Nicotinamide adenine dinucleotide (NAD+) is a naturally occurring metabolic cofactor in mammals that declines with age. Evidence suggests boosting NAD+ levels could improve egg quality and ovarian function (1,2,3,4). NAD+ is a large molecule and poorly absorbed through digestion, so injections or IV infusions are a preferred way to increase levels. Our team at Lily + Horn has collaborated with Reproductive Endocrinologists in New York City, as well as experienced physicians who have been using NAD+ for years, to create a dosage and protocol targeting ovarian function and egg quality.
People experiencing fertility struggles, especially women over 35 who have had poor outcomes with previous attempts to create healthy embryos, are great candidates for trying NAD+. We suggest an 12-week course, as this is the amount of time it takes for a follicle (containing an egg) to go through all stages of maturation before ovulation/retrieval. However, we have observed improvements in embryo quality after the 2 month mark at Lily + Horn. These 8-12 weeks are also a great time to optimize your diet and lifestyle and incorporate weekly acupuncture to have the greatest impact on improving body chemistry and impact egg quality. 60% of patients with previous poor embryo outcomes in IVF cycles produced more euploid (chromosomally healthy) embryos after 2 months of our protocol. Meta analysis of NAD+ studies suggest that while emerging evidence is ongoing for the effects of NAD+ on aging, fertility, and longevity, NAD+ supplementation is very likely safe (5).
NAD+ injections have been in use for years as an agent to slow aging, improve cellular health, and target degenerate disease processes. It is a cofactor for many metabolic reactions, helping cells produce energy optimally (6). It is also a co-substrate used in multiple pathways that repair DNA damage (7). Mammalian fertility studies have looked mostly at murine and porcine models, but clinically, we have witnessed successful improvement in patients' IVF outcomes enough that we are excited to offer access to NAD+. In our almost two decades of supporting women trying to conceive, we have seen that nothing can drastically change egg quality for everyone. It is more common that multiple factors such as changing diet, incorporating regular acupuncture, using targeted customized supplements, herbs, appropriate medications and procedures like IVF, etc. combine to change outcomes and improve live birth rates (8).
Dr. Nandini Yadav, MD, and Dr. Rebecca Summers, MD, administer NAD+ injections at Lily + Horn after an initial screening (which can be in-person or virtual). To learn more, contact us here.
1 Michael J. Bertoldo, Dave R. Listijono, et.al., NAD+ Repletion Rescues Female Fertility during Reproductive Aging. Cell Rep. 2020 Feb 11; 30(6): 1670–1681.e7
2 Lan Li, Xin Zhou, Wene Liu, Zhen Chen, Xiaoqin Xiao, Guiming Deng. Supplementation with NAD+ and its precursors: A rescue of female reproductive diseases. Biochemistry and Biophysics Reports. Volume 38, July 2024, 101715
3 Guo, Z., Yang, J., Yang, G. et al. Effects of nicotinamide on follicular development and the quality of oocytes. Reprod Biol Endocrinol 20, 70 (2022). https://doi.org/10.1186/s12958-022-00938-x
4 Liang, J., Huang, F., Song, Z. et al. Impact of NAD+ metabolism on ovarian aging. Immun Ageing 20, 70 (2023). https://doi.org/10.1186/s12979-023-00398-w
5 Radenkovic D, Reason, Verdin E. Clinical Evidence for Targeting NAD Therapeutically. Pharmaceuticals (Basel). 2020 Sep 15;13(9):247
6 Xie, N., Zhang, L., Gao, W. et al. NAD+ metabolism: pathophysiologic mechanisms and therapeutic potential. Sig Transduct Target Ther 5, 227 (2020). https://doi.org/10.1038/s41392-020-00311-7
7 Francisco Alejandro Lagunas-Rangel. Current role of mammalian sirtuins in DNA repair. DNA Repair. Volume 80, August 2019, Pages 85-92
8 Lee E Hullender Rubin, Michael S Opsahl, Klaus E Wiemer, Scott D Mist, Aaron B Caughey. Impact of whole systems traditional Chinese medicine on in-vitro fertilization outcomes. Reprod Biomed Online. 2015 Jun;30(6):602-12. Epub 2015 Feb 24