Causes of infertility - premature ovarian failure (POF/POI)

Premature extinction of ovarian function is a condition diagnosed in approximately 12% patients of infertility clinics. It usually occurs in women aged 23-40 years.

How to detect premature expiration of ovarian function?

Premature cessation of ovarian function can be evidenced by menstrual cycle disorders such as excessively long cycles or irregular periods. On ultrasound examination, the condition manifests as a low number of ovarian follicles and reduced ovarian volume. 

Laboratory tests detect a decrease in the AMH hormone level in the blood, followed by a decrease in Inhibin B and - finally - an increase in follicutropic hormone (FSH) and a decrease in oestradiol.

Causes of premature extinction of ovarian function.

Premature cessation of ovarian function may follow radiotherapy or chemotherapy as part of anticancer treatment. Surgery on the adnexa, carried out due to the presence of cysts or tumours, can also contribute to damage to the ovaries. If the cause of premature ovarian expiration is different, the doctor will order a karyotype and FRAX test to exclude a genetic factor. The next step is to start treatment appropriate to the patient's age and the degree of ovarian function limitation.

What are the treatment options?

In young patients with clear fallopian tubes and even a slight ovarian response to stimulation, stimulated cycles are carried out. The partner's semen should have normal parameters. The cumulative treatment success rate with stimulation protocols does not exceed 25% in this case. Lack of pregnancy after 6 stimulated cycles may be an indication for in vitro fertilisation.

Patients over the age of 35 or with a severely limited ovarian reserve (AMH concentration below 0.25) should first take advantage of the attempt to collect ova for IVF. The stimulation of ovarian function is usually non-standard in their case, and the stimulation protocols used are combined with so-called priming, i.e. cycle preparation (here estrogens and androgens such as testosterone and DHEA are helpful).

As the statistics show, there are unsuccessful attempts to retrieve normal oocytes or obtain embryos in approximately 35% cycles. Per single transfer, the treatment success rate is approximately 16%. When there is no chance of successful stimulation, and when in vitro fertilisation is unsuccessful, the couple can proceed with an oocyte adoption programme.