NAD+ Supplementation and Egg Retrieval
There are no established clinical guidelines recommending NAD+ supplementation for women undergoing egg retrieval, and current evidence-based fertility preservation protocols do not include NAD+ or its precursors as standard therapy.
Current Guideline-Based Approach to Egg Retrieval
The established protocols for optimizing egg retrieval outcomes focus on:
Controlled ovarian stimulation with gonadotropins remains the gold standard approach for routine fertility preservation and IVF, with no mention of NAD+ supplementation in current American Society for Reproductive Medicine or American College of Obstetricians and Gynecologists guidelines 1
Random-start stimulation protocols can be initiated at any point in the menstrual cycle and completed rapidly within 2 weeks when time-sensitive, representing the evidence-based approach to fertility preservation 1
For patients with specific medical conditions (such as antiphospholipid syndrome), appropriate antithrombotic treatment with low-dose aspirin and/or LMWH is recommended during ovarian stimulation and egg retrieval, not NAD+ supplementation 2, 3
Research Evidence on NAD+ (Not Yet Guideline-Supported)
While animal studies show promise, these findings have not been translated into clinical practice guidelines:
Preclinical mouse studies demonstrate that NAD+ precursors (NMN and NR) can improve oocyte quality in aged animals by restoring mitochondrial function, reducing oxidative stress, and improving spindle/chromosome structure 4, 5, 6
NMN supplementation in aged mice increased ovulation rates, improved meiotic competency, and enhanced fertilization ability through restoration of NAD+ levels that decline with reproductive aging 5
Nicotinamide riboside (NR) supplementation in aging mice increased follicle numbers, ovulatory potential, and live birth rates while improving mitochondrial membrane potential and reducing reactive oxygen species 6
Critical Limitations and Clinical Reality
The gap between animal research and human clinical application is substantial:
No human clinical trials have established safety, efficacy, or appropriate dosing of NAD+ precursors for women undergoing egg retrieval 4, 5, 6
The American College of Rheumatology and EULAR guidelines for reproductive health make no mention of NAD+ supplementation in their comprehensive recommendations for assisted reproduction 2
Evidence-based multinutrient supplementation studies have focused on folic acid, selenium, vitamin E, omega-3 fatty acids, and antioxidants—not NAD+ precursors 7
Recommended Clinical Approach
Focus on proven interventions rather than experimental supplements:
Optimize timing of egg retrieval using evidence-based ovarian stimulation protocols tailored to the patient's age, ovarian reserve (AMH, FSH), and medical conditions 1
For patients with diminished ovarian reserve, consider alternative protocols such as minimal stimulation, natural cycle, or in vitro maturation (IVM), which achieves 59.7% oocyte maturation rates with comparable outcomes 1
Address modifiable lifestyle factors including tobacco cessation and alcohol reduction, which have established negative impacts on fertility 2
For patients requiring cyclophosphamide therapy, use GnRH agonist co-therapy for fertility preservation, which has demonstrated efficacy (RR 0.12 for preventing premature ovarian failure) 2
Common Pitfalls to Avoid
Do not delay evidence-based fertility treatments in favor of unproven therapies, as this may reduce conception chances, especially for women of advanced maternal age 1
Do not substitute experimental supplements for guideline-recommended interventions such as appropriate anticoagulation in antiphospholipid syndrome patients or GnRH agonists for chemotherapy patients 2, 3
Recognize that age is the most significant factor in oocyte quality, and no supplement has been proven to reverse age-related decline in human fertility 1