NMN and Egg Retrieval
Current evidence-based guidelines for egg retrieval do not include NMN supplementation, and no established medical societies recommend its use for women undergoing IVF cycles. 1
Guideline-Based Recommendations
The standard approach to egg retrieval should follow established protocols without NMN supplementation. The American College of Obstetricians and Gynecologists and American Society for Reproductive Medicine recommend controlled ovarian stimulation with gonadotropins as the gold standard for IVF and fertility preservation, with no mention of NAD+ or NMN supplementation. 1
Evidence-Based Protocols to Follow
Use controlled ovarian stimulation with gonadotropins starting on cycle day 2-3 with recombinant FSH at 150-225 IU daily, adjusted for age and ovarian reserve. 2
Implement GnRH antagonist protocols starting on day 5-6 of stimulation to prevent premature progesterone rise, particularly beneficial in egg donor cycles. 3
Trigger ovulation with hCG after adequate follicular maturation, with oocyte retrieval performed 36-38 hours later via transvaginal ultrasound-guided follicle aspiration. 2
What the Research Shows About NMN
While animal studies suggest potential benefits, the evidence for NMN in humans undergoing egg retrieval is insufficient to recommend its use. Two preclinical studies in aged mice showed that NMN supplementation increased NAD+ levels, improved oocyte quality, enhanced meiotic competency, and restored fertility. 4, 5 However, these are animal models that cannot be directly extrapolated to human clinical practice.
A 2024 umbrella review of nutrient supplements for female infertility found that the available evidence is insufficient to recommend nutrient supplementation to improve fertility outcomes in women trying to conceive naturally or utilizing assisted reproduction. 6 This review specifically noted that while various supplements showed some promise, all had very low certainty evidence. 6
Critical Pitfalls to Avoid
Do not delay evidence-based fertility treatments in favor of unproven therapies like NMN, as this may reduce conception chances, especially for women of advanced maternal age where time is critical. 1
Do not substitute experimental supplements for guideline-recommended interventions such as appropriate anticoagulation in antiphospholipid syndrome patients (prophylactic LMWH during ovarian stimulation, withheld 24-36 hours before retrieval). 7, 2
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
Special Considerations for Specific Populations
For patients with antiphospholipid antibodies: Use prophylactic anticoagulation with low molecular weight heparin (enoxaparin 40 mg daily) starting at the beginning of ovarian stimulation, withheld 24-36 hours prior to oocyte retrieval, and resumed following retrieval. 7, 2
For patients at high risk of ovarian hyperstimulation syndrome: Consider ovarian stimulation protocols incorporating aromatase inhibitors, which yield lower peak serum estrogen levels. 7, 3
For patients with diminished ovarian reserve: Consider alternative protocols such as minimal stimulation, natural cycle, or in vitro maturation rather than experimental supplements. 1
What Actually Improves Outcomes
Focus on modifiable lifestyle factors with established evidence: tobacco cessation and alcohol reduction have documented negative impacts on fertility. 1 These interventions have stronger evidence than any supplement currently available.