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Darja Wagner, PhD
Author of the #1 rated e-book on Amazon: How to Improve Egg Quality: The Smart Way to Get Pregnant & Blog Paleo-Mama , Paleo Mama
Category:
Lifestyle and Fertility, Low Ovarian Reserve
In this webinar, Darja Wagner, PhD, cell biologist, author of the #1 rated e-book on Amazon: How to Improve Egg Quality: The Smart Way to Get Pregnant & Blog Paleo-Mama, has talked about the best time for having babies and how we can improve egg quality naturally.
When couples plan to have a family, they think about cute, perfect, healthy babies, and that makes sense in a way. However, what couples and women should be thinking about is perfectly healthy, beautiful-looking eggs. Eggs are, in a way, much more important.
At the beginning of every human life, there is a single egg cell, so it’s an egg that leads to an embryo, it’s an egg that leads to a pregnancy, finally to a baby. Nothing in terms of becoming a mother happens without at least 1 egg, although it’s never 1 egg, it’s a certain quality of perfect, healthy, robust eggs. For couples who are trying to get pregnant naturally, it means: no eggs equals no babies.
This is an issue, especially in women over 35, and Dr Wagner emphasized that women should know more about how eggs live, metabolize, how they give babies. They should be able to apply this knowledge to improve their egg quality naturally and when to start having babies.
The truth about woman’s eggs is that all women are born with all the eggs they will ever have. There will never be new ones coming up. The woman’s eggs are formed when she is 16 to 20 weeks old fetus in her mom’s belly. At about this stage, a female fetus has a small clump of just 50 stem cells. These stem cells migrate to a place where ovaries will later grow and then divide. A female fetus has about 5, maybe even 7 million eggs. However, at some point, they start deteriorating, so they start declining in numbers. Unfortunately, we don’t know why that happens.
When a female baby is born, she comes into this world with about 1 million to 2 million eggs. That sounds quite a lot, but they will still keep declining in number. When a young woman reaches puberty, she will be left with about 3 to 4 hundred thousand cells. From that point on, the eggs will disappear at a rate of about 1 000 eggs per month.
After the age of 30 and especially 35, this will be maybe several hundred eggs per month. A very important paper was presented around 11 years ago, it is shown that at the beginning, there is quite a fair amount of eggs. Then there are fewer and fewer eggs left. Toward the end of the fertile life of a woman, this curve is becoming more exponential.
Scientifically speaking, the question: When should women have babies? is very easy to answer. On the graph, there are two curves. The first curve shows a huge amount of eggs at the beginning of life. Then there is a sort of linear depression until about the age of 35 to 37. After that, there is an exponential decline. The second curve starts at about the onset of a cycle. First poor quality oocytes will appear, and also, selection processes will start taking place with each new ovulation, and then selection processes will become weaker and not so precise. After the point when these two lines cross, pregnancy is not very likely. It is not impossible, but not very likely to happen. If a couple is serious about becoming genetic parents to their children, they should use this graph and focus on the area beneath the curve. For the woman, it means the time between 19 and 29 is the best time women should start having children or at least have their first baby. Unfortunately, we don’t listen to our biological clocks.
There is an explosion of late childbearing today. We all know that, especially, in western countries, women are delaying childbirth for all kinds of reasons. There is a true explosion of late mummies in the group of 35 to 39 years old women. In a group of 40 to 44 years old women, first birth increased to about 70% in the past less than 20 years, which is huge. This is something that reproductive clinics witness, and these numbers are due to advances in reproductive technologies. Dr Wagner explained that as she is a biologist and she’s spent 13 years in the lab working on the regeneration of stem cells. Eggs are the ultimate sort of stem cell, capable of regenerating the entire organism.
