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Chapter 19 - Premature Ovarian Insufficiency

from Section 3 - Reproductive Endocrinology and Infertility

Published online by Cambridge University Press:  24 November 2021

By
Mohamed Elmoursi  and
Tahir Mahmood
Edited by
Tahir Mahmood ,
Charles Savona-Ventura ,
Ioannis Messinis  and
Sambit Mukhopadhyay
Tahir Mahmood
Affiliation:
Victoria Hospital, Kirkcaldy
Charles Savona-Ventura
Affiliation:
University of Malta, Malta
Ioannis Messinis
Affiliation:
University of Thessaly, Greece
Sambit Mukhopadhyay
Affiliation:
Norfolk & Norwich University Hospital, UK
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Summary

Ovarian insufficiency is the inability of the ovary to function effectively in a woman under the age of 40 years. It is considered primary if it fails to respond to appropriate gonadotrophic stimulation and secondary when there is failure on the part of the hypothalamus and pituitary axis to produce appropriate gonadotrophic stimulation. There are various risk factors and associated diseases that can lead to ovarian insufficiency, leading to menstrual irregularities, anovulation, reproductive failure and premature menopause. When POI is suspected, diagnosis is confirmed by measuring serum hormone concentrations of FSH and oestradiol twice ≥1 month apart; levels indicate menopausal range, specifically FSH > 40 units/L and oestradiol < 50 pg/ml. Chromosomal analysis should be performed in all women with non-iatrogenic POI. Management includes counselling with appropriate information and use of appropriate terminology. Treatment is directed towards ovarian hormone replacement, restoration of fertility, and psychological wellbeing. There exists a variety of interventions to prevent iatrogenic ovarian insufficiency resulting from chemo- or radiotherapy.

Keywords

premature ovarian insufficiency (POI)amenorrhoeachromosomal abnormalitiesgonadectomyX chromosome geneshormone replacementfertility preservation strategies
Type
Chapter
Information
The EBCOG Postgraduate Textbook of Obstetrics & Gynaecology
Gynaecology
 , pp. 152 - 160
Publisher: Cambridge University Press
Print publication year: 2021

