If you have PMOS (PCOS) and you are trying to conceive, or even just thinking about it, there is one book I come back to again and again. Not because it promises miracles. Because it does something more valuable: it explains why your biology works the way it does, and what the research actually says you can do about it.

It Starts With The Egg by Rebecca Fett is that book.

I first picked it up during a period when I was trying to make sense of my own PCOS diagnosis and what it meant for my fertility. When I came across Fett's work, something shifted. Not because it solved everything overnight. But because it gave me a framework, a way to understand what was happening in my body rather than just being handed another prescription and sent home.

This review is my honest take on the book, specifically through the lens of PMOS (PCOS) and fertility. What Fett gets right, what the research behind it actually shows, and why, over a decade later, it still belongs on your shelf.

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Who Is Rebecca Fett and Why Does Her Credibility Matter?

It Starts With The Egg is not written by a doctor. It is written by someone with a degree in molecular biotechnology and biochemistry who went through fertility struggles herself, and then did what scientists do: she dug into the research.

Fett was told in her late twenties that she had diminished ovarian reserve. Her first IVF cycle produced only a small number of viable embryos. Rather than accepting that as the ceiling, she spent months reviewing studies on egg quality, mitochondrial function, oxidative stress and supplementation, then applied what she found. Her next cycle produced 20 high-quality embryos, by her own account a dramatic improvement.

That is not marketing copy. It is a documented, self-reported outcome that prompted her to write the book, and it is worth being precise about: it is her account of her own cycle, not a controlled clinical trial. Individual results vary enormously, and no book can promise a specific outcome.

What makes the writing work is that she does not overclaim. She is careful with language. She distinguishes between strong evidence and emerging evidence. She explains mechanisms rather than just handing you a supplement list. For a sceptical audience, and let's be honest, most of us with PMOS (PCOS) are deeply sceptical after years of being fobbed off, that matters enormously.

You do not need a biochemistry degree to read it. But you will finish it feeling like you understand your own biology in a way your GP appointments probably never gave you.

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What the Book Covers (And What It Does Not)

The book spans three areas: environmental toxins and their impact on egg quality, nutritional and supplement strategies, and the specific considerations that differ depending on your situation, whether that is natural conception, IUI, or IVF.

For the purposes of this review, I am focusing specifically on what Fett recommends for women with PMOS (PCOS). That is where the book is most directly applicable to the MyOva community, and where the evidence she presents is some of the most compelling.

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BPA and Environmental Toxins: The Chapter Most Women Skip (Don't)

Before Fett gets to supplements, she spends significant time on environmental toxins, and the PMOS-specific research here stopped me cold.

BPA stands for Bisphenol A. It is an industrial chemical found in certain hard plastics, food can linings, thermal paper receipts, and more. It mimics oestrogen in the body, meaning it can disrupt hormonal signalling at a cellular level.

Research in mice has shown that BPA exposure can disrupt the chromosome alignment process during cell division, an effect known as meiotic aneuploidy [Hunt et al., Current Biology, 2003]. When chromosomes fail to separate correctly, eggs become aneuploid, meaning they carry the wrong number of chromosomes, which is one of the reasons embryos can fail to develop or implant. This is animal research, so it demonstrates a plausible mechanism rather than proving the same thing happens in the same way in humans.

Here is the part that is particularly relevant if you have PMOS (PCOS): research has found that women with PCOS have measurably higher circulating BPA levels than women without the condition [Kandaraki et al., Journal of Clinical Endocrinology & Metabolism, 2011]. The relationship appears bidirectional. BPA exposure may worsen insulin resistance and androgen levels, while the metabolic environment of PMOS may impair the body's ability to clear BPA efficiently.

Fett recommends reducing BPA exposure as a foundational step before anything else. Practically, that means:

• Replacing plastic food containers and bottles with glass or stainless steel
• Avoiding microwaving food in plastic
• Not handling thermal receipts where possible, or washing hands immediately after
• Choosing fresh or frozen produce over canned where possible

This is not about fear or a perfection checklist. Small, consistent swaps compound over three to six months, which is precisely the window that matters for egg maturation.

