Primary Ovarian Failure: What It Is and How To Deal With It

For younger women who are dealing with infertility, menopause is not an issue. Thus, they often wonder what else could be causing the problem. Since the ovaries must be functioning correctly in order for a woman to get pregnant, loss of ovarian function before the age of 40 years is known as premature ovarian failure. In other literature, it may be discussed as premature ovarian insufficiency or hypergonadotropic hypogonadism.

Women of all ages know that pregnancy success rates decline as they get older; this decline in fertility continues until their mid-forties and fifties, when menopause occurs. At this time, your ovaries are no longer functioning. Women in their post-menopausal years are no longer expected to be able to fertilize an egg, carry a pregnancy to term. In other words, their years of getting pregnant are over.

Premature ovarian failure affects around one percent of women in their reproductive years. Studies have shown that girls in their teenage years have also been diagnosed with this disorder. Loss of eggs as they develop within the follicles, or overall ovarian dysfunction is unlike natural menopause, and is usually due to some underlying medical disorder. Prompt medical attention is needed, since infertility may occur if it is left untreated.

Hormonal causes of premature ovarian failure include estrogen insufficiency along with high levels of follicle stimulating hormone in the blood. Since estrogen is deficient, findings such as decreased bone density, or signs and symptoms of osteoporosis may be present. With increased levels of FSH, the ovaries are simply not responding as they should: by producing estrogen and developing eggs. Ultrasound examination of the ovaries would reveal that they are shrunken, shriveled, or smaller than they would normally be.

Premature ovarian failure can be caused by one of two mechanisms. What they share in common is that they are inextricably linked to the health and viability of the ovarian follicles. The first mechanism involves having few to no remaining follicles, due to autoimmune disease, chemotherapy, ionizing radiation, genetic disorders, endometriosis, surgery, and ascending genitourinary infection.

The other mechanism is when the primordial follicles are many in number, or at least at or above normal, however autoimmune processes destroy the maturing follicles. This inhibits the development of enough mature eggs to be released at ovulation. Sometimes, this same mechanism can be caused by a faulty ovarian response to FSH, wherein the hormone binds to the receptors but there is no effect.
Premature ovarian failure may be diagnosed via serum FSH measurements. The procedure is simple: the OB-GYN or fertility specialist takes two blood samples one month apart. If the FSH level is over 40 mIU/ml, then the patient has premature ovarian failure.

Treatment for premature ovarian failure involves hormonal therapies, such as estrogen supplement therapy, DHEA, and transdermal estradiol have been shown to be effective for these patients. Up to 10% of women with POF may become pregnant through hormonal treatment alone, although in-vitro fertilization may be a viable option for them as well.