Having spoken with hundreds of women in the past few years dealing with infertility, I can definitely say that Premature Ovarian Failure or else Primary Ovarian Insufficiency is one of the most frustrating cases.
And the obvious reason is that it is affecting relatively younger women who by nature are least likely to have an issue with conceiving. This journey to fertility is challenging and sometimes difficult to handle, but with knowledge, expertise and support along the way, anything is possible!
What is Premature Ovarian Failure?
Premature Ovarian Failure or else Primary Ovarian Insufficiency happens when the ovaries stop working properly before the age of 40. More or less, 1% of the female population is affected by this disorder, where estrogen hormone is not produced in an expected amount, and eggs are not released regularly. This leads to fertility issues at a relatively young age and can cause a lot of frustration in women trying to conceive.
I myself prefer to call it POI (Primary Ovarian Insufficiency) and not POF (Premature Ovarian Failure) since the word “failure” is far from accurate. In some women, POI is temporary. With the right treatment, early diagnosis, and the right psychology while confronting it (it is an undeniable fact that our attitude affects many things), may remit the consequences of this condition. There are chances for women with POI to succeed in a natural conception. So, describing it as failure is not suitable at all!
What are the causes?
Although fertility treatments and ART have progressed immensely the last decade, there are some things that are still difficult to diagnose and justify. One of these cases is the Premature Ovarian Failure. In about 90% of the cases, the cause is unknown. From the known cases though, a 20%-30% is reported to be associated with autoimmune diseases.
Research indicates that follicle problems (e.g dysfunctional follicles making it impossible for the eggs to grow and mature inside) may cause ovarian insufficiency.
Therefore, the diagnosis might be difficult and stressful for women suffering from infertility due to this condition. Some of the known causes are the following:
Some genetic disorders such as Turner Syndrome, Fragile X Syndrome
Toxins such as chemicals, pesticides and cigarettes
Autoimmune diseases such as thyroiditis and Addison disease
Radiation therapy or chemotherapy
- Medical history of Ovarian Surgery
Is it the same with premature menopause?
A very common mistake that follows POI is the confusion with Premature Menopause. While in the first one your periods might be irregular for years and even conceive, during the second one, the period stops and getting pregnant becomes more difficult.
Menopause indicates the end of menstrual life and usually occurs around 50 years of age. POI is a different condition from menopause although the symptoms are similar. Around 50% of women experiencing POI, can still have their ovaries functioning -intermittently maybe- for several years. That means that women can still achieve pregnancy even after the diagnosis.
How is Premature Ovarian Failure diagnosed?
There is always a possibility of misdiagnosing and that’s the reason why the fertility expert needs to exclude causes of menstrual cycle dysfunction such as thyroid disorder -evaluating TSH level - and hyperprolactinemia -evaluating prolactin level-.
Although women might notice signs of POI, the condition may be suspected by the doctor only if your periods stop being regular or if you are having trouble getting pregnant.
Before diagnosing POI, your doctor might recommend a pregnancy test, hormone levels tests or even search for certain genetic/gene defects such as Fragile X Syndrome.
Hot flashes or vaginal dryness might suggest POI if it is combined with lack of period or irregularity of cycles. But the absence of these symptoms does not necessarily mean that there is no POF. In order for the doctor to be 100% sure that it is indeed POF you are dealing with, they will need to make a thorough research of your medical history along with blood tests measuring AMH (anti-müllerian hormone) level, FSH and Estradiol Level and it might be necessary to assess the AFC (antral follicle count) in the ovaries by a transvaginal sonogram.
All in all, irregular cycle or no cycle at all, an elevated FSH, low Estradiol levels, an insignificant level of AMH, in women younger than 40 years old, can be consistent with Premature Ovarian Failure.
Symptoms of Premature Ovarian Failure
As mentioned before, although similar to menopause symptoms, is it not the same condition and cannot be treated in the same way.
Amenorrhea | Irregularity in periods or absence of them
Indications of estrogen deficiency such as: Mood swings, hot flashes, vaginal dryness, low sex drive, energy loss, FSH levels the same as in menopause range, bladder control problems.
Other symptoms such as dry eye syndrome
Treatment for Premature Ovarian Failure
Women who suffer from this condition have a lower chance of conceiving compared to other women however, spontaneous pregnancies can happen. Although the majority of doctors and scientists have not found a way to increase the number of new eggs in the ovaries or improve the quality of the existing ones, there is one innovative treatment performed by several fertility specialists in Greece and in the US, the Ovarian Rejuvenation Therapy as mentioned in this study.
It is a procedure that can create new eggs in the ovaries of women who are unable to conceive due to early menopause, advanced maternal age or low ovarian reserve, but who wish to have their own biological child.
There is also no age limit for the candidates, but as common for all fertility treatments, best chances are if you are under 40 years of age.
Hormone Replacement Therapy (HRT) is a commonly recommended solution as in some cases it alleviates the symptoms of POF. Some women have second thoughts about getting this specific therapy since there are several side effects (e.g bloating, swelling, feeling sick, leg cramps etc) and it is also medication based.
The only treatment that is generally accepted to increase the likelihood of pregnancy is IVF with Egg Donation.
Last but not least, there are a few health tips to improve egg fertility, such as a healthy diet, stress management and achieve a normal BMI (body mass index).
Since it is an early age disorder -sometimes in women under 30 years of age- it is very important for the health care providers to offer support to these women in order for them to process better an infertility issue that was not expected. Once it is diagnosed, it needs to be evaluated at least once a year.
The battle against infertility may seem uneven sometimes, but thanks to the extended research and expertise on the matter, the chances of winning are becoming more each day!