Primary Ovarian Failure

Abstract

Primary ovarian failure (POF) is a common cause of infertility in women. It is characterized by amenorrhea, hypoestrogenism and elevated gonadotropin levels in women younger than 40 years of age. Primary causes of POF are the X chromosome abnormalities (monosomy, trisomy, translocation, deletion) or genetic defects that can occur as a result of autosomal gene mutations. Autoimmune ovarian damage may be seen alone or may be associated with some autoimmune diseases or syndromes; but the specificity and sensitivity of ovarian antibodies is still under debate. Bilateral oophorectomy, chemotherapy, radiotherapy and infections cause the secondary POF. Symptoms of POF include irritability, nervousness, loss of libido, depression, dry skin, vaginal dryness and frequent infections. POF is diagnosed with FSH levels higher than 40 IU/L and estradiol levels below 50 pmol/L in women younger than 40 years of age. For the patients who desire pregnancy, consecutive estrogen-progesterone replacement therapy is the first step treatment, and oocyte donation may be advised thereafter. Suitable estrogen-progesterone treatment improves quality of life, and protects patients from complications such as osteoporosis, cardiovascular disease and stroke. Pregnancy has been obtained with assisted conception held by donated oocytes in women with POF. Cryopreservation of oocytes, embryos and ovarian tissue is used to preserve ovarian reserve in women undergoing cancer treatments.