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The Three Supplements Fett Highlights for PMOS (PCOS)

This is the section I have returned to most often. Fett reviews the evidence behind dozens of supplements throughout the book, but three are specifically flagged as most relevant for women with PMOS (PCOS). All three are discussed in relation to the same underlying pathway: insulin sensitivity, which in turn is closely linked to ovulation and egg quality in PMOS.

Understanding why insulin matters so much in PMOS is essential context here.

Why Insulin Is at the Centre of PMOS (PCOS) Fertility Challenges

PMOS is frequently described as a hormonal condition, and it is, but the hormonal disruption is often downstream of a metabolic one. Elevated insulin levels signal the ovaries to produce more testosterone. That excess testosterone disrupts normal follicle development, interfering with regular ovulation and, over time, egg quality.

This is why the pill or progesterone-only approaches, while sometimes useful for managing symptoms, do not address the root cause for most women with PMOS. The insulin-ovary-androgen pathway keeps running in the background.

The supplements Fett examines are discussed in relation to this pathway.

Myo-Inositol: The Most Studied Supplement in PMOS (PCOS) Fertility

Myo-inositol is a naturally occurring compound in the body, a member of the B-vitamin family. Women with PMOS (PCOS) tend to have disrupted inositol signalling, which is thought to contribute to insulin resistance and impaired follicle maturation.

Fett is enthusiastic about the evidence here, and there is a genuine research base. But it is worth being precise about what the current, independently reviewed evidence actually shows, since some of the older individual trials in this space have since been retracted or come from researchers under active scrutiny for research misconduct. The most useful recent synthesis is a 2024 systematic review and meta-analysis conducted to inform the international evidence-based PCOS guidelines, which found the overall evidence for inositol supplementation in PCOS to be limited and inconclusive, with the clearest signal being a potential benefit from D-chiro-inositol specifically for ovulation, and no meaningful difference from metformin on reproductive outcomes [Fitz, Graca, Mahalingaiah et al., Journal of Clinical Endocrinology & Metabolism, 2024].

A separate, smaller double-blind trial found improvements in oocyte quality and fertilisation rates in women with PMOS undergoing IVF who took myo-inositol, alongside reduced testosterone and improved hormonal profile [Ciotta et al., European Review for Medical and Pharmacological Sciences, 2011]. It is worth noting this was a small trial (46 women), so it is one useful data point rather than definitive proof.

It is also worth flagging a related but distinct compound: one of the foundational trials often cited alongside myo-inositol actually tested D-chiro-inositol, a different inositol stereoisomer, and found improved insulin sensitivity and ovulation in women with PMOS [Nestler et al., New England Journal of Medicine, 1999]. The two compounds are related and sometimes discussed together, but they are not interchangeable, and it is easy to see how a supplement's evidence base gets overstated when the two are blurred together.

Put plainly: this is not a magic fix, and the strongest, most current review of the evidence is more cautious than some of the older trial literature suggests. But it remains one of the most researched compounds in this space, and the biological rationale, insulin signalling and follicle maturation, is sound. It takes approximately three months for an egg to complete its maturation cycle, a process called oogenesis. If you want supplementation to influence egg quality, you need to start at least three months before you intend to conceive. This is not about patience for its own sake. It is biology.

Alpha-Lipoic Acid: Antioxidant Support With a Mechanistic Rationale

Alpha-lipoic acid (ALA) is a potent antioxidant produced naturally in the mitochondria, the energy-producing structures inside each cell, including eggs. Fett explains that mitochondrial function is central to egg quality; eggs with healthy mitochondria have the energy they need to complete fertilisation and early embryo development correctly.

What makes ALA particularly relevant is a specific mechanism explored in foundational laboratory research: it appears to stimulate glucose uptake via GLUT4 translocation, with the p38 mitogen-activated protein kinase pathway implicated in that activation [Konrad et al., Diabetes, 2001]. This is mechanistic, cell-level research rather than a PMOS-specific clinical trial, so it explains a plausible route by which ALA could support insulin sensitivity rather than proving a specific fertility outcome in women with PMOS.

Oxidative stress is significantly elevated in women with PMOS (PCOS) compared to those without the condition [Murri et al., Human Reproduction Update, 2013], which is the broader rationale for antioxidant support, including ALA, in this population. Fett cites smaller clinical studies looking at ALA and insulin sensitivity or ovulation specifically in PMOS; if you want to explore that literature yourself, her book's reference list is a reasonable starting point, and it is worth discussing the evidence with your GP or a fertility specialist before adding a new supplement.

