What is Premature Ovarian Failure?

For many women, it is common knowledge that the success rates of pregnancy decrease as you get older. This decline in fertility continues until menopause, usually at about 51 years of age, when your ovaries are no longer functioning. Post-menopausal women are no longer expected to be able to carry a pregnancy to term, let alone fertilize an egg. For them, getting pregnant is not an option.

In younger women who are not facing menopause but are still faced with infertility, they often wonder what is the underlying cause attributable to this problem, and seek medical counsel. Ovarian function is a fundamental factor in getting pregnant. To lose this function before hitting 40 years of age is known as premature ovarian insufficiency, hypergonadotropic hypogonadism, or simply, premature ovarian failure.

Premature ovarian failure affects about one percent of women. Even girls in their teenage years have been documented as being affected by this disorder. Unlike natural menopause, ovarian dysfunction or loss of ova while they develop within the ovarian follicles is not natural. It can be attributable to some underlying disorder and warrants prompt medical attention, as infertility can result.

Medically, hormonal causes of premature ovarian failure include estrogen insufficiency, and presents as decreased bone density or osteoporosis. There are also high levels of follicle stimulating hormone (FSH) in the blood, which means that the ovaries are not responding to FSH by producing estrogen and developing ova as they would if they were normal. An ultrasound examination by an OB GYN would reveal shrunken or shriveled ovaries.

Premature ovarian failure has two pathways, both involving the health and viability of the ovarian follicles. The first mechanism involves few to no remaining follicles. This can be due to genetic disorders, endometriosis, damage from autoimmune diseases, radiation or chemotherapeutic therapies, surgery and infection.

The second is when there is an abundance of primordial follicles available, however autoimmune disease damages the maturing follicles, to inhibit the development of enough mature ova to be released during ovulation. Another cause of the second mechanism of premature ovarian failure is hormonal, in which FSH binds to a receptor site on the ovaries, but still be inactive.

As mentioned above, the failure in FSH leads to estrogen insufficiency within the ovaries themselves. Thus, premature ovarian failure can be diagnosed via serum FSH measurement alone. The OB GYN usually takes two blood samples with a one-month interval in between. If the FSH level is over 40 mIU/ml, then the patient is diagnosed as having POF.

POF does not necessarily spell infertility for women. There are several hormonal therapies that can be applied, especially hormone replacement therapy. Estrogen supplement therapy, DHEA and even transdermal estradiol patches have been used. As much as 10% of women with POF may become pregnant, even without the application of medical or surgical intervention. In-Vitro Fertilization is quite a viable option for couples looking to get pregnant without initiating hormone therapy.