When I started planning my family, I became sort of obsessed with eggs. That was about the time when I decided to focus my entire energy just on researching eggs. Anything backed up by good and solid science that helps women regenerate their eggs, maximize their egg quality. In a way, that is the science of turning back the biological clock. It’s not wise to think we can switch off biological clocks, but at that time, if we start having babies late and if we are chasing every single ovulation, it’s very much worth investing all the effort to maximize the egg quality and to do what’s possibly best out of our remaining eggs and embryos.
Dr Wagner supports patients in any way she can, and around 10 years ago, she started a website which is probably the most popular fertility blog in Germany, called paleo-mama.de or paleo-mama.com. She is also an author of books focused on egg quality improvement.
In all my consulting and writing, and giving talks, I try to transform and tell you everything I’ve learned from many experts that I’ve met in the past years. I was incredibly privileged to meet the top people in the field. I very often visited them in their clinics, in their laboratories. I talked to liquid biologists, embryologists, fertility specialists, gynaecologists, naturopathic doctors, psychologists. Lately, also people from several sperm banks and so on. We talked about the most essential things related to making babies, eggs and embryos and also sperm. I’m very happy to share that, and on my website, you will find a ton of interviews, also in English and very often, it’s not information that you will find on the clinic’s website or if you just research anywhere on the Internet. It’s a very distilled sort of knowledge.
Dr Wagner once spoke to a very famous, very well-known embryologist who is working in one of the top clinics in Spain. She asked her if she can confirm what was being published about when should women start having babies, and she said:
For a woman’s biological clock, the mid-20s is the best time to have children or at least to have a first baby.
That is about the time when ovarian reserve will start significantly decreasing, and at the same time, oocyte, and embryo aneuploidy will increase. By the time women come into their 40s’ up to 90% of their eggs are not able to give viable embryos anymore. When a woman is 45, the chances of a successful pregnancy, even with the help of IVF, fall to fewer than 5%. These facts are quite brutal, and in Dr Wagner’s experience, many women, even smart, educated women, choose to ignore these facts because they believe there is nothing to be done anyway. However, it is very possible to improve egg and embryo quality.
Every woman should be aware of some numbers which have to do with estimating ovarian reserve. We are very much used to estimating the ovarian reserve when there is hardly anything left or when we seek the help of reproductive medicine specialists. Dr Wagner emphasized that this is very wrong, all young women hopefully will take initiative to find out more about their eggs, their ovarian reserve when they are still young so that they can plan their life accordingly.
About 5% of all women will come into menopause very early. In the worst case, at 25. But it can happen at 30, 32, 33. There are some genetic factors to this, but this is not very clear. Nobody knows whether this will happen or not, and the only way to avoid it is to know beforehand and be able to consider these numbers and plan.
Many women tend to focus on just one hormone, such as FSH, and they become very stressed at the beginning of the month when they get their FSH test at the beginning of the cycle. They focus on AMH too much, which is wrong. There are 3 parameters, and all three are equally important. There is Antral Follicle Count (AFC), it should be as high as possible, but not too high for a given age. The same goes for AMH, which is produced by granulosa cells and pre-antral follicles. Then there is an FSH, which comes from the brain. These three factors need to be combined, and it’s best if the fourth-factor Estrogen is added at the beginning of the cycle. This together will give almost a perfect estimate of an ovarian reserve, and as you can see, it’s not an extreme science, it’s nothing that can’t be easily done. Young women just need to be educated to want to do this.
There are all sorts of sperm issues or bad intercourse timing sometimes, block tubes, or all kinds of implantation issues. All that plays a role in getting and staying pregnant. Nowadays, we know much more about the so-called peri-implantation window, these are the months before the conception takes place. Before you plan a pregnancy or before you go to IVF, at least 3 to 5 months, it takes some dedication, and it’s also the only intelligent solution to invest your time and effort into improving eggs and sperm, so improving cells that are supposed to make the baby.
The first factor that plays a huge role in egg quality and successful pregnancy, and it’s also the one that we can’t influence, is the woman’s age. However, there are many other factors involved, such as weight, nutrition, physical activity, avoidance of smoking, alcohol, drugs, etc.