N-Acetyl Cysteine (NAC): The Overlooked Fertility Supplement

NAC is less frequently discussed in general fertility conversations, which is frustrating given the evidence behind it. It is a precursor to glutathione, the body's most powerful endogenous antioxidant, and it has documented effects on insulin signalling.

Fett references a clinical trial in women with clomiphene-resistant PMOS (PCOS), meaning their ovulation had not responded to clomiphene citrate alone. Adding NAC to clomiphene citrate led to a markedly higher ovulation rate than clomiphene plus placebo, and higher pregnancy rates too [Rizk, Bedaiwy & Al-Inany, Fertility and Sterility, 2005]. Because this trial was specifically in women whose PMOS had not responded to clomiphene alone, the results describe that particular clinical scenario rather than NAC's effect in every woman with PMOS, and it should be read as evidence for a specific adjunct use, not a standalone fertility treatment.

Beyond ovulation, chronic low-grade oxidative stress and inflammation are recognised features of PMOS (PCOS) that compound metabolic and reproductive dysfunction [Victor et al., Journal of Clinical Endocrinology & Metabolism, 2011]. NAC's role as a glutathione precursor gives it a plausible mechanistic link to that picture, though direct evidence for NAC's anti-inflammatory effect specifically in PMOS remains an emerging area rather than a settled one.

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The Three Supplements At A Glance

Compound	Proposed Mechanism	What the Evidence Shows
Myo-inositol	Supports insulin signalling and follicle maturation	Overall evidence limited and inconclusive per the most recent systematic review; a small trial found improved oocyte quality in IVF
Alpha-lipoic acid	Mitochondrial antioxidant; may support glucose uptake via GLUT4	Mechanistic laboratory evidence; PMOS-specific antioxidant rationale is well established
N-acetyl cysteine	Glutathione precursor; supports insulin signalling	Clinical trial evidence in clomiphene-resistant PMOS specifically, added to clomiphene citrate

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What the Three-Month Window Really Means

Fett is consistent on this point throughout the book, and it is worth spending a moment on it.

An egg does not develop overnight. The follicle that will eventually ovulate goes through a roughly 90-day maturation process before it is released. The quality of that egg, its chromosomal integrity, mitochondrial health, responsiveness to hormonal signals, is influenced by the environment it develops in during those three months.

This means that everything you do today is shaping the egg that will ovulate in approximately three months' time.

It sounds daunting. It is actually clarifying. Because it means the window for meaningful change is real and relatively short. You are not trying to undo decades of damage. You are supporting a three-month biological process.

Starting supplements, reducing BPA exposure, stabilising blood sugar, and supporting insulin sensitivity now will influence egg quality in a timeframe that is practical and meaningful, whether you are preparing for natural conception, IUI, or IVF.

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Supporting Your Body: Where the MyOva Preconception Supplement Fits

Everything Fett discusses about myo-inositol, alpha-lipoic acid, and NAC maps directly to the nutrients in the MyOva Preconception Supplement. We formulated it specifically with women who have PMOS (PCOS) in mind, combining those three compounds alongside CoQ10 (ubiquinol form, for mitochondrial support), folate, vitamin D3, zinc, selenium, magnesium, and a comprehensive B-vitamin profile.

I did not design it as a shortcut. I designed it because accessing this evidence base separately, in the right forms and doses, is unnecessarily complicated. Fett's book was one of the research inputs that shaped it, alongside the wider clinical literature, including the more cautious recent systematic reviews.

If you are in your preconception window, the supplement is worth reading about. It is not a magic fix. But it gives your body what it is often missing.

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What Fett Gets Right That Most Fertility Advice Gets Wrong

The fertility information space is dominated by two extremes: overly cautious medical advice that rarely goes beyond "take folic acid and have regular sex," and wellness content that overclaims, underreferences, and sells transformation in 30 days.

Fett occupies a rarer position. She is willing to say what the evidence supports, not more, not less. She is precise about dosages. She distinguishes between correlation and causation in the studies she cites. She is honest when evidence is preliminary versus when it is robust, even if, as this review has shown, some of the individual trials she and others rely on have since been reassessed or corrected by more recent research.

