It Starts with the Egg

What if the secret to improving your fertility lay not in medical miracles, but in your everyday choices — the food you eat, the supplements you take, and even the plastic containers in your kitchen? In It Starts with the Egg, molecular biologist Rebecca Fett argues that the quality of a woman’s eggs — once thought to be beyond her control — can, in fact, be improved through scientifically guided lifestyle changes. She presents a comprehensive, research-backed plan showing that women can reclaim their fertility by protecting and nurturing their eggs during the critical months before ovulation.

Challenging the Fertility Myth

For decades, women have been told that egg quality declines inevitably with age — that biology sets an unchangeable timer on their fertility. Fett dismantles this fatalism using evidence from hundreds of peer-reviewed studies. Drawing from her background in molecular biology and biochemistry, she explains that most chromosomal abnormalities in eggs don’t accumulate over a woman’s lifetime but develop during the final three to four months before ovulation. That’s the window of opportunity in which external factors like toxins, oxidative stress, and nutrient levels can either damage or protect eggs.

When Fett herself faced a fertility diagnosis — diminished ovarian reserve before age 30 — doctors offered little more than aggressive hormone protocols. Instead, she turned to scientific research and found actionable ways to restore her egg health. Her personal experience anchors her argument: with targeted interventions, she improved her ovarian response, producing a record number of high-quality embryos in a single IVF cycle. The message is empowering — biology isn’t destiny; knowledge is.

The Quiet Revolution in Fertility Science

The book opens a window into what Fett calls a “quiet revolution” in reproductive science. Researchers have discovered that energy production in mitochondria — the cell’s powerhouses — directly determines whether an egg matures with the right chromosomes. This makes mitochondrial health a central focus, influenced by factors like Coenzyme Q10, antioxidants, and insulin sensitivity. Rather than accepting age-related decline, understanding how to protect these energy systems allows women to extend and enrich their fertility potential.

Equally revolutionary is the evidence linking environmental toxins to poor egg quality. Everyday compounds such as BPA, phthalates, and endocrine disruptors in plastics and cosmetics can sabotage hormone balance and embryo viability. Fett translates laboratory findings—like those from Harvard’s School of Public Health and the University of Missouri—into practical, easy-to-follow steps for removing these toxins from one’s environment. This research-driven guidance helps transform confusion into clarity, replacing fear with agency.

A Blueprint for Change

Fett organizes her book into three major parts that function as an evidence-based roadmap to conception. The first, “What Your Doctor Isn’t Telling You,” introduces the biological basics of egg quality and the hidden dangers of toxins. The second, “How to Choose the Right Supplements,” is a masterclass in fertility nutrition, covering prenatal vitamins, CoQ10, melatonin, myo-inositol, and DHEA. She summarizes which supplements improve egg health, which are harmful, and which help under specific conditions like PCOS or diminished ovarian reserve. The final section, “The Bigger Picture,” zooms out to address diet, sperm health, and a step-by-step fertility action plan.

One of Fett’s key innovations is her system of Basic, Intermediate, and Advanced Plans. These flexible programs guide readers depending on their fertility stage and specific challenges — from those just starting to try conceiving, to those facing IVF or recurrent miscarriage. This structure makes the complex science highly practical, turning the daunting task of improving fertility into manageable daily actions.

Why It Matters: The Intersection of Science and Empowerment

Fett’s book isn’t just about biology; it’s about empowerment. For countless women frustrated by the vague reassurance of “just relax” or the cold precision of IVF statistics, It Starts with the Egg offers a middle ground — one where cutting-edge science meets self-care. By bridging academic research and accessible guidance, Fett gives women tools to take measurable control of their reproductive health.

Her message resonates beyond fertility treatments. The same mechanisms that protect egg DNA from damage also promote longevity, hormonal balance, and metabolic health. Improving egg quality, in Fett’s view, is about optimizing the foundation of life itself — the quality of the genetic material we pass on. Whether you’re preparing for pregnancy, facing unexplained infertility, or simply want to future-proof your reproductive health, her framework applies to every stage.

A Science-Backed Path to Hope

Ultimately, It Starts with the Egg transforms fertility from a matter of luck into a process of intentional preparation. Fett encourages women to think of themselves as “pre-pregnant” for at least three months before conception, using that window to nurture their eggs. With her combination of scientific precision and compassion, she reframes fertility not as a biological cliff, but as a system responsive to care, knowledge, and persistence. As she writes, the miracle of life doesn’t just start at conception—it starts months earlier, with the health of the egg.

Fett begins by explaining that egg quality—the egg’s potential to become a viable embryo—is the single most important factor in female fertility. In contrast to popular focus on ovulation timing, she shows that the ability of an egg to produce a chromosomally normal embryo determines whether fertilization, implantation, and pregnancy will succeed.

The Role of Chromosomal Abnormalities

Most failed IVF cycles and early miscarriages stem from eggs with chromosomal abnormalities, or aneuploidy. Fett cites studies showing that up to 70% of embryos fail to implant or miscarry due to these errors. The mistake usually happens during meiosis—the cell division process where an egg halves its chromosomes. Surprisingly, these errors occur not gradually over decades but in the final months of egg maturation.

The implication is revolutionary: by improving the conditions during this key developmental window, women can reduce chromosomal mistakes. Advanced embryo-screening technology, Fett notes, demonstrates that selecting chromosomally normal embryos can double success rates in women over 40—proof that egg quality changes outcomes more than age alone.

Energy Production and the Mitochondrial Connection

Each egg contains over 15,000 mitochondria—ten times more than any other cell type. These structures generate ATP, the energy currency that cells need to divide and mature correctly. However, as women age or face oxidative stress, mitochondrial damage limits energy production. Fett draws on Dr. Robert Casper’s metaphor: the aging ovary is like a flashlight with dead batteries. Recharging those “batteries” through CoQ10 and antioxidants becomes a central fertility strategy.

Fett’s explanation connects cellular biology directly to hope: energy deficits, not permanent genetic decline, are the main issue. Boosting mitochondrial health, therefore, can restore the egg’s ability to separate chromosomes correctly and sustain early embryo development.

Why This Matters for Every Woman

Even younger women ovulate a proportion of abnormal eggs—often up to 25%. Thus, improving egg quality isn’t only for those undergoing IVF or nearing 40; it benefits anyone hoping to conceive efficiently and reduce miscarriage risks. The takeaway, Fett stresses, is proactive preparation: what you do in the months before ovulation can determine whether your next egg is capable of becoming a healthy baby.

After establishing that egg health is malleable, Fett focuses on the external threats undermining it—chief among them BPA and phthalates. These ubiquitous chemicals interfere with hormonal signals and damage eggs at the cellular level. Her message: small lifestyle adjustments can drastically cut exposure and improve your reproductive environment.

The BPA Crisis

Bisphenol A (BPA), found in many plastics and can linings, mimics estrogen and disrupts endocrine function. Fett recounts Dr. Patricia Hunt’s accidental 1998 discovery: when BPA leached from lab equipment, chromosomal errors in mouse eggs skyrocketed from 2% to 40%. Follow-up human studies by Harvard and UCSF confirmed that women with higher BPA levels produced fewer eggs and embryos during IVF, with twice the risk of implantation failure.

Fett explains practical steps: replace plastic with glass or stainless steel, avoid canned foods unless labeled BPA-free, refuse receipts when possible, and never microwave plastic containers. These small actions lower BPA in the body within days—a striking example of control over one’s fertility environment.

Phthalates, Fragrance, and Fertility

Phthalates—chemicals that soften plastic and prolong fragrance—pose another invisible threat. They appear in cosmetics, nail polish, vinyl, and even air fresheners. Fett cites Dr. Shanna Swan’s studies linking maternal phthalate exposure to altered hormone levels and reduced fertility. For women attempting conception, phthalates can disrupt estrogen production, inhibit follicle growth, and increase oxidative stress inside the ovaries.

Her detox strategy starts in the bathroom: switch to fragrance-free products, avoid nail polish during preconception, and choose natural cleaners like Seventh Generation or The Honest Company. Even such simple changes can halve phthalate levels within weeks, safeguarding both eggs and future pregnancies.

One of the book’s most practical sections deals with targeted supplementation. Fett separates science from hype, showing which compounds are truly effective in boosting egg quality. Her framework is built on research-grade evidence—not marketing claims—and offers a tailored approach to different fertility contexts.

Foundations: Prenatal Multivitamins

Every fertility plan begins with a robust prenatal containing folate, B12, B6, zinc, iodine, and selenium. Fett revisits the historic folic acid story: decades passed between studies showing its power to prevent neural tube defects and public acceptance. She warns against repeating that delay when it comes to egg-quality nutrition. Folate is not only vital for fetal development but also for proper DNA replication in eggs. Women with MTHFR gene variants, common in up to 40% of the population, should consider methyl-folate rather than synthetic folic acid to ensure absorption.

Repowering the Egg: Coenzyme Q10

CoQ10 stands at the heart of Fett’s supplement discussion. It fuels the mitochondria’s ability to produce ATP, which eggs need for chromosome division. Clinical studies on older IVF patients show that CoQ10 supplementation increases the number of mature eggs and viable embryos. Fett recommends 100–300mg of the active form, ubiquinol, taken with food for optimal absorption. It’s particularly helpful for women over 35 or those with diminished ovarian reserve.

Antioxidants and Hormone Support

Beyond CoQ10, Fett highlights antioxidants like vitamin E, vitamin C, alpha-lipoic acid, and melatonin. In IVF settings, melatonin has been shown to halve oxidative stress in follicles and nearly double fertilization rates—although she cautions against its use for women conceiving naturally because it can disrupt ovulation cycles. For women with PCOS or insulin resistance, she recommends myo-inositol, which restores ovulation and may prevent gestational diabetes. And for those facing severely low ovarian reserve, DHEA—a mild androgen precursor—can improve egg quantity and quality when used under medical supervision.

Even with clean habits and supplements, some hidden medical factors may still block conception. Fett shines a light on often-overlooked conditions—vitamin D deficiency, hypothyroidism, celiac disease, and gum inflammation—that quietly undermine fertility but are easily testable and treatable.

Vitamin D and Thyroid Health

Studies show women with adequate vitamin D levels during IVF are four times more likely to conceive. This vitamin influences hormone regulation and uterine receptivity. Similarly, an underactive thyroid or autoimmune thyroid antibodies (even with normal hormone levels) can double miscarriage risk. Fett urges women with recurrent loss or unexplained infertility to demand thyroid testing—including antibody screens—not just standard hormone panels.

Celiac Disease and Gum Health

Celiac disease, triggered by gluten, can silently interfere with nutrient absorption and raise miscarriage risks ninefold. In countries like Italy where screening is routine, fertility outcomes improve dramatically with a gluten-free diet. Fett also cites surprising evidence that untreated gum disease—present in up to 40% of women—can delay conception by two months and increase preterm birth risk. Regular dental care, she argues, is an underestimated fertility intervention.

If egg quality begins in the mitochondria, then food is the fuel that drives it. Fett dedicates an extensive chapter to crafting an egg-quality diet that stabilizes blood sugar, reduces oxidative stress, and supports hormonal balance. Her recommendations build on the Nurses’ Health Study and align closely with Mediterranean-style nutrition.

Balancing Blood Sugar

Refined carbohydrates—white bread, pastries, sugary beverages—spike insulin, which in turn disrupts ovarian hormone balance and triggers PCOS-like symptoms even in women without the condition. Fett emphasizes choosing slow-digesting, low-glycemic foods such as quinoa, lentils, and bran cereals. This stabilizes insulin, reduces androgen dominance, and boosts fertility hormones naturally.

Healthy Fats and Anti-Inflammation

Replacing trans fats with monounsaturated fats is vital for insulin sensitivity. She highlights olive oil, nuts, seeds, and avocados, along with omega-3-rich fish like salmon. These choices mirror the Mediterranean diet, which dramatically raises IVF success rates. The same omega-3 to omega-6 balance that reduces heart disease risk also protects ovarian function and embryo quality. Avoiding high-mercury fish and heavily processed oils completes the plan.

Alcohol, Caffeine, and Moderation

Although research is mixed, Fett recommends minimizing alcohol and caffeine—especially before IVF—to avoid subtle hormone disruptions and oxidative stress. A single glass of wine here and there is unlikely to harm fertility, but heavy consumption can lengthen time to conception and double miscarriage risk.

Her dietary philosophy is not about deprivation but optimization: feeding the mitochondria and stabilizing hormones for peak egg performance.

Fett dedicates a full section to a topic often ignored in fertility books: male reproductive health. Half of infertility cases involve sperm factors, and lifestyle changes can dramatically improve them. Just as eggs suffer oxidative damage, sperm DNA integrity declines with stress, age, and toxins.

Boosting Sperm Health

Men benefit from similar antioxidant regimens: vitamins C and E, selenium, zinc, folate, and CoQ10 improve sperm count, motility, and DNA stability. In clinical studies, antioxidant supplementation quadrupled conception rates and quintupled live birth rates. Fett also advises reducing alcohol, keeping cell phones out of pockets, avoiding heat exposure, and minimizing phthalate and BPA contact through non-plastic containers and fragrance-free products.

Shared Responsibility for Conception

By extending her research beyond women, Fett reframes fertility as a shared health project. When both partners optimize their cellular health, not only do embryo quality and pregnancy rates improve, but miscarriage rates decrease and long-term child health benefits follow. Fertility, she reminds readers, is a mirror of overall vitality for both sexes.

Fett concludes with structured, step-by-step plans tailored to each fertility challenge. These Basic, Intermediate, and Advanced Plans turn complex biochemistry into daily routines. The unifying theme: three months of preparation equals stronger, healthier eggs.

The Basic Plan

Ideal for women just starting their journey, this plan focuses on foundational practices: begin a prenatal multivitamin with 800mcg of folate, replace plastic food containers with glass, cut refined carbs, and add 100mg of CoQ10. Small shifts, Fett promises, make measurable cellular differences within weeks.

Intermediate and Advanced Plans

For women experiencing infertility, the Intermediate Plan includes higher CoQ10 doses, additional antioxidants, and screening for thyroid, celiac, and vitamin D deficiencies. The Advanced Plan, suited for IVF, recurrent miscarriage, or diminished ovarian reserve, adds DHEA, melatonin during IVF stimulation, and personalized adjustments based on age and diagnosis. Each plan emphasizes that consistency over three to four months aligns with the egg’s full maturation cycle, giving every measure time to work.

Fett closes by reframing fertility as an act of preparation, not desperation. When you care for your eggs as if already nurturing a future child, she writes, you embody both scientific wisdom and maternal instinct—transforming hope into probability.