Dr. Shannon Sinsheimer, ND

 

Subheadline

A clinical review of mitochondrial dysfunction, oxidative stress, and evidence-informed nutritional strategies to support oocyte maturation, embryo quality, and successful conception in advanced reproductive age.

 

Short Description

This article explores the impact of age-related mitochondrial decline, oxidative stress, and environmental influences on oocyte quality and fertility outcomes in women over 37. Through case-based clinical application, it highlights integrative strategies—including targeted antioxidants, hormonal optimization, detoxification support, and lifestyle interventions—to improve reproductive potential.

 

Introduction

At age 37 and beyond, oocyte quality declines, impairing the ability to achieve and sustain a full-term pregnancy. Age-related mitochondrial dysfunction, together with external factors such as maternal nutrition, environmental toxicant exposures, and epigenetic influences, further contributes to reduced oocyte maturation and declining fertility rates. Clinical case presentations highlight individualized protocols designed to optimize mitochondrial function, with the potential to improve conception and live birth rates. However, certain clinically studied nutrients can be incorporated into a fertility optimization protocol regardless of — or even before obtaining — specific laboratory values.

 

A female patient presenting at age 37 or older with the goal of achieving a full-term pregnancy and live birth requires initial laboratory assessments to guide targeted nutritional, antioxidant, and herbal therapies. Evaluation of female hormone levels, together with a functional nutritional blood assay that includes key antioxidant markers, provides individualized insight into specific antioxidant dysfunctions and metabolic imbalances that may affect fertility.  This personalized approach helps avoid unnecessary over-supplementation while supporting therapies tailored to the patient’s specific physiological needs. However, a foundational protocol applicable across most cases may include antioxidant, herbal, and nutritional therapies that have been extensively studied for their potential to support oocyte quality, promote maturation, and improve overall fertility outcomes.

 

Case #1:

 

A 37-year-old female G0P0 with 39-year-old male partner presents to clinic following 3 visits with a reproductive specialist who declined continued treatment due to 1 egg retrieval over 3 attempts, <6mm uterine lining, low AMH levels, lack of single embryo development and low oocyte count on pelvic ultrasound.

 

She has a moderate body composition with daily supplementation of EPA/DHA fish oil blend, choline, basic multi-nutrient blend, vitamin D 1000iu, L-carnitine 500mg, beef liver capsules and levothyroxine 25mcg x10 years. She has a generally healthy lifestyle and dietary habits.

 

The female patient began a 21-day structured detox protocol involving targeted detoxification supplements, reduced hormone-disrupting toxicants in household and personal care products and completed a nutrient laboratory assay and day 3 menstrual cycle lab work. She incorporated organic sweet potatoes three times per week, increased organic greens to four cups daily, began drinking one cup each of organic green tea and red raspberry leaf tea per day, eliminated red meat and beef liver capsules, and started Epsom salt baths three times per week.

 

Lab Results:

 

AMH	0.439	TSH	1.7
Estradiol	963	Free T3	2.3
Progesterone	27.4	Free T4	1.07
FSH	<0.3	Vitamin D	33

 

*Nutritional Assay results with deficiencies in glutathione, carnitine, vitamin B2, vitamin A, and selenium.

 

Treatment Protocol:

 

Armour Thyroid 30 mg	Prenatal vitamins with folate
Vitamin D3/K2  5000iu QD	Herbal preconception blend
Acetyl-L-Carnitine 500mg TID	Cortisol regulation blend
Ubiquinol 250 mg BID	Liposomal Glutathione 100mg QD
Selenium 200 mcg BID	Vitamin A 2500 iu QD

                    *Discontinue Levothyroxine 25mcg

 

The patient was counseled that the above healthy history including unsuccessful attempts at egg retrieval for IVF and current hormonal lab values post reproductive treatments had challenges but were not unachievable obstacles. Specifically, success was possible if detox pathways, nutrient protocols with targeted antioxidants, and a reduction in environmental exposures with cortisol regulating habits was enacted. 

