Premature ovarian failure: a systematic review on therapeutic interventions to restore ovarian function and achieve pregnancy

Abstract

Infertility is an important issue for patients with premature ovarian failure (POF). Although oocyte donation offers an alternative method to achieve a pregnancy, many patients seek to reproduce with their own gametes. We performed a literature search to evaluate the possibility of pregnancy following diagnosis, and the additional value of treatment strategies. We found 52 case reports, eight observational studies, nine uncontrolled studies and seven controlled trials. Due to a strong variability in study design, patient selection and mode of intervention, it was not possible to combine the data of the seven studies to perform a meta-analysis. None of the studies showed a statistically significant difference between both (or more) study groups. Due to a lack of incorporation of a placebo group, preference of any treatment over no treatment could not be established. Importantly, the collected data of observational, uncontrolled and controlled studies indicate that POF patients still have a 5-10% chance to conceive following diagnosis. Approximately 80% of the reported pregnancies resulted in the birth of a healthy child. There is no evidence that any treatment can enhance this pregnancy rate.

Resumption of ovarian function after 4 years of estro-progestin treatment in a young woman with Crohn’s disease and premature ovarian insufficiency: a case report

“…Overall, POI patients appear to have an approximately 5 to 10 % chance of conceiving after receiving their diagnosis [20]. This resumption may be either spontaneous or as a consequence of a corticosteroid or estrogen treatment.…”

“…Indeed, follicle-like structures were demonstrated by ultrasound in earlier follow-up visits (see Table 1), but they weren't likely to demonstrate a functional ovarian activity. As a matter of fact, pelvic ultrasound may show ovarian follicle-like structures in 41 % of POI patients, but these follicles doesn't appear to function normally, due to poor correlation between their diameter size and estradiol serum level [20].…”

Falência ovariana prematura: aspectos atuais

“…A prevalência de FOP em pacientes com amenorréia primária é de 10-28% e 4-18% com amenorréia secundária (4,5). A FOP esporádica é a forma mais comum, porém em cerca de 5% dos casos observa-se uma história familial positiva, o que sugere uma predisposição genética para essa patologia (6).…”

“…O início preciso da FOP é, em muitos casos, difícil de determinar, pois como já referido, a evolução pode ter um curso flutuante, com níveis elevados de gonadotrofinas seguidos por perío-dos de retorno à normalidade, inclusive com ovulação e, em 5 a 10% dos casos, gestação e parto (5,7). Essa variabilidade da evolução clínica foi também observada numa coorte de 39 pacientes com FOP e cariótipo 46 XX, que estão sendo acompanhadas na Unidade de Endocrinologia Ginecológica do Serviço de Endocrinologia, no Hospital de Clínicas de Porto Alegre.…”

In vitro fertilisation (IVF) with donor eggs in post-menopausal women: are there differences in pregnancy outcomes in women with premature ovarian failure (POF) compared with women with physiological age-related menopause?

“…It is characterized by amenorrhea, either primary or secondary, and symptoms of hypoestrogenism, with elevated serum gonadotropin concentrations. The aetiology of POF is diverse and includes chromosomal, autoimmune, iatrogenic, infectious, and idiopathic causes [6].…”