Fertility treatment in women with premature ovarian failure. (May 2011)

• Record Type: Journal Article
• Authors: Blumenfeld, Zeev
• Is Part Of: Expert review of obstetrics & gynecology. Volume 6:Number 3(2011)
• Page Start: 321
• Page End: 330
• Publication Date: 2011-05
• Subjects: fertility treatment -- GnRH agonist -- gonadotoxicity -- hypergonadotropic amenorrhea -- POF; Obstetrics -- Periodicals; Gynecology -- Periodicals; 618.05
• DOI: 10.1586/eog.11.15
• Languages: English
• ISSNs: 1747-4108

Abstract

Premature ovarian failure (POF) is defined as ovarian failure and early menopause before the age of 40 years. This POF occurs in 1% of women younger than 40 and up to 0.1% women younger than 30, and may have different etiologic causes, such as genetic, autoimmune, iatrogenic, toxic, enzymatic, infectious and metabolic. The etiologic cause can be diagnosed in less than half of the cases. Signs of intermittent ovarian function in karyotypically normal women have been described, but predicting the probability of spontaneous remission in a specific woman is impossible. The possible beneficial effect of treatments such as immunosuppressive therapies, gonadotropin-releasing hormone (GnRH) agonists, exogenous high-dose gonadotropins and estrogen replacement, published in numerous anecdotal case reports, is unclear, and the cause––effect relationship has not been proven by prospective randomized studies. Therefore, in order to find effective treatments, basic pathophysiologic mechanisms must be better understood. For those women who want to conceive, it seems reasonable to attempt a corrective therapy based on defined etiology, before falling back on a donor oocyte program. Iatrogenic POF after chemotherapy has gained worldwide interest owing to significantly improved survival in the last three decades, and owing to the ability to preserve future fertility and ovarian function in many young female survivors of young-age malignancy. The attempts of IVF-assisted reproductive technologies and embryos or unfertilized oocytes cryopreservation, combined with ovarian tissue cryopreservation and coadministration of GnRH agonists in parallel to chemotherapy, may maximize future fertility and minimize long-term POF in these women.