Poor Ovarian Function, Few Eggs Retrieved? Can NAD+ Really Improve Egg Quality?

Can NAD+ Really Improve Egg Quality?

In assisted reproductive clinics, many women around age 40 or with diminished ovarian reserve share a common concern:

• Low egg retrieval numbers, often only 1–2 per cycle.
• Few embryos, sometimes none available for transfer.
• After PGT, no embryos are suitable for transfer.
• Despite not being very old, egg quality is poor.

When ovarian function declines, many worry: Is the success rate already too low? Is there any way to improve?

In recent years, functional medicine has turned attention to a substance—NAD+—and is exploring it as an adjunct therapy to help improve the energy status of eggs. So, what exactly is NAD+? Does it really help?

1. What is NAD+?

NAD+ (nicotinamide adenine dinucleotide) is a coenzyme naturally present in the human body, widely involved in cellular energy metabolism.

Simply put, it is a "key coenzyme" for mitochondria.

Mitochondria are the "power plants" of the cell.

Egg cells are among the most energy-demanding cells in the body: fertilization requires energy, cell division requires energy, and embryo development requires energy.

If mitochondrial function within the egg declines, energy supply may be insufficient, potentially affecting fertilization rates and embryo development quality.

Therefore, one theory suggests that appropriate supplementation with NAD+ may help improve mitochondrial function, thereby enhancing the egg's energy status.

2. Egg Count Is Fixed—So How Can One "Increase Follicles"?

Many women ask: "Isn't the number of eggs fixed from birth? Can new eggs really grow?"

Indeed, the total egg count is limited. However, in each cycle, the antral follicles visible on ultrasound are only a subset.

At an earlier stage, there are preantral follicles that are not visible on ultrasound.

Through interventions that improve the ovarian environment, it may be possible to help these follicles become activated and enter the growth phase.

This is not "creating new eggs out of thin air," but rather activating follicles that already exist but were not recruited.

Therefore, after intervention, some individuals may observe:

• A slight increase in AMH;
• An increase in the number of baseline follicles;
• A modest increase in the number of eggs retrieved during a stimulation cycle.

3. Clinical Observations

In some clinical observations from fertility centers, for women with diminished ovarian reserve who received NAD+ infusion, the following trends have been noted:

• An average increase of about 1 egg retrieved;
• An increase in the number of good-quality blastocysts;
• Patients who previously had "no embryo after PGT" later obtained usable embryos.

In isolated cases:

• Multiple IVF cycles had failed;
• After improving mitochondrial function, natural pregnancy occurred.

Of course, it must be emphasized that these are clinical observations and not everyone will experience the same results. Individual differences remain significant.

4. How Is an NAD+ Adjunct Cycle Typically Scheduled?

In practice, a common schedule is:

• Start about one month before the planned IVF cycle;
• Begin after ovulation or 14 days before menstruation;
• Once a week;
• After 2–3 infusions, start ovarian stimulation;
• Continue with 2–3 more infusions during stimulation;
• The total course is usually 5–6 infusions.

The goal is to improve egg energy status before stimulation and to maintain support throughout the process.

5. Is There Still a Chance in Your 40s?

Age is one of the most important factors affecting egg quality.

Generally speaking:

• Before age 46, it is still possible to obtain usable embryos;
• After age 46, the success rate with own eggs declines significantly.

But the prerequisite is—as long as you have not reached menopause, follicular development may still occur.

Whether it is appropriate to try depends on a comprehensive assessment including: AMH level, baseline follicle count, hormone profile, and previous response to stimulation.

6. How Safe Is It?

NAD+ is a naturally occurring substance in the human body.

In theory, supplementation involves "replenishing a substance already present in the body."

However, it is important to note:

• It must be administered in a reputable medical facility;
• Use only after evaluation by a physician;
• Self-medication is not advised;
• No treatment or adjunct therapy can guarantee results, nor is it suitable for everyone.

7. A Rational Perspective: Miracle Cure or Waste of Money?

Currently, NAD+ is considered an adjunct therapy in reproductive medicine, not a standard first-line treatment.

It is best understood as a supportive approach aimed at improving mitochondrial function in individuals with diminished ovarian reserve.

It is not:

• A way to reverse age;
• A method to indefinitely increase egg count;
• A guarantee of success.

But for some individuals with clear egg quality issues, repeated PGT failures, or diminished ovarian reserve, it may be a direction worth discussing.