Ovarian health, Egg quality, and the Fertility journey

Fertility is one of those topics that most of us don't think about until we need to. But by then, time may already be working against us. In this episode of Her Body, Her Health, host Christine sits down with Dr. Chua, a fertility specialist, and Physician Yi Ting, a TCM practitioner, to unpack the science and wisdom behind ovarian health — and what women at every age can do to protect it.

The Two Things That Define Your Ovarian Health

According to Dr. Chua, ovarian health comes down to two distinct factors: quantity and quality — and they're not the same thing.

Quantity is measurable. It's assessed through Anti-Müllerian Hormone (AMH) blood tests and an Antral Follicle Count (AFC) via ultrasound. Dr. Chua recommends doing both, as each test can occasionally give an incomplete picture on its own.

Quality, however, is a different story. There is no blood test, no scan that can directly measure egg quality. The best proxies we have are age — quality is generally good in your twenties and early thirties, declines after 35, and drops significantly after 40 — and whether a woman has previously conceived, which at least confirms quality was sufficient at some point.

Other factors that affect both quantity and quality include a history of ovarian cysts or surgery, and family history of early menopause.

How TCM Reads Your Fertility

Physician Yi Ting's approach goes beyond lab results. While she also reviews AMH levels, TCM looks holistically at the entire menstrual cycle — its length, regularity, and the symptoms that accompany it.

One key pattern she watches for: as women age and AMH declines, menstrual cycles often shorten — from 28 days down to 24 or 26 — a sign that ovulation is happening earlier. From a TCM lens, this reflects kidney deficiency, which may also manifest as back aches, fatigue, and changes in cervical mucus.

The TCM model focuses on three organ systems governing fertility: the kidney, spleen, and liver. Treatment through herbs and acupuncture aims to address deficiencies in these systems while supporting hormonal balance.

Why So Many Women Are Caught Off Guard

"In our thirties, we are still feeling really healthy — at the peak of our physical prime. You cannot feel that your fertility is going down." — Dr. Chua

This is one of the most important takeaways from the episode: fertility decline is silent. It's not taught in schools, and it doesn't announce itself with symptoms. Dr. Chua regularly sees patients who were previously unaware of their low egg count — often learning about it only after struggling to conceive.

One particularly important tip: if you're considering ovarian cyst surgery (especially for endometriosis), get your AMH tested beforehand. Removing cysts inevitably damages surrounding egg tissue, and endometriosis cysts often recur — meaning each surgery further depletes the ovarian reserve. Knowing your baseline may change your decision-making entirely.

Egg Freezing: When Is the Right Time?

The ideal window for egg freezing is before 35, when both quantity and quality are at their best. Singapore's government-regulated upper age limit of 38 reflects this — beyond that point, egg quality diminishes enough to significantly impact success rates.

On the question of eggs versus embryos: embryos are hardier. Embryo survival rates post-thaw now sit at 95–99%, up dramatically from 60% a decade ago. Egg survival rates are around 80–90% — still good, but embryos remain more resilient. For women with low AMH, Dr. Chua recommends embryo banking first (collecting and freezing multiple embryos over several cycles) before attempting transfer.

Perimenopause: Earlier Than You Think

The average age of menopause is 51, but perimenopause — the transition period marked by rising FSH, irregular cycles, hot flashes, mood changes, and sleep disruption — can begin in the late forties, or even earlier for women with low AMH or a history of ovarian trauma.

Physician Yi Ting has seen perimenopausal symptoms in women in their thirties with significantly depleted ovarian reserves. In TCM, this is understood as a kidney yin deficiency causing excess internal heat — treated with herbal medicine and dietary recommendations including phytoestrogen-rich soy products to ease symptoms.

Cycle-Synced Support: Why Every Phase Matters

One of the most practical concepts from the episode is cycle support — the idea that different phases of your menstrual cycle call for different kinds of nourishment and treatment.

• Menstruation: Focus on replenishing blood and kidney energy to prepare follicles for healthy growth.

• Follicular phase: Support follicle development with nourishing herbs.

• Luteal phase: Boost kidney yang energy to support progesterone production and maintain a warm uterine environment.

Physician Yi Ting cautions against self-prescribing TCM supplements without guidance — timing matters, and the wrong herbs at the wrong phase can be counterproductive.

The Stress Factor — And What to Do About It

Both practitioners highlighted chronic stress as a significant but under-addressed driver of fertility decline. While cortisol testing isn't standard practice (and can sometimes amplify anxiety), TCM practitioners can identify stress patterns through pulse diagnosis and symptoms like anxiety, poor sleep, and work-related dreams.

Acupuncture — particularly on the head — is used to reduce nervous system tension and lower cortisol. Dr. Chua noted that Western fertility doctors are increasingly referring patients for acupuncture specifically for stress reduction, recognising what medicine alone can't fully address.

On the Horizon: What's Next for Egg Quality Research

Two exciting (though still early-stage) developments were discussed:

• Stem cell research: Scientists are exploring whether new egg cells can be grown from stem cells, potentially reversing ovarian aging. Still years from clinical application.

• Follicular fluid rejuvenation: Singapore researchers discovered that placing older eggs into the follicular fluid of younger women appears to reverse certain ageing effects — and vice versa. The fluid environment around an egg plays a critical role in its quality.

Busting the Myths

• "As long as I'm menstruating, I can get pregnant." True in theory, but the fertile window narrows dramatically with age. Having periods in your forties doesn't mean conceiving will be easy.

• "Fertility is only about AMH numbers." The number matters, but so does your environment — chronic stress, poor diet, chemical exposure, and lifestyle factors can accelerate decline even in younger women.

When Should You Start Paying Attention?

Both Dr. Chua and Physician Yi Ting agree: don't wait. Getting a preconception check — AMH, hormone profile, and a semen analysis for your partner — as early as when you're considering starting a family gives you time to act on what you find.

"Start early" doesn't mean panic — it means informed. Knowing your numbers, understanding your cycle, addressing stress and lifestyle, and working with practitioners across both Western and TCM modalities gives you the best possible foundation.