 

After 2 months on the above protocol, the patient achieved a successful pregnancy naturally and carried to full term with healthy delivery. The mom and child continue to thrive with acknowledgment that the above multi-faceted protocol led to a successful gestation from improved egg, uterine, and hormonal balance.

 

Case #2:

 

A 39-year-old female, G1P2, with a 42-year-old male partner, presents to the clinic with a history of successful natural conception and pregnancy 7 yrs ago, now experiencing difficulty achieving a second full term conception. She achieved pregnancy 4 years ago with miscarriage at 6 weeks from undetermined causes. 

 

She has a moderate body composition with excess stress from the workplace. She has supplemented on and off with prenatal multi-nutrients and occasional additions to her supplement plan such as vitamins C and D. She has attempts at healthy daily nutrition but can default to processed or packaged foods for convenience. Sleep schedule and lifestyle habits are moderate. Patient has a regular menstrual cycle and regular intercourse without achieving pregnancy since birth of her first. She has not sought any other interventions to improve fertility until this time. 

 

Patient began with basic lab testing on day 3 of cycle and supplementation to improve pelvic circulation to enhance a healthy uterine lining, hormone balance, and oocyte quality and maturation. She was counseled to focus on a fresh, whole foods diet with organic options when possible.

 

Lab Results:

AMH	1.8	TSH	0.8
Estradiol	62	Free T3	2.8
Progesterone	0.5	Free T4	1.2
FSH	6	LH	8

 

Treatment Protocol:

 

Chaste tree berry 500 mg QD	Prenatal vitamins with folate TID
Melatonin 3 mg QPM	Herbal preconception blend BID
Shatavari 500 mg QD	Cortisol regulation blend QPM
Ubiquinol 250 mg BID	Anti-inflammatory protein blend with turmeric
DHEA 25 mg QD	NAD Injection 50 mg QWK

 

The patient chose to begin on the above protocol without retesting or beginning other treatments or interventions for 3 continuous months. At 6 months without further treatment, the patient had achieved a successful pregnancy. She carried the pregnancy to term with the healthy birth of her second child. She, her partner, and both her children continue to flourish in good health. 

 

Case studies demonstrate how protocols are individualized according to findings identified during intake, laboratory evaluation, physical examination, and anticipated patient compliance, as not all patients are willing or able to implement extensive supplementation or dietary modifications. Clinical research has identified several nutrients that support mitochondrial function, a key underlying factor associated with age-related decline in oocyte maturation in women over 37 years of age. Mitochondrial dysfunction in this population is associated with slower follicular development, fewer mature oocytes, and reduced rates of successful pregnancy. A targeted antioxidant protocol may help optimize mitochondrial function, thereby supporting improved oocyte quality, maturation, and overall reproductive potential.

 

Potential Antioxidant Therapies for Oocyte Maturation:

Supplement	Dose	Citation
CoQ 10 as Ubiquinone	250mg BID after meals	1, 2, 3
Acetyl-l- Carnitine	500mg BID after meals	4, 5
Melatonin	5mg at QPM	6,7
PQQ	20mg QD	8
NAD	250mg QD or 50mg IM QWK	9
*Exosome Therapy	1-4 treatments	10
*PRP Ovarian Rejuvenation	1 treatment	11

*Therapies under review for potential to improve oocyte quality in >37yo females

 

There are multiple fertility-support protocols available for females over 37 years of age, including foundational nutrients, folate, vitamin D, omega-3 fatty acids, and herbal hormone-balancing formulas. However, the specific nutrients outlined above are supported by clinical evidence demonstrating their broad applicability in this patient population and their potential to promote positive health outcomes. The goal is always to develop a comprehensive, individualized treatment plan that addresses the patient’s unique needs. In these cases, incorporating well-studied antioxidants may be a valuable addition to support mitochondrial function and reduce oxidative stress.

