What is the Best Management Strategy for a 20-year-old Woman With Premature Ovarian Failure?

Melanie C. Davies; Beth Cartwright

Disclosures

Clin Endocrinol. 2012;77(2):182-186. 

In This Article

Fertility

A 5–10% background pregnancy rate is seen in spontaneous POF.[31,32] It is important to counsel patients about the small chance of spontaneous conception, and the need to use contraception if pregnancy is not desired. The OCP may be a good choice for these women. HRT is not contraceptive.

It is not possible to predict which patients will conceive, although positive prognostic factors include short duration of amenorrhoea, autoimmune aetiology, and ovarian activity seen on ultrasound scan.[31,32] Pregnancy can occur in young women despite very low AMH. Sadly, no intervention has been found to improve conception rates: ovarian stimulation, FSH suppression and the use of steroids in autoimmune POF are all ineffective.[31]

The only treatment option is in vitro fertilization with donor oocytes. Prior to embryo transfer, the endometrium is thickened using high-dose HRT. Treatment has a high success rate (which can reach 50% per cycle) dependent on the age of the donor. The psychological and ethical implications must be carefully considered, and counselling is mandatory for both the recipient and donor. Donors are medically screened, should be aged <35 and may be known or unknown to the recipient; a related donor may respond poorly to ovarian stimulation owing to the familial nature of POF.

The availability of treatment varies widely; egg donation is not allowed in some countries, for example Germany, and is carefully regulated in others, for example UK & Canada. The supply of donor gametes is limited in the UK, where donors are unpaid and their anonymity is not guaranteed (offspring have the right to obtain registry details of their genetic parent). As a result, many couples seek treatment overseas in so-called reproductive tourism. This practice has raised ethical concerns as donors in some countries may be motivated by economic deprivation.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....