It Starts with the Egg: The Science of Egg Quality for Fertility, Miscarriage, and IVF

by Rebecca Fett

The definitive guide to egg quality and fertility, fully revised and updated in 2023 with new chapters

Genres: Nonfiction, Health

436 pages, Paperback

Published August 29, 2023

Reviews

[Chloe Rockel · Rating 5 out of 5]

Eggcellent. It was an eggstremely informative read!

[Sarah Collier · Rating 5 out of 5]

Very well researched information given in this book for overall health to become pregnant or going through infertility treatment.

[Allie Lively · Rating 4 out of 5]

While knowledge is power, knowing that basically everything is designed to make me ill and disrupt my health feels more defeating than empowering.
I deeply appreciate the author putting all the research together in an easy read with action steps for different focuses. I did gain some action steps that I can start today.

[Samantha Robles · Rating 4 out of 5]

My wife and I are in the early stages of our IVF journey. The information in this book about preparing for egg retrieval feels invaluable and much more in-depth than what we’ve received from even our fertility doctor! It was an easy, enjoyable, informative read.

[Stefanie Christiane · Rating 4 out of 5]

It’s a very helpful book. Of course, you only start reading these helpful books (in most cases) when you already have issues, not as a preventative measure. I read the newest edition, so there is updated information which was great. It made me realise all the things that do work for us and which don’t.
The reason why it is 4 and not 5 stars (and that’s very personal to me), this book was not written for Europe. Some of the dangers discussed, are not a thing in the EU. Same with the ivf procedure, so I could relate a little bit less to this.

[Sara Fradette · Rating 5 out of 5]

Anyone who wants to conceive in the next year needs to read this book! This book is full of research based knowledge and has so many recommendations for unexplained infertility, PCOS, low ovarian reverse, IVF, etc. It’s incredibly helpful, and you can choose which strategies to try based on what makes the most sense for your situation.

[Elizabeth Bennett · Rating 5 out of 5]

I’ve read every edition more than once. It’s like an infertility bible, highly recommend.

[Megan Hoag · Rating 4 out of 5]

🥗 DIET & BLOOD SUGAR (Foundation)

Goal: Reduce insulin spikes & oxidative stress

Avoid refined carbs & added sugars
• White bread, white rice, white pasta
• Bagels, crackers, sugary cereals
• Pastries, cookies, table sugar
• Corn syrup & high-fructose corn syrup
• Sugary drinks & sauces

Eat a Mediterranean-style diet
• Slow-digesting carbs: lentils, steel-cut oats, nuts, seeds
• Leafy greens + moderate fruit
• Lean protein: fish, chicken, beans
• Healthy fats: olive oil, avocado, nuts, seeds
• Omega-3 fish (salmon, mackerel) 2x/week
• Limit caffeine & alcohol

⸻

🧪 TOXIN REDUCTION (Very important)

Key toxins to avoid: BPA, phthalates, heavy metals

Kitchen & food
• Avoid plastic bottles (especially sauces, oils, dressings)
• Buy glass or stainless steel
• Don’t eat hot food from plastic containers
• Reduce canned foods & drinks

Home & personal care
• Avoid fragrance/perfume (DEP, DBP, DMP, DEHP, parabens)
• Use fragrance-free cleaning & laundry products
• Skip dryer sheets → use wool dryer balls
• Candles: soy or beeswax only
• Brands: Better Life, 7th Generation
• Cleaning agents: alcohol or hydrogen peroxide

👉 Product guide:
https://www.itstartswiththeegg.com/pr...

⸻

🧬 KEY NUTRIENTS FROM FOOD

Folate-rich foods
• Berries, oranges
• Broccoli, cauliflower
• Kale, asparagus
• Avocado, lentils

Antioxidant foods
• Nuts (esp. vitamin E)
• Fruits & vegetables (vitamins A, C, E)

⸻

💊 SUPPLEMENTS (Preconception Core)

Start at least 3 months before trying

Essential
• Prenatal (daily) – never too early
• Folate (B9): 400–800 mcg (methylfolate preferred)
• Vitamin D3: 4,000–5,000 IU/day
• Goal blood level: >40 ng/mL
• Take with fat or K2
• Omega-3 (DHA/EPA) or choline
• Vitamin C: 1,000 mg/day (1 month before TTC)
• Vitamin E: ~200 IU/day (from nuts or supplement)
• Zinc & Selenium (often in prenatals)
• Selenium: 200 mcg/day (1 Brazil nut ≈ 90 mcg)