On Dr Wagner’s website, you will find a ton of references, bibliography, literature, scientific papers and so on. Sometimes even simple live interventions like losing weight or bringing body mass index into a certain range, and very often your BMI should be between 19 and 25, but that’s quite a general approach. It is best if your BMI is about 21 to 23. If your BMI is below that range, for example, 19 or even below, it’s sort of underweight for pregnancy, and it’s quite likely that the body is just not happy with being pregnant. When you go above to 25, it’s not that critical, it’s some extra weight around the belly, it’s not a problem for getting pregnant, but anything beyond this, there are difficulties. Some papers are describing that having a BMI of 28 will reduce pregnancy chances by about 4%. It’s not just about getting pregnant, it’s also about staying pregnant. Miscarriages would also increase in numbers. This increase will not be linear, it will be exponential and so on.
There are other relatively simple interventions as well, such as nutrition. In terms of nutrition, anti-inflammatory nutrition is discussed a lot. This is very close to the Mediterranean diet style. Mediterranean diet will not mean pizza and pasta and so on but will rather mean barely processed foods and lots of vegetables and fruits, fish and a lot of omega-3 and olive oil, and so on. There is a lot that can be done with that for both women. There are excellent studies on the benefits of the Mediterranean diet for both men and women if applied just 6 months before pregnancy.
It is not known why this is the case, it may have something to do with vitamins B, with plentiful folate, sometimes some people say it has to do with red wine, with the resveratrol from red wine. Possibly it’s coming from all ingredients together, we don’t know, but there is something to it, and you should take the advantage of it if you are preparing for an expensive IVF or if you are trying to get pregnant naturally.
There is also targeted supplementation. There is a lot that can be done with supplements such as folic acid, omega-3, vitamin D, women should get about 40 nanograms per millilitre of vitamin D when they’re trying to get pregnant, give it also to your partner. Coq10 is a great supplement as well. These substances are backed up by science, and any woman trying to get pregnant should take a decent amount of this. Many other substances are very helpful as well, but they should better be individually adjusted.
- Questions and AnswersThis will depend on her eggs, her ovarian reserve, so I would need to see your hormonal values. The answer very likely will be yes, but at this age, there are just no guarantees. Without seeing any hormonal values, it’s just difficult to say more. AMH of 1.62 is quite good, and FAH of 7 at the beginning of the cycle for a 39-year-old woman without previous medical history or any difficulties, and so on, especially if she’s had a child before should be able to fall pregnant and to have a healthy baby. There are thousands of other factors to it, but it’s a fairly promising situation.
You can improve your egg quality with time and dedication. It will give good results, it may not work equally for everyone, it’s sort of individual and genetically determined. It also has to do with previous lifestyle a lot but just like with anything else if you want to strengthen your body for the beach and start exercising and having a diet in winter you will see the results in the summer. It’s very similar to the rest of your body which you can’t see, and these are your organs and everything going on there, so it is, of course, possible to change the metabolism of just about any organ and especially to take part in what’s going on during egg maturation. Please, don’t forget, women are very much used to think that eggs are sort of passively resting in the ovaries like nothing is going on there. This is the truth before eggs go into maturation and towards ovulation. It takes two to three months for primordial cells to reach the antral follicle stage, so already in the ovary in this very early maturation phase, it’s very important to supply good nutrients.
Most biologists who research the DHEA tend to believe that this is the stage where DHEA is best applied and improves testosterone. We still don’t know all the details. When you have antral follicles, you have the last two weeks of very rapid egg maturation, so towards ovulation. In a natural cycle, there will be a lot of selective pressure applied, and most of the antral follicles will go into atresia, so they will die, and one will be left in the middle of the cycle. In the IVF, because of stimulation drugs, atresia will be cancelled, so they will not die. All follicles will develop towards the mid-cycle, they will be saved, in a way. This is the time where you want to have good nutrients in your blood and supply your ovaries. Yes, DHEA can be a part of this equation for many, not for all.
