Abstract
We analyzed data from 466 patients with premature ovarian insufficiency (POI) who wished to have a biological child and were followed up while undergoing hormone replacement (HR) therapy with or without ovarian stimulation (OS) between April 2014 and December 2020. OS was conducted in 6891 cycles in 429 patients (Group OS), whereas only HR (Group HR) was conducted in 1117 cycles in 37 patients. The follicle growth rate was 48.3% (207/429) per patient in Group OS and 5.4% (2/37) in Group HR (p<0.01). There were 51 live births (LBs) in 50 patients during follow-up. In Group OS, the LB rate was 5.8% (47/807) in cycles where in vitro fertilization (IVF) and embryo transfer were attempted (Group IVF), and 1.3% (3/236) in cycles where intrauterine insemination/timed intercourse was attempted (p<0.01). No pregnancies occurred in Group HR. Among the patients in Group IVF, the LB rate was significantly higher in patients aged <35 years at the initiation of follow-up than in patients who started at later ages (p<0.01). Among the cases who achieved an LB, 39 were patients with idiopathic POI (Group IVF-1, n=297) and seven were patients who had undergone surgical treatment for benign ovarian tumors (Group IVF-2, n=50); however, no LBs occurred in patients who had undergone treatment for malignancy (n=17), and only one in patients with chromosomal abnormalities (n=22). The LB rate per case in the patients in Group IVF-1 and those aged <35 years at the start of follow-up (Group IVF-1-a) was 24.1% (26/108), which was higher than those of the other age groups. The LB rate per case in the patients in Group IVF-1-a with <4 years of amenorrhea was 37.3% (19/51), and that in the patients in Group IVF-2 with <4 years of amenorrhea was 21.2% (7/33). These results suggest that infertility treatment is possible in some patients with POI, especially those that can be classified in Group IVF-1-a and Group IVF-2 with <4 years of amenorrhea. Therefore, OS combined with HR therapy should be considered for such patients before attempts at oocyte donation.
Highlights
The incidence of premature ovarian insufficiency (POI), which refers to natural menopause before the age of 40 years, was originally reported to be 1% by Coulam [1]
Data were collected from patients who were first seen for infertility treatment at Rose Ladies Clinic in Tokyo, Japan from April 2014 to December 2017 and diagnosed as POI according to the European Society of Human Reproduction and Embryology (ESHRE) guidelines [12]
A total of 466 patients with POI who we first saw at our clinic between April 2014 and December 2017 were retrospectively analyzed until December 2020 under estrogen and progestin replacement therapy with or without repeated ovarian stimulation (OS), as described above
Summary
The incidence of premature ovarian insufficiency (POI), which refers to natural menopause before the age of 40 years, was originally reported to be 1% by Coulam [1]. Ovarian stimulation (OS) by a short protocol of recombinant follicle-stimulