Fertility made simple

After having written quite a few blogs on the subject of fertility and read quite a bit about it, especially on the internet, I am struck by how few articles give easy-to-understand and succinct explanations on the most important factors in fertility. So, here’s a primer on both male and female fertility.

What is most important for male fertility?

Sperm quantity and sperm quality

Many people might assume this is an obvious question — the answer, of course, being sperm.
But let’s be precise: we’re asking about the most important factor in male fertility, not just any contributing factor. And the answer is clear — it is the quantity and quality of sperm.

This is not to dismiss other causes of male infertility, such as erectile dysfunction or retrograde ejaculation. However, these are less common and less decisive compared to problems with sperm production or function.

In fact, issues like erectile dysfunction or retrograde ejaculation can often be bypassed by retrieving sperm directly from the testes and using IVF. But if the sperm itself is of poor quality — low count, poor motility, or high DNA fragmentation — then even IVF may not succeed.

What is most important for female fertility?

Egg quality

The scientific literature, common sense, and over 20 years of our clinical experience all point to one conclusion:
While many factors influence female fertility, the most important and decisive factor is egg quality.

It’s not difficult to see why. A baby results from the union of a sperm and an egg. In natural conception, millions of sperm are ejaculated into the female reproductive tract during ovulation, hoping to fertilize the single egg released that month.

On the male side, both sperm quantity and quality matter. On the female side, however, despite widespread belief, egg quantity (or "egg reserve") is not a limiting factor in natural conception, unless we're talking about IVF — more on that in a moment.

In natural conception, only one egg is released, and whether or not pregnancy occurs largely depends on the quality of that one egg. If the egg is healthy and meets a competent sperm, conception is likely.

In IVF, egg quantity becomes relevant because multiple eggs must be retrieved to increase the chances of fertilization and embryo development. Even so, only a few eggs typically lead to viable embryos, and often just one or two are suitable for transfer. In most failed IVF cycles, poor egg quality is cited as a primary cause, not a lack of eggs.

In short, whether in natural conception or IVF, egg quality is the most critical determinant of success.

What impacts egg quality?

Research shows that there are four major factors that influence egg quality:

1. Genetic integrity – This determines the health and structure of the chromosomes within the egg.
2. Mitochondrial function – Mitochondria produce the energy (ATP) required for the egg’s development, especially during maturation and early embryo formation.
3. Hormonal balance – Hormones regulate the process of folliculogenesis, the development of the follicle, which culminates in ovulation and the release of a mature egg.
4. Inflammation – Or rather, the lack of it. A low-inflammatory environment supports healthy follicle and oocyte development.

While all four are important, only hormonal balance can be readily assessed through clinical tests. Hormones such as FSH, LH, oestradiol, progesterone, and AMH can provide measurable insight into ovarian function and response to treatment.

The other three factors — genetic integrity, mitochondrial function, and inflammation — are not directly measurable in most clinical settings. Any improvements in these areas are typically inferred indirectly, either through improved hormone profiles or through personal changes: more stable energy, better sleep, less pain, and more regular menstrual cycles.

How can egg quality be improved?

At TCM Healthcare, we support patients in improving the key factors that influence egg quality — genetic integrity, mitochondrial function, hormonal balance, and inflammation — through the use of traditional herbal medicine.

Our approach is rooted in Traditional Chinese Medicine (TCM), which takes a holistic view of the human body, distinct from the framework used in Western medicine. Rather than focusing on isolated symptoms or lab values, TCM aims to restore harmony by improving the function of interconnected organ systems and balancing the body’s internal energy flow, or Qi.

We begin by reviewing patients’ hormone test results. In our clinical experience, the vast majority show signs of hormonal imbalance, many of which have been overlooked or untreated, particularly when the primary focus is IVF rather than restoring natural function.

In addition to lab data, we take a detailed clinical history, with particular attention to the menstrual cycle — including cycle regularity, period pain, flow, energy levels, sleep patterns, and stress. These subjective markers give us valuable insight into overall reproductive health and hormonal rhythm.

After several months of treatment, we encourage patients to repeat hormone tests and reflect on their changes — both biochemically and experientially. Many report more regular cycles, improved energy and sleep, and reduced period pain — changes that are often accompanied by measurable improvement in hormone profiles.

These improvements suggest better egg quality, and many of these patients have gone on to conceive naturally or with minimal medical intervention. You can read patient reviews on our website describing these outcomes in their own words.

You may also find other blogs on the website useful. Happy reading!