If you have 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 science actually says you can do about it.

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

I first picked it up during one of the hardest periods of my life. I had been diagnosed with PCOS at 19, had experienced multiple miscarriages, and found myself doing what most of us do at 1am when the doctors have run out of answers — searching, reading, trying to make sense of it all. 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 PCOS and fertility. What Fett gets right. What the research behind it looks like. And why, over a decade later, it still belongs on your shelf.

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 handful of eggs. Rather than accepting that as the ceiling, she spent months reviewing studies on egg quality, mitochondrial function, oxidative stress and supplementation. She applied what she found. Her next IVF cycle produced 22 eggs. Nineteen fertilised to become good-quality blastocysts. Her fertility clinic described it as results they had never seen in a single cycle.

That is not marketing copy. That is documented clinical outcome that prompted her to write the book.

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 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.

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 — natural conception, IUI, or IVF.

For the purposes of this review, I am focusing specifically on what Fett recommends for women with 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.

Before Fett gets to supplements, she spends significant time on environmental toxins — and the PCOS-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.

Studies have consistently shown that BPA exposure affects egg quality by disrupting the chromosome alignment process during cell division [Hunt et al., Environmental Health Perspectives]. When chromosomes fail to separate correctly, eggs become aneuploid — meaning they carry the wrong number of chromosomes — which is one of the primary reasons embryos fail to develop or implant.

Here is the part that is particularly relevant if you have PCOS: research has found that women with PCOS have measurably higher BPA levels in their bloodstream compared to women without the condition [Kandaraki et al., Environmental Science & Technology, 2011]. The relationship appears bidirectional — BPA exposure may worsen insulin resistance and androgen levels, while the metabolic environment of PCOS 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 if possible (or washing hands immediately after)
• Choosing fresh or frozen produce over canned where possible

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

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 PCOS. All three work through the same underlying mechanism: improving insulin sensitivity, which in turn supports ovulation and egg quality.

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

PCOS 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 the normal follicle development process, 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 PCOS. The insulin-ovary-androgen pathway keeps running in the background.

The supplements Fett examines work on this pathway directly.

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

Fett describes the evidence as particularly strong here. Multiple randomised controlled trials have shown that myo-inositol supplementation in women with PCOS leads to:

• Improved insulin sensitivity and reduced fasting insulin levels [Nestler et al., New England Journal of Medicine, 1999]
• Restoration of regular ovulatory cycles in women with anovulation [Gerli et al., Gynecological Endocrinology, 2007]
• Improved oocyte quality and fertilisation rates in IVF cycles [Ciotta et al., European Review for Medical and Pharmacological Sciences, 2011]
• Reduced testosterone levels and improved hormonal profile

Fett is direct about its potential to reduce miscarriage risk associated with insulin resistance. This was significant for me personally. When I was trying to understand my own recurrent losses alongside PCOS, myo-inositol became the first supplement I explored in any depth — and the evidence I found aligned with everything she describes.

It takes approximately three months for an egg to complete its maturation cycle (a process called oogenesis). Fett is clear on this timeline: 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 (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 for PCOS is not just its antioxidant capacity in general, but a specific mechanism: it appears to improve insulin sensitivity through activation of AMPK pathways, which are key regulators of cellular energy and glucose uptake [Konrad et al., Diabetes Care, 2002].

The direct PCOS-fertility evidence Fett cites is notable. One study found that women with PCOS taking 600mg of ALA twice daily for 16 weeks showed improved insulin sensitivity and resumed ovulating regularly. That is a functional, measurable outcome — not just improved blood markers, but restored ovulation.

Oxidative stress is significantly elevated in women with PCOS compared to those without the condition [Murri et al., Clinical Endocrinology, 2013], making the antioxidant case for ALA particularly compelling in this population.

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 well-documented effects on insulin signalling.

Fett summarises a clinical study in which women with PCOS who had experienced infertility for an average of four years were given NAC alongside Clomid (an ovulation-inducing medication). The results were striking: 45% of women in the NAC group ovulated, compared to 28% in the placebo group. Pregnancy rates were 21% versus 9% respectively.

Beyond ovulation, researchers have observed that NAC reduces both insulin and testosterone levels in PCOS — again pointing back to the insulin-androgen pathway that sits at the centre of so many reproductive challenges in this condition.

NAC also appears to have anti-inflammatory properties, which is relevant given the growing evidence that low-grade chronic inflammation is a feature of PCOS that compounds metabolic and reproductive dysfunction [Victor et al., Journal of Reproductive Immunology, 2009].

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.

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 PCOS in mind, combining those three key 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 the research is clear on what matters, and because accessing all of it separately — in the right forms and doses — is unnecessarily complicated. Fett's book was one of the research inputs that shaped it.

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.

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.

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 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.

It Starts With The Egg is particularly relevant if you:

• Have PCOS and are trying to conceive naturally
• Have 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 PCOS and age-related egg quality concerns, it is genuinely the most evidence-led book I have come across.

Fett's own outcome — 22 eggs from a cycle that previously yielded very few — is extraordinary. The book 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 all obstacles. They cannot guarantee a specific outcome.

But for women with PCOS, where insulin resistance, oxidative stress, and disrupted inositol signalling are actively creating the wrong environment for egg development, addressing those factors is not a shot in the dark. It is a logical, evidence-grounded step.

That is the spirit in which I recommend the book. Not as a promise. As a starting point for making informed decisions.

Yes, with some caveats. 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 PCOS who wants to understand the relationship between their metabolic health and reproductive function — regardless of their immediate fertility goals.

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.

The research support for myo-inositol in PCOS is among the strongest of any supplement in this space. Multiple randomised controlled trials have found improvements in insulin sensitivity, ovulatory frequency, oocyte quality, and hormonal profile in women with PCOS. It is not a universal solution, and it works best as part of a broader approach, but the evidence is genuinely compelling — not just marketing.

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.

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.

• What Is Insulin Resistance and How Does It Affect PCOS?
• Myo-Inositol for PCOS: What the Research Actually Says
• 6 of the Best Apps and Devices for Tracking Your Cycle and Ovulation With PCOS
• PCOS and Egg Quality: What You Need to Know Before IVF

1. Hunt PA, et al. Bisphenol A causes meiotic aneuploidy in the female mouse. Environmental Health Perspectives, 2003.
2. Kandaraki E, et al. Endocrine disruptors and polycystic ovary syndrome (PCOS): elevated serum levels of bisphenol A in women with PCOS. Environmental Science & Technology, 2011.
3. Nestler JE, et al. Ovulatory and metabolic effects of D-chiro-inositol in the polycystic ovary syndrome. New England Journal of Medicine, 1999.
4. Gerli S, et al. Randomized, double blind placebo-controlled trial: effects of Myo-inositol on ovarian function and metabolic factors in women with PCOS. Gynecological Endocrinology, 2007.
5. Ciotta L, et al. Effects of myo-inositol supplementation on oocyte's quality in PCOS patients: a double blind trial. European Review for Medical and Pharmacological Sciences, 2011.
6. Konrad D, 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, 2002.
7. Murri M, et al. Circulating markers of oxidative stress and polycystic ovary syndrome (PCOS): A systematic review and meta-analysis. Human Reproduction Update, 2013.
8. Victor VM, et al. Oxidative stress, leukocyte activation, and inflammation in polycystic ovary syndrome. Journal of Reproductive Immunology, 2009.
9. Fett R. It Starts With The Egg. Franklin Fox Publishing, 3rd edition, 2019.