Posted on January 21st, 2019by Dr. Lawrence Grunfeldin Infertility Conditions

What is Premature Ovarian Failure?

What is Premature Ovarian Failure?
Premature ovarian failure, also known as primary ovarian insufficiency, is the loss of normal function of the ovaries before the age of 40. Without properly functioning ovaries, estrogen is not produced and eggs are not released regularly. As a result, those diagnosed with premature ovarian failure may experience infertility.

While premature ovarian failure is sometimes referred to as premature menopause the two conditions are very different. Women with premature ovarian failure can still have irregular or occasional periods whereas women going through menopause stop having periods altogether. Additionally, women with premature ovarian failure often still have follicles but they may be depleted or dysfunctional. Women undergoing menopause, however, no longer have follicles to produce eggs.

What are the symptoms of Premature Ovarian Failure?
Women experiencing either of these two conditions may exhibit similar symptoms, including:

  • Hot flashes
  • Night Sweats
  • Vaginal dryness
  • Decreased sexual desire
  • Irritability or difficulty concentrating
    These symptoms are due to the lack of estrogen produced by the ovaries. Low estrogen levels can also lead to bone loss or osteoporosis.

What Causes Premature Ovarian Failure?
There are several known causes of premature ovarian failure. Chromosomal defects, including Turner’s syndrome in which a woman has only one normal X chromosome and Fragile X syndrome in which the X chromosomes are fragile and break, are two genetic disorders associated with premature ovarian failure. The FMR1 gene is associated with Fragile X syndrome and is often found to function abnormally in premature ovarian failure. An autoimmune disease that produces antibodies against ovarian tissue could also cause premature ovarian failure. While this condition is rare, the damage it inflicts on an individual’s eggs can be enough to cause infertility.

How to Diagnosis and Treat Premature Ovarian Failure
Diagnosis of premature ovarian failure consists of blood tests and possibly a transvaginal ultrasound. In premature ovarian failure the hormone FSH is abnormally high and estrogen is very low or zero. AMH levels can be undetectable. Usually, a physician will use a transvaginal ultrasound to confirm premature ovarian failure. The ovaries will appear small and only a few follicles can be seen. Interestingly, 1-2% of women with premature ovarian failure can still conceive and deliver spontaneously when a healthy egg is released between skipped menstruation cycles.

Treatment plans typically address the problems that arise as a result of too little estrogen. Women with premature ovarian failure are prescribed estrogen in order to relieve side effects, such as hot flashes, and prevent long term problems, such as osteoporosis. Progesterone is also typically prescribed in conjunction with estrogen in order to protect the lining of the uterus from precancerous changes caused by taking estrogen alone. While these hormones won’t restore ovarian function they should cause vaginal bleeding and a restoration of the period.

Fortunately, advances in reproductive medicine have made having a child possible for those facing infertility as a result of premature ovarian failure. A woman with premature ovarian failure is still capable of carrying a child to term because her uterus is intact and healthy. For women with a known genetic risk of premature ovarian failure, egg freezing may be indicated before they start to see a decline in ovarian function. She can then choose to undergo in vitro fertilization (IVF) using her own eggs when she is ready to start building a family. For those unable to produce their own eggs, IVF using donor eggs is a viable option. Through advanced reproductive technology procedures, that egg can be collected, fertilized, tested, and implanted to result in a healthy pregnancy.

If you suspect that you may have symptoms of premature ovarian failure, be sure to consult your physician. Together you can choose the best treatment plan to help you address your symptoms and determine the best way to build a family.

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