This is what hormonal literacy actually looks like. Not pseudoscience. Not miracle cures. Clear, mechanistic explanation of what is known and why it might matter for you.

For women with PMOS (PCOS) specifically, the book validates something many of us have felt for years: that our fertility challenges are not just about "trying harder" or "relaxing." They are rooted in real biochemistry. And that biochemistry responds to real, evidence-based interventions, even where the evidence is still developing rather than definitive.

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Who This Book Is Most Useful For

It Starts With The Egg is particularly relevant if you:

• Have PMOS (PCOS) and are trying to conceive naturally
• Have PMOS (PCOS) and are preparing for IUI or IVF
• Have experienced unexplained infertility or recurrent early miscarriage
• Have been told your egg quality is a concern
• Are in your thirties and want to proactively support ovarian function
• Have been offered generic advice and want to understand the mechanism behind it

It is less focused on conditions like endometriosis or premature ovarian insufficiency, where different mechanisms are at play. For those, other resources will be more directly applicable. But for PMOS (PCOS) and age-related egg quality concerns, it remains one of the most evidence-led books available to general readers.

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An Honest Note on Managing Expectations

Fett's own outcome, from a small number of viable embryos to 20 high-quality embryos in her next cycle, is striking, by her own account. It is also one person's experience, not a controlled trial, and the book itself is clear that results vary enormously between individuals depending on age, underlying diagnosis, baseline ovarian reserve, and other factors.

What the supplements and strategies she describes can reasonably be expected to do is support the conditions in which good egg development is possible. They cannot override every obstacle. They cannot guarantee a specific outcome, and as this review has shown, some of the individual pieces of supporting evidence are more provisional than the book's confident tone might suggest.

But for women with PMOS (PCOS), where insulin resistance, oxidative stress, and disrupted inositol signalling are actively creating a difficult environment for egg development, addressing those factors is not a shot in the dark. It is a reasonable, evidence-informed step, taken with realistic expectations.

That is the spirit in which I recommend the book. Not as a promise. As a starting point for making informed decisions, alongside your GP or fertility specialist.

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Conclusion

It Starts With The Egg is not a cure, and it does not promise one. What it offers is something rarer in the fertility space: a clear, evidence-grounded explanation of why egg quality matters in PMOS (PCOS), and what you can reasonably do to support it. Some of the individual studies behind the book's recommendations have aged better than others, and this review has tried to be honest about which is which. But the core message holds up: insulin resistance, oxidative stress, and disrupted inositol signalling are real, addressable factors in PMOS-related fertility challenges, and a three-month window of consistent, well-evidenced changes is a reasonable, achievable goal.

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Frequently Asked Questions

Is 'It Starts With The Egg' relevant if I have PMOS (PCOS) but am not currently trying to conceive?

Yes, with some caveats. The book's egg-quality content is most directly useful in a preconception context, but the insulin resistance, oxidative stress and environmental toxin sections are useful background for anyone with PMOS.

The core material on egg quality and supplements is most directly relevant in a preconception context. However, the sections on insulin resistance, oxidative stress, and environmental toxins offer useful background for anyone with PMOS (PCOS) who wants to understand the relationship between their metabolic health and reproductive function, regardless of their immediate fertility goals.

How long before trying to conceive should I start the supplements Fett recommends?

A minimum of three months, because that is how long it takes for an egg to complete its maturation cycle.

Fett is clear that a minimum of three months is needed, because that is how long it takes for an egg to complete its maturation cycle. Starting earlier gives more time for the body to respond, but three months is the practical minimum for supplementation to influence the quality of the eggs you will be releasing.

Does myo-inositol really help with PMOS (PCOS) fertility?

The evidence is genuinely mixed. The most recent systematic review found it limited and inconclusive overall, with a possible benefit specifically for D-chiro-inositol and ovulation.

Some individual trials have shown encouraging results, but the strongest, most current systematic review of the evidence describes it as limited and inconclusive overall, with the clearest potential benefit around D-chiro-inositol and ovulation specifically, and no meaningful advantage over metformin for reproductive outcomes. It is a reasonable, well-tolerated option to discuss with your GP or fertility specialist, not a guaranteed fix.