There are over 80 studies so far done on DHEA, so it’s a very well-known substance. There are thousands of women worldwide who have taken part in clinical studies and who have seen improvement in egg and embryo quality after DHEA supplementation, so there is nothing new about that. It’s more for women on decreased ovarian reserve side or even on the premature ovarian failure side, or I would say almost generally for women over 40. It’s not for younger women, especially, it’s not for women with higher androgens, but it’s difficult. DHEA is something that needs individual estimation.
This is what I see daily. I tell women which supplements to take, and this is just partially true because much more often, I tell them which supplements not to take. I observed that when women try to get pregnant and at some point it doesn’t work, and there is an IVF option coming up, and so on, they will take anything that they can find or see on the Internet. I frequently see women taking the entire lists of 20 and sometimes more supplements. All I can say is, please, don’t do it. You can damage certain processes, but also keep in mind that nobody in the world knows how these supplements work with each other. The thing is, whatever we put into our system it will lead to some effects.
All substances will have some effect, and how they will cross and how they will interact, nobody can tell you especially, when this comes together with all kinds of drugs and stimulation stuff, and so on. It’s not good, so be careful about this, and it’s not only extra supplements it’s also extra herbs. I often see women who are doing acupuncture. They almost invariably get all sorts of tinctures which are highly concentrated plant extracts. Please remember that one single pharmaceutical plant can have dozens of active compounds, and half of those compounds can act as an estrogen receptor or some other steroid receptor. They work on a hormonal level, so when you put all that together, it’s like a mixture that no one can control. I recommend working with a limited or targeted supplementation with a minimal amount of substances, but that is backed by science to work in defined clinical studies available to read and understand. There are very few substances we are talking about here.
This is indeed a difficult question. It’s much easier to tell you which one any woman trying for a baby should take. The supplements you need to think about is folic acid should be taken 800 micrograms per day, or even if you take one milligram per day, it’s fine. The second one you should be thinking of is vitamin D, and with this one, please try to get in a range of 40 to 50 nanograms per millilitre.
The third one to think about is omega-3 which should be taken one to two gram per day. The major omega-3 sources are EPA and DPA, so these two combined should be about one to two gram. While increasing omega-3, please try to decrease your omega-6 via nutrition. This is the anti-inflammatory effect you are trying to reach, you are trying to fix this ratio from omega-3 to omega-6. We normally have way too much Omega-6 in our diet, so that’s why we are trying to decrease this and have regenerative processes taking over, not the inflammatory ones. Having the cell membranes being nice and fluid, not fragile and thick.
The last one you should be thinking about is CoQ10, so any woman trying for a baby should be supplementing at least 200 milligrams. This is something extremely important, especially for women over 35. This has to do with mitochondria and spindle, which is a very late mitotic division and also in early embryo with cellular divisions, so this is where it helps. Everything else can be too much depending on the hormonal profile, so some things are excellent like DHEA, Myo-inositol or something for thyroid support depending on what issues a woman has, but anything else is very often not helpful.
It sounds good, so if you are trying to get pregnant naturally. I would add omega-3 to this, try to eat an anti-inflammatory diet, try to research about it, it’s not difficult or try to get a cookbook for the Mediterranean diet, then you’ll be fine. Decrease carbs, gluten, this helps, I must say, control your thyroid and think about your partner or husband because we very often tend to take everything on ourselves. I see every day how deeply women get involved even with treatment already without their partner visiting a doctor even once, not having had a single sperm analysis. There are two in this game. Remember that these days, we are talking about huge sperm issues as well.
I don’t work with this one. I guess if it’s on the market and if you got it from your therapist should be safe, but if it is efficient, or if it should be recommended, I don’t know. This would probably depend on everything else, just continue talking to your therapist and make sure to understand what it does.
