Book Review: “It Starts with the Egg” by Rebecca Fett
This is a book written by a non-medical writer who was also a former infertility patient. It was published only this year and is available in paperback. As with most books about infertility, there are good points and bad points. On the whole, however, it is very readable and to the author’s credit, she does give extensive references to back up most of the statements made.
The chapter "Understanding Egg Quality" is excellent and gives the reader good insight into why fertility declines with age and why most embryos do not implant: it is almost always about the egg and about the high proportion of human eggs that have chromosomal abnormalities.
The premise of the book is that egg quality and chromosomal normality are due, at least in part, to environmental factors that cause oxidative damage to eggs. The author brings up the point that age and genetics are major factors but for the remainder of the book, stresses that we can reverse poor egg quality by avoiding environmental toxins in foods, food containers and cleaning products and by taking anti-oxidant supplements. She does use references to back up her contentions, but some of the references are a handful of papers quoted multiple times.
Some of the supplements that she describes are DHEA, Co-enzyme Q10 and melatonin. She even describes a few substances that may be harmful. She emphasizes that a high sugar, high-refined carbohydrate diet may be toxic to eggs because of resulting increases in insulin which may increase testosterone levels, and testosterone may be bad for eggs. While the arguments sound reasonable on the surface, the real mechanisms are probably much more complex. Some "theories" defy logic or are competitive in their reasoning. For instance, one of the theories behind using DHEA as a supplement is that it raises male hormone levels, such as testosterone, and that this may be good for eggs.
The author also discusses dietary issues such as the optimal types of foods for fertility. The "Mediterranean" diet with vegetables, lean meats, healthy oils, and fish is considered an excellent diet for overall health and may improve fertility. She also discusses some of the limited data on negative effects on alcohol and caffeine on IVF outcomes and miscarriage rates. She also discusses pre-natal vitamins and the roles of vitamins in health and fertility. Again, extensive scientific references are given.
There is also a chapter on sperm and its contribution to embryo quality. She discusses the scientific literature on anti-oxidants and sperm which is, at this point, fairly extensive.
She states: "The proportion of eggs with chromosomal abnormalities can be influenced by nutrients and lifestyle factors you can control." Unfortunately, the scientific studies to back up this statement are often problematic in their methodology. So the scientific evidence that we can control the chromosomal makeup of eggs is very incomplete and preliminary. It is a well-known fact for instance, that female age is the number one predictor of the percentage of eggs that have normal chromosomes. And the only control we have over that is to get pregnant at a younger age or freeze eggs for later use.
The book also describes Comprehensive Chromosomal Screening (CCS) of embryos, which allows us to determine which embryos have normal chromosomes before embryo transfer. As we now know, IVF with CCS substantially improves the rates of embryo implantation and reduces risks of miscarriage and chromosomal abnormalities such as Down Syndrome. This is definitely useful information that is explained in accessible language.
Overall, I think this book is interesting and easy to read. It has a lot of good, common sense advice that can result in improved overall health. Whether or not everything she suggests will turn out to be truly advantageous when it comes to egg quality and fertility will have to be seen as more studies and better studies are performed. In the end, I do recommend that fertility patients read this book.
-Carolyn Givens, M.D.