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References

Hewlett, M, Mahalingaiah, S. Update on primary ovarian insufficiency. Curr Opin Endocrinol Diabetes Obes 2015;22:483–489.Google Scholar
De Vos, M, Devroey, P, Fauser, BC. Primary ovarian insufficiency. Lancet 2010;376:911–921.Google Scholar
Cordts, EB, Christofolini, DM, Dos Santos, AA, Bianco, B, Barbosa, CP. Genetic aspects of premature ovarian failure: a literature review. Arch Gynecol Obstet 2011;283:635–643.CrossRefGoogle ScholarPubMed
Torrealday, S, Kodaman, P, Pal, L. Premature ovarian insufficiency: an update on recent advances in understanding and management. F1000Res 2017;6:2069.Google Scholar
Webber, L, Davies, M, Anderson, R, et al. ESHRE Guideline: management of women with premature ovarian insufficiency. Hum Reprod 2016;31:926–937.Google Scholar
Donnez, J, Dolmans, MM. Fertility preservation in women. Nat Rev Endocrinol 2013;9:735–749.Google Scholar
Sklar, CA, Mertens, AC, Mitby, P, et al. Premature menopause in survivors of childhood cancer: a report from the childhood cancer survivor study. J Nat Cancer Instit 2006;98:890–896.CrossRefGoogle ScholarPubMed
Larsen, EC, Muller, J, Schmiegelow, K, Rechnitzer, C, Andersen, AN. Reduced ovarian function in long-term survivors of radiation- and chemotherapy-treated childhood cancer. J Clin Endocrinol Metab 2003;88:5307–5314.CrossRefGoogle ScholarPubMed
Oktay, K, Kim, JY, Barad, D, Babayev, SN. Association of BRCA1 mutations with occult primary ovarian insufficiency: a possible explanation for the link between infertility and breast/ovarian cancer risks. J Clin Oncol 2010;28:240–244.Google Scholar
Caburet, S, Arboleda, VA, Llano, E, et al. Mutant cohesin in premature ovarian failure. N Engl J Med 2014;370:943–949.CrossRefGoogle ScholarPubMed
Bakalov, VK, Gutin, L, Cheng, CM, et al. Autoimmune disorders in women with Turner syndrome and women with karyotypically normal primary ovarian insufficiency. J Autoimmun 2012;38:315–321.CrossRefGoogle ScholarPubMed
Reato, G, Morlin, L, Chen, S, et al. Premature ovarian failure in patients with autoimmune Addison’s disease: clinical, genetic, and immunological evaluation. J Clin Endocrinol Metab 2011;96:E1255–E1261.CrossRefGoogle ScholarPubMed
Smith, JA, Vitale, S, Reed, GF, et al. Dry eye signs and symptoms in women with premature ovarian failure. Arch Ophthalmol 2004;122:151–156.CrossRefGoogle ScholarPubMed
Luborsky, JL, Meyer, P, Sowers, MF, Gold, EB, Santoro, N. Premature menopause in a multi-ethnic population study of the menopause transition. Hum Reprod 2003;18:199–206.Google Scholar
Popat, VB, Calis, KA, Vanderhoof, VH, et al. Bone mineral density in estrogen-deficient young women. J Clin Endocrinol Metab 2009;94:2277–2283.CrossRefGoogle ScholarPubMed
Snowdon, DA, Kane, RL, Beeson, WL, et al. Is early natural menopause a biologic marker of health and aging? Am J Public Health 1989;79:709–714.Google Scholar
Pellegrini, VA, Calis, KA. Ovarian insufficiency. 2016. Available at: https://emedicine.medscape.com/article/271046-overview#a5.Google Scholar
Buijsen, RA, Visser, JA, Kramer, P, et al. Presence of inclusions positive for polyglycine containing protein, FMRpolyG, indicates that repeat-associated non-AUG translation plays a role in fragile X-associated primary ovarian insufficiency. Hum Reprod 2016;31:158–168.Google Scholar
Bardoni, B, Mandel, JL, Fisch, GS. FMR1 gene and fragile X syndrome. Am J Med Genet 2000;97:153–163.Google Scholar
Murray, A, Schoemaker, MJ, Bennett, CE, et al. Population-based estimates of the prevalence of FMR1 expansion mutations in women with early menopause and primary ovarian insufficiency. Genet Med 2014;16:19–24.CrossRefGoogle ScholarPubMed
Kim, TJ, Anasti, JN, Flack, MR, et al. Routine endocrine screening for patients with karyotypically normal spontaneous premature ovarian failure. Obstet Gynecol 1997;89(5 Pt 1): 777–779.Google Scholar
Rebar, RW, Connolly, HV. Clinical features of young women with hypergonadotropic amenorrhea. Fertil Steril 1990;53:804–810.CrossRefGoogle ScholarPubMed
Beck-Peccoz, P, Persani, L. Premature ovarian failure. Orphanet J Rare Dis 2006;1:9.Google Scholar
Rebar, RW. Premature ovarian failure. Obstet Gynecol 2009;113:1355–1363.Google Scholar
Nelson, LM. Clinical practice. Primary ovarian insufficiency. N Engl J Med 2009;360:606–614.Google Scholar
Vujovic, S. Aetiology of premature ovarian failure. Menopause Int 2009;15:72–75.CrossRefGoogle ScholarPubMed
Baker, VL. Primary ovarian insufficiency in the adolescent. Curr Opin Obstet Gynecol 2013;25:375–381.Google Scholar
Ipswich, M. Primary ovarian insufficiency (POI). 1995. Available at: www-dynamed-com.knowledge.idm.oclc.org/topics/dmp~AN~T114914.Google Scholar
Practice Committee of American Society for Reproductive Medicine.Current evaluation of amenorrhea. Fertil Steril 2008;90:S219–S225.CrossRefGoogle Scholar
Dewailly, D, Andersen, CY, Balen, A, et al. The physiology and clinical utility of anti-Mullerian hormone in women. Hum Reprod Update 2014;20:370–385.Google Scholar
Novosad, JA, Kalantaridou, SN, Tong, Z-B, Nelson, LM. Ovarian antibodies as detected by indirect immunofluorescence are unreliable in the diagnosis of autoimmune premature ovarian failure: a controlled evaluation. BMC Women Health 2003;3:2.CrossRefGoogle ScholarPubMed
ACOG. Committee opinion no. 691: carrier screening for genetic conditions. Obstet Gynecol 2017;129:e41–e55.CrossRefGoogle Scholar
Kalantaridou, SN, Calis, KA, Vanderhoof, VH, et al. Testosterone deficiency in young women with 46,XX spontaneous premature ovarian failure. Fertil Steril 2006;86:1475–1482.Google Scholar
Lydic, ML, Liu, JH, Rebar, RW, Thomas, MA, Cedars, MI. Success of donor oocyte in in vitro fertilization: embryo transfer in recipients with and without premature ovarian failure. Fertil Steril 1996;65:98–102.CrossRefGoogle ScholarPubMed
Silber, SJ, Gosden, RG. Ovarian transplantation in a series of monozygotic twins discordant for ovarian failure. N Engl J Med 2007;356:1382–1384.Google Scholar
Silber, SJ, Lenahan, KM, Levine, DJ, et al. Ovarian transplantation between monozygotic twins discordant for premature ovarian failure. N Engl J Med 2005;353:58–63.Google Scholar
Silber, SJ, Grudzinskas, G, Gosden, RG. Successful pregnancy after microsurgical transplantation of an intact ovary. N Engl J Med 2008;359:2617–2618.CrossRefGoogle ScholarPubMed
Maruyama, T, Miyazaki, K, Uchida, H, et al. Achievement of pregnancies in women with primary ovarian insufficiency using close monitoring of follicle development: case reports. Endocrine J 2013;60:791–797.CrossRefGoogle ScholarPubMed
Gold, EB, Bromberger, J, Crawford, S, et al. Factors associated with age at natural menopause in a multiethnic sample of midlife women. Am J Epidemiol 2001;153:865–874.Google Scholar
Hu, FB, Grodstein, F, Hennekens, CH, et al. Age at natural menopause and risk of cardiovascular disease. Arch Intern Med 1999;159:1061–1066.CrossRefGoogle ScholarPubMed
Schmidt, PJ, Cardoso, GM, Ross, JL, et al. Shyness, social anxiety, and impaired self-esteem in Turner syndrome and premature ovarian failure. JAMA 2006;295:1374–1376.CrossRefGoogle ScholarPubMed
Cooper, AR, Baker, VL, Sterling, EW, et al. The time is now for a new approach to primary ovarian insufficiency. Fertil Steril 2011;95:1890–1897.Google Scholar
Practice Committees of American Society for Reproductive Medicine.Mature oocyte cryopreservation: a guideline. Fertil Steril 2013;99:37–43.Google Scholar
ACOG. Committee opinion no. 584: oocyte cryopreservation. Obstet Gynecol 2014;123:221–222.Google Scholar
Bisharah, M, Tulandi, T. Laparoscopic preservation of ovarian function: an underused procedure. Am J Obstet Gynecol 2003;188:367–370.CrossRefGoogle ScholarPubMed

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