Yes, anything that brings your body mass index out of this range between 21 and 23 should be avoided. Women obsess a lot about what diet I should have, they google a lot to find out which foods help, and sometimes it’s just about what should be omitted, like too many carbohydrates coming from simple sugar, reducing gluten without being too radical. If you don’t have an allergy, if your body is not creating antibodies, if you don’t have celiac disease, you don’t need to be radical about reducing it.
However, reducing gluten to say 80% will help and not just with getting pregnant, it will help with many other issues. I would say it’s not possible to reduce gluten to a large amount without seeing many positive things on the body. I have women reporting all kinds of things like feeling less swollen, not having headaches, thinking more clearly, but knowing its inflammatory capacities, it’s possible. I would say avoiding anything increasing inflammation in the body is what you want to do during trying to conceive journey.
I’ve done many experiments with glutathione, and I loved it in the cell culture, it works like a charm, it’s beautiful, but many things that we know work great, and cell culture just don’t work in real people the same way. Our bodies, our intestines are very wise and very clever, and they are suspicious towards most of the substances. Very often, they won’t even take them. Sometimes we ring it on the labels, great things and beautiful claims about different substances and supplements, but this comes from cellular culture work, and in reality, it will never even get to the blood, so it just goes through the digestive system and goes out. Things need to be controlled, and I always say, have a look at that company if they do have any testing, do they show absorption rates in people, how much of that substance is there after six hours, eight hours, 24 hours, is there anything around and so on. I’m not aware of any clinical studies related to improving egg quality with glutathione.
No woman is defined as a Paleo mama, it’s just the name of my website. People who are improving egg quality and sort of trying to reverse reproductive ageing a bit, a lot of that goes into this more natural mode of functioning. You have to ask yourself what is with this modern lifestyle that is working against me, what is it that I can learn from the past, what would my grand grandmothers do differently. This is where it came from, the name Paleo mama.
Advanced reproductive ageing is a term that is used for describing women over 35. Women trying to have babies over 35 belong to this group, this is what we’re talking about in these studies when you have this reproductive age.
If you understand German and go to my website, I have a very long article on this. Some months ago, I went very deeply into this topic with several other people, and we have had some contacts actually with people in the company who has made the Pfizer vaccine. As you may know, the vaccine technology has been made in Germany, and then it was picked up and scaled up and distributed by Pfizer. We took quite a deep look into this, and it’s still sort of difficult to say. There are very serious people and absolutely great doctors and great scientists having doubts whether women who didn’t have children should take it, and I understand that very well.
We still need to understand much more about how the virus works and how the vaccine works before we tell women who haven’t had children yet to take a vaccine. I think this is pretty much the last group that should be thinking about getting vaccinated. There are many reasons for this. It’s probably better not to panic about it, but there are way too many open questions. Women who have immunological issues, autoimmunity issues or who are prone to biochemical pregnancies, in theory, could be suffering from certain types of vaccines even more. We have no idea, and just for that reason, I would say it’s better to wait.
The impact of radiation is definitely very negative. There are different sorts of rays, and they shouldn’t be mixed up, and I think this is something that only time can show. For men, it’s not good to keep their mobile phones around their testicles for so many hours a day. We used to think that it has to do with the thermic effects, but it’s not. We have many great studies on cell culture where our cells definitely behave differently when they are just being kept around switched on mobile phones, and evidence on men is still lacking because it’s unethical to do this sort of experiments with people, so the evidence is more like anecdotal, and you can also imagine that industry has no interest in finding out and so on.
I’ve just had a lady, she’s been irradiated in the lower back when she was young six or seven times without using protection, this happened somewhere in Russia, she’s now like not even 35, and she’s having huge problems like her eggs are totally broken, she’s not getting any embryos at all and so on. This example just fits perfectly well with what we know about radiation, it’s deleterious for chromosomes, DNA. We are probably exposing ourselves to way too many sorts of radiation in our daily life. Some people are more robust and will not have any consequences, but some people will and do. What will happen in the next generation when effects become cumulative? This is something nobody knows, and we are definitely running huge and many experiments on ourselves, all of us, every day.
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