Egg quality & oxidative stress
• CoQ10 (ubiquinol)
• 200 mg/day (up to 400–600 mg if intermediate fertility concerns)
• Take in the morning with food
• Takes 3 months to work
• Stop once pregnant
• Alpha-lipoic acid
• NAC
• Melatonin: 3 mg before bed

PCOS / insulin support
• Myo-inositol (6 months)
• Helps ovulation, egg development, insulin resistance
• Can be taken with melatonin
• Metformin (if prescribed)

⸻

🧠 HORMONE & LAB OPTIMIZATION
• AMH: 1.0–3.5
• FSH: <10
• TSH (thyroid): ideally <1
• DHEA:
• Dose: 75 mg/day (25 mg x 3)
• Optimal blood level: 95–270 (ideal ~180)
• Total testosterone: 25–40
• Avoid high or low iron
• Check B12:
• 1,000–2,000 mcg/day (active form)

⸻

🚫 SUPPLEMENTS TO AVOID / USE WITH CAUTION
• Resveratrol
• Turmeric / curcumin
• Vitex (chasteberry)
• Maca
• Pycnogenol
• Royal jelly
• L-arginine

⸻

👶 Sperm Quality (3+ months before TTC)

Lifestyle
• Avoid heat: saunas, hot yoga, hot baths/showers
• No tight underwear
• Limit cycling
• Reduce alcohol
• Avoid smoking & fragrances

Diet & supplements
• Mediterranean diet
• Daily multivitamin with methylfolate
• CoQ10: 200 mg/day
• Omega-3 (DHA)
• Fruits & vegetables
• Shift from red meat to fish, nuts, legumes

Timing
• Quality > quantity
• Try daily starting 4 days before ovulation

[Lindsay · Rating 4 out of 5]

I don't agree with IVF *at all.* I think I need to state that outright. See https://www.epm.org/resources/2010/Fe... for some of why.

In fact, I wouldn't have any role in IVF processes in the corporate realm even when it looked like it'd cost me my job.

That said, I still found this book helpful on a number of topics, from limiting toxins in food and body care items, to what level to keep my TSH below during the first trimester to limit miscarriage risks, to discussing how age-related problems in early pregnancy processes may come down to a decrease in cellular energy.

[Savannah · Rating 5 out of 5]

Very informative on the different factors that can be affecting fertility for women. Everything was backed up by research and studies. Along with diving into what could be negatively affecting fertility this book also gives recommendations on supplements to take and diet changes/foods you should avoid or consume more of to help combat that and increase fertility. I also appreciated the chapter on sperm quality and looking at fertility on the men’s side.

[Lauren Jones · Rating 5 out of 5]

Found this book to be insightful and well researched. I recently experienced an early miscarriage. This book helped expand on information provided by doctors, to understand better that I truly wasn’t at fault (and it isn’t just something people say). It also helped me feel more in-control, with precautions I could work into my everyday life that could lead to a better outcome next go around.

[Chelsea Reid · Rating 4 out of 5]

4.5 ✨ The research that went into this book is truly spectacular. My family doctor said to me “its just a chromosone imbalance” my naturopath looked into me further and explained so much information based on hormones and diet. After reading this book it confirmed everything my naturopath said but in such grave detail.

[Mary Rickmeyer · Rating 4 out of 5]

Really informative and helpful. Every chapter is defined with what information it will give, and in the chapter you get explanatory information and at the end of every chapter it gives a bulleted action list.

[Nicole · Rating 5 out of 5]

Very informative!

[Lindsey Finton · Rating 5 out of 5]

Excellent. I will be using this as reference! I appreciate that the author is taking the studies and science and making it accessible for people like me.

[Taylor Schulz · Rating 5 out of 5]

4.5 rounded up

[Ambs · Rating 5 out of 5]

Fascinating! Highly recommend to anyone that wants to have kids one day and is interested in improving egg quality for their future babies 😊

[Sanam Sanghera · Rating 5 out of 5]

Excellent book that all women should read

[Christine Barnabic · Rating 3 out of 5]

Refers to scientific studies. Good advice but some of the negative stuff was hard to hear, naturally.

[Lia · Rating 5 out of 5]

Fascinating. Consider this my villain origin story against bisphenol A 😤

[katie reynolds wilbanks · Rating 4 out of 5]

a bit repetitive at times due to the style of the book but ~eggstremely~ informative!!!

[Alexa · Rating 4 out of 5]

a solid read for ttc. however it seems like you can get a summary of the content of this book on the website for free, which defeats the point of reading / listening to this book.

[Andraya Hennessy · Rating 3 out of 5]

While very informative, parts of this book felt more defeating than empowering and I wish I would’ve read it at least a year before starting all of my infertility treatments