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Female Infertility

Premature Ovarian Failure

Premature ovarian failure (POF) is defined as the loss of ovarian function before age 35

The average age of menopause (or “ovarian failure”) in the United States is approximately 51 years of age, however the average age of loss of fertility in women appears to be around 45-47 years of age.

Premature ovarian failure (POF) is defined as the loss of ovarian function before age 35.  Ovarian failure results from the loss of oocytes from the ovary, which leads to an inability of the ovary to produce estrogen.  Common symptoms include the cessation of menses, and the development of hot flushes and vaginal dryness.  Obviously, complete ovarian failure results in permanent infertility.

Premature ovarian failure can be caused by endometriosis

Premature ovarian failure or POF usually results from a genetically predetermined loss of a woman’s oocytes. However, it can also be the consequence of the ovary having been damaged or destroyed by disease processes. One of the most common diseases is endometriosis. Also, benign ovarian tumors and borderline malignant tumors of the ovary can destroy the ovary.  Surgical treatment of these diseases can result in the removal of normal ovarian tissue as well.

It is not uncommon for women to lose an ovary from surgery for a Fallopian tube problem and/or a surgery for a benign ovarian problem. A much less common condition is destruction of the ovary from an autoimmune process where a woman develops anti-ovarian antibodies that attack the egg containing follicles in the ovary.

Chromosomal evaluations are recommended for women diagnosed with premature ovarian failure

All women with POF should have a chromosomal evaluation, which can be performed by a simple blood test.  The majority of women with POF will have a normal chromosomal evaluation.  However, occasionally a small fragment of the Y chromosome may be detected.  In this situation, the ovaries should be removed as soon as possible because there is an increased chance of developing ovarian cancer.  Usually the removal of the ovaries can be achieved laparoscopically.

Donor eggs are an answer for couples facing premature ovarian failure

Although the diagnosis of POF is often devastating to a couple attempting pregnancy, it is still possible for an affected woman to achieve pregnancy through the use of donor oocytes (see the section on donor oocyte cycles). If the woman has a younger sister, she may be a candidate for donating oocytes. The advantage of utilizing the woman’s sister’s oocytes is that this will enable the woman to pass along her family’s genetic material to her children. It is worthwhile to educate the woman’s younger sister about POF since the cause is commonly genetic and she may eventually experience the same problem. If the patient does not have a younger sister, or if her sister is similarly affected with POF, another viable option for pregnancy is the use of oocytes donated by an anonymous donor.  Regardless of the source of the donated eggs, the success of IVF using donor oocytes is quite high.

Since women with POF have a significant deficiency in estrogen production, they should consider taking estrogen replacement therapy while they are evaluating their fertility options and as soon as possible after they deliver a baby. Replacing estrogen usually alleviates the symptoms of estrogen deficiency as well as other associated conditions that can ultimately develop such as the premature development of significant bone loss (osteoporosis). All patients with POF should discuss estrogen replacement with their primary care physician to see if they are good candidates for estrogen replacement therapy.

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