 

References:

1. Ben-Meir A, Burstein E, Borrego-Alvarez A, et al. Coenzyme Q10 restores oocyte mitochondrial function and fertility during reproductive aging. Aging Cell. 2015;14(5):887-895. doi:10.1111/acel.12368
2. Shang Y, Song N, He R, Wu M. Antioxidants and Fertility in Women with Ovarian Aging: A Systematic Review and Meta-Analysis. Adv Nutr. 2024;15(8):100273. doi:10.1016/j.advnut.2024.100273
3. Xu Y, Nisenblat V, Lu C, et al. Pretreatment with coenzyme Q10 improves ovarian response and embryo quality in low-prognosis young women with decreased ovarian reserve: a randomized controlled trial. Reprod Biol Endocrinol. 2018;16(1):29. Published 2018 Mar 27. doi:10.1186/s12958-018-0343-0
4. Agarwal A, Sengupta P, Durairajanayagam D. Role of L-carnitine in female infertility. Reprod Biol Endocrinol. 2018;16(1):5. Published 2018 Jan 26. doi:10.1186/s12958-018-0323-4
5. Li J, Liu L, Weng J, Yin TL, Yang J, Feng HL. Biological roles of l-carnitine in oocyte and early embryo development. Mol Reprod Dev. 2021;88(10):673-685. doi:10.1002/mrd.23542
6. Zhang H, Li C, Wen D, et al. Melatonin improves the quality of maternally aged oocytes by maintaining intercellular communication and antioxidant metabolite supply. Redox Biol. 2022;49:102215. doi:10.1016/j.redox.2021.102215
7. Zhang M, Dai X, Lu Y, et al. Melatonin protects oocyte quality from Bisphenol A-induced deterioration in the mouse. J Pineal Res. 2017;62(3):10.1111/jpi.12396. doi:10.1111/jpi.12396
8. Zhang K, Xu R, Ma J, et al. Pyrroloquinoline-quinone supplementation restores ovarian function and oocyte quality in a mouse model of advanced maternal age†. Biol Reprod. 2025;112(2):346-360. doi:10.1093/biolre/ioae174
9. Bertoldo MJ, Listijono DR, Ho WJ, et al. NAD+ Repletion Rescues Female Fertility during Reproductive Aging. Cell Rep. 2020;30(6):1670-1681.e7. doi:10.1016/j.celrep.2020.01.058
10. Lin J, Wang Z, Huang J, et al. Microenvironment-Protected Exosome-Hydrogel for Facilitating Endometrial Regeneration, Fertility Restoration, and Live Birth of Offspring. Small. 2021;17(11):e2007235. doi:10.1002/smll.202007235
11. Molinaro P, Ballester A, Garcia-Velasco JA, Muñoz M, Herraiz S. Impact of bilateral intraovarian platelet-rich plasma in women with poor ovarian response or primary ovarian insufficiency: a retrospective study. Fertil Steril. 2025;124(3):496-505. doi:10.1016/j.fertnstert.2025.05.143

 

Bio:

Shannon Sinsheimer, ND is a California-licensed naturopathic doctor and Medical Director of Optimal Health Center, which she founded as the first naturopathic medical clinic serving California’s Coachella Valley. For more than 18 years, she has provided integrative, patient-centered care with a reputation for clinical excellence, integrity, and compassionate service.

Dr. Sinsheimer earned her Doctor of Naturopathic Medicine degree with honors from the National University of Natural Medicine (NUNM) in Portland, Oregon. Her postgraduate training included advanced coursework and clinical experience at the Homeopathic Medical College in Mumbai, India, research participation with the Oregon Collaborative for Complementary and Alternative Medicine (ORCCAMIND) at Oregon Health & Science University, and a year-long internship at the Center for Natural Medicine with a focus on cardiopulmonary health and endocrine disorders.

In addition to her clinical practice, Dr. Sinsheimer is an educator, writer, and media contributor. She served as creator and production coordinator for a six-part PBS documentary series on naturopathic medicine, has authored articles for medical publications, and is a frequent guest on podcasts and educational media programs.

Her clinical approach emphasizes individualized care, utilizing lifestyle medicine, nutrition, botanical medicine, homeopathy, and targeted supplementation to help patients achieve optimal health and wellness.