any bearing on a reserve diagnosis years later is not something anyone can answer definitively. It is worth exploring rather than dismissing, which is not what usually happens.

Is it my eggs or his sperm? It is usually not one or the other, and framing it that way tends to send the whole investigation down one track. Cause is multi factor. The egg, the sperm, the lab environment and the wider clinical picture all sit in it.

When development stopped can be a useful clue, and it points rather than proves. Earlier arrest tends to raise questions about the energy and machinery the egg brought with it. Later development involves the DNA contribution from both partners. Neither reading rules the other one out, and a standard semen analysis does not settle it either way, because it does not assess DNA integrity.

Can egg quality be improved? Egg quality isn't something that can be measured directly or improved on demand, which is part of why the term is so frustrating. What can change is the environment the follicle develops in, and that's what we work on.

My AMH is normal but my embryos still arrested. Why? AMH counts follicles. It says nothing about what's happening inside them or the environment they're developing in. Normal AMH with poor embryo outcomes means the quantity was there and something else is worth investigating.

Functional Fertility Second Opinion

If you've been told it's egg quality and you don't want to go into another retrieval wondering what was missed, this is why we created the Functional Fertility Second Opinion.

Before the call we review your fertility history and the bloodwork you have from both partners, so we can look for patterns, unanswered questions, and areas still worth investigating. Sometimes the review confirms that going ahead makes sense. Sometimes there are things worth addressing first, so the timing works in your favour. Either way, you make the next decision with a fuller picture.

A free 45-minute call. Bring your partner and upload what you have.

About the host

I'm Sarah Clark, founder of Fab Fertile and host of Get Pregnant Naturally, a podcast with over one million downloads. My functional fertility team works with couples navigating low AMH and failed IVF, reviewing functional lab results, gut microbiome, food sensitivity, vaginal microbiome, nutrigenomics, HTMA, DUTCH, toxin testing, and bloodwork alongside nervous system work, to help identify patterns that may not have been considered. We work alongside your medical team, not instead of them.

Sarah Clark, founder of Fab Fertile, host of Get Pregnant Naturally (1M+ downloads), and author of Fabulously Fertile. Last reviewed September 2026.