Can I take these supplements alongside medication for PMOS (PCOS) or fertility treatment?

Always discuss with your doctor or fertility specialist before adding supplements to an existing medication regimen, particularly alongside Metformin or ovulation-stimulating drugs.

Always discuss with your doctor or fertility specialist before adding supplements to any existing medication regimen. This is especially important if you are taking Metformin, which works on similar insulin pathways to myo-inositol, ovulation-stimulating drugs, or are mid-cycle in a fertility treatment protocol.

Is the book available in the UK?

Yes, It Starts With The Egg is available through major UK retailers including Amazon UK, and the third edition (2019) is the most up to date.

Yes. It Starts With The Egg is available through major UK retailers including Amazon UK. A third edition was released in 2019, which is the most up-to-date version and the one I recommend picking up.

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Further Reading

• Understanding Insulin Resistance: What It Is and How It Drives PMOS Symptoms
• What Is Myo-Inositol and Why Does It Matter for PMOS (PCOS)?
• 6 of the Best Apps and Devices for Tracking Your Cycle and Ovulation With PMOS (PCOS)
• The 10 Best Books for PMOS (PCOS)

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References

1. Hunt PA, Koehler KE, Susiarjo M, et al. Bisphenol A causes meiotic aneuploidy in the female mouse. Current Biology. 2003;13(7):546-553.
2. Kandaraki E, Chatzigeorgiou A, Livadas S, et al. Endocrine disruptors and polycystic ovary syndrome (PCOS): elevated serum levels of bisphenol A in women with PCOS. Journal of Clinical Endocrinology & Metabolism. 2011;96(3):E480-E484. doi:10.1210/jc.2010-1658.
3. Nestler JE, Jakubowicz DJ, Reamer P, Gunn RD, Allan G. Ovulatory and metabolic effects of D-chiro-inositol in the polycystic ovary syndrome. New England Journal of Medicine. 1999;340(17):1314-1320.
4. Fitz V, Graca S, Mahalingaiah S, et al. Inositol for polycystic ovary syndrome: a systematic review and meta-analysis to inform the 2023 update of the international evidence-based PCOS guidelines. Journal of Clinical Endocrinology & Metabolism. 2024;109(6):1630-1655. doi:10.1210/clinem/dgad762.
5. Ciotta L, Stracquadanio M, Pagano I, Carbonaro A, Palumbo M, Gulino F. Effects of myo-inositol supplementation on oocyte's quality in PCOS patients: a double blind trial. European Review for Medical and Pharmacological Sciences. 2011;15(5):509-514.
6. Konrad D, Rudich A, Bilan PJ, et al. The antihyperglycemic drug alpha-lipoic acid stimulates glucose uptake via both GLUT4 translocation and GLUT4 activation: potential role of p38 mitogen-activated protein kinase in GLUT4 activation. Diabetes. 2001;50(6):1464-1471.
7. Murri M, Luque-Ramirez M, Insenser M, Ojeda-Ojeda M, Escobar-Morreale HF. Circulating markers of oxidative stress and polycystic ovary syndrome (PCOS): a systematic review and meta-analysis. Human Reproduction Update. 2013;19(3):268-288.
8. Victor VM, Rocha M, Banuls C, et al. Induction of oxidative stress and human leukocyte/endothelial cell interactions in polycystic ovary syndrome patients with insulin resistance. Journal of Clinical Endocrinology & Metabolism. 2011;96(10):3115-3122. doi:10.1210/jc.2011-0651.
9. Rizk AY, Bedaiwy MA, Al-Inany HG. N-acetyl-cysteine is a novel adjuvant to clomiphene citrate in clomiphene citrate-resistant patients with polycystic ovary syndrome. Fertility and Sterility. 2005;83(2):367-370.
10. Fett R. It Starts With The Egg. Franklin Fox Publishing, 3rd edition, 2019.

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This article is for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before making changes to your diet, supplementation, or treatment plan, particularly if you are pregnant, trying to conceive, or taking medication.

This blog post contains affiliate links to the book we recommend. We may receive a small commission if you make a purchase after clicking one of these links, at no additional cost to you.

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References