What you need to know about egg quality

A lot of our clients come to us with questions about what AMH means for their reproductive health, so we’ve decided to answer some questions in this blog post.

Is AMH an indicator of egg quality? 

AMH is not an indicator of your egg quality in general: its level does not directly relate to egg quality in most cases. However, if your AMH is too high, it may mean that your egg quality is compromised. This is because AMH is one of two hormone markers for PCOS (polycystic ovary syndrome) and having high AMH can mean you have PCOS.

PCOS is a hormonal imbalance condition with symptoms such as hair loss or growth, skin issues such as acne and pimples, irregular periods and weight gain. PCOS suffers have poor egg quality. This is why women with PCOS may find conception difficult and are more likely to have miscarriages.

In short, you do not want your AMH to be high as low AMH has little bearing on egg quality. However, if your AMH is exceptionally low, it is also a form of hormonal imbalance and any form of hormonal imbalance negatively impacts egg quality.

Can a scan determine my egg quality? 

In short, no. To see if you have poor egg quality, we have to run a few tests and look at all the markers in their entirety to work out the quality of your eggs. While antral follicle scans can check how many follicles you have in one cycle, they can’t check the quality of your eggs. Instead, we at TCM Healthcare also check the hormones that can affect egg quality to figure out what state your egg reserve is in. 

What determines egg quality then?

Intrinsic Factors - Age associated factors

Older age is often cited as a cause of declining egg quality. More precisely, age itself is not the cause but is closely associated with reduced egg quality due to biological processes that unfold over time. With advancing age, eggs undergo cumulative damage that affects their structural and functional integrity. Key mechanisms include:

• Chromosomal Instability: The likelihood of chromosomal segregation errors increases, raising the risk of aneuploidy.
• Mitochondrial Dysfunction: Decline in mitochondrial number and function reduces energy production, impairing developmental potential.
• Cumulative Exposure to Harmful Factors: Over time, eggs are exposed to damaging influences such as:
  • Oxidative stress
  • Chronic low-grade inflammation
  • Environmental toxins

These time-dependent factors collectively compromise the quality of eggs in older women, making age a strong marker—but not a direct cause—of egg quality decline.

Like age, the intrinsic factors are by and large immutable. Scintific ressearch put the contribution of intrinsic factors at about 70%.

Extrinsic factor - hormones

Hormones are the most important extrinsic factors affecting egg quality for the following reasons

1. Hormones Orchestrate Folliculogenesis
   Hormones such as FSH (follicle-stimulating hormone), LH (luteinizing hormone), oestradiol, and progesterone regulate every stage of follicle development—from the recruitment of antral follicles to final maturation. This process directly determines the quality and competence of the egg.
2. Hormones Influence Key Egg Quality Determinants
   • Mitochondrial activity (energy supply to the egg)
   • Chromosome segregation (avoiding aneuploidy)
   • Follicular fluid composition (nutrient-rich medium)
   • Communication between granulosa cells and the oocyte (critical for cytoplasmic maturation)
3. Hormonal Imbalance Can Undermine Egg Quality
   Disorders such as:
   • PCOS (excess androgens, high LH)
   • Hypothalamic amenorrhea (very low FSH/LH)
   • Thyroid dysfunction or insulin resistance
     can all interfere with hormone signalling and lead to compromised folliculogenesis and egg maturation.
4. Hormonal Environment Sets the Developmental Tone
   Once an egg is recruited into the growth phase (about 3–6 months before ovulation), it is entirely dependent on the hormonal environment. Even a genetically healthy egg can develop poorly in a suboptimal hormonal setting.

The good news is unlike the age related intrinsic factors such as genetics, hormones are modifiable and trackable. Specifically, hormone levels can be

·     Monitored (e.g. via blood tests)

·     Adjusted through clinical intervention (e.g.ovulation induction, lifestyle change, stress reduction)

·     Optimised over time, allowing therapeutic strategies to

improve the environment the egg develops in.

Scientific research puts the extrinsic factors's contribution to egg quality at around 30%.

What we found in the last 25 years ?

Our over 20 years of clinical experience in traditional Chinese medicine also agree with the findings of scientific research. We found that the single most important and direct factor impacting on egg quality is a small group of reproductive hormones: AMH, FSH, LH, oestradiol, prolactin, and testosterone. Each of these plays a vital part in impacting egg quality in the most fundamental way. 

FSH, LH and oestradiol are hormones that directly impact on the period cycle. When they are out of sync, a woman’s periods will move, getting too long, too short or even going missing. When the periods are irregular or missing, one’s egg quality is compromised. This is why women with irregular or missing periods find it hard to conceive. 

When prolactin is high, ovulation can be suppressed.When ovulation does not occur, or is disrupted, one can infer the egg quality has to be poor. 

AMH and testosterone are the (only) two hormone makers for PCOS, which is a hormonal imbalance condition. As PCOS sufferers have imbalanced hormones, they may have elevated AMH and testosterone, which can make the PCOS sufferers have poor egg quality, causing them to find conceiving difficult and have frequent miscarriages.

All in all, there are only a small number of key reproductive hormones that can reliably tell us about egg quality.

Can egg quality be improved?

This is the question our clients want to know the answer to. Since some key reproductive hormones are strongly associated with egg quality, it follows that, if these hormones can be improved, egg quality can be improved. That’s what we do at TCM Healthcare: We help women to improve egg quality by improving their hormones, through prescribing herbal medicine in our traditional Chinese medicine practice.

What about supplements?

Some patients of ours have been advised to take DHEA (dehydroepiandrosterone, a hormone that our bodies naturally produce) to improve egg quality before they come to us. But they were generally not told how DHEA can improve egg quality, and, especially how they can know if egg quality has in fact improved —  we at TCM Healthcare offer egg quality tests, and make sure you test before and after all our treatments to see if they’ve worked.

What we do know is that from both the literature and clinical experience, DHEA increases one’s testosterone level pretty quickly. We also know that high testosterone impacts on period regularity — a sign of poor egg quality is if your period becomes irregular.

Nearly all of our patients who come to us are already taking an array of supplements. They say they take them to improve egg quality. However, when asked how they know their egg quality has improved after taking them, few can provide answers.

The fact is, there are hundreds, if not thousands, of supplements out there. All of them are marketed for health benefits. The only way to know they benefit egg quality is to obtain egg quality indictors before using them and then to check the indicators after using them. We seldom come across patients who have done that. Supplements are usually taken as an act of faith.

Another problem with supplements is that patients usually take quite a number of them. Few, including those who market the supplements, can tell us what the interactive effects are.

Finally, the fact that many prospective patients have been using them and then seek further help, from people like traditional Chinese medicine practitioners like ourselves, may mean that the supplements have not been helping, or only have limited value. 

What we do when patients come to us with egg quality questions and issues?

Like we’ve done in this blog article, we explain to prospective patients the following:

• Why egg quality is one of the most important (if not the most important) factors for fertility
• What determines egg quality
• How to measure egg quality
• How to improve egg quality
• And how they would know egg quality has improved after a course of treatment

Research evidence for hormones impacting egg quality can be found in our resource page — please click here. 

If you want to find out more about our treatment for improving egg quality, please click here.

To test your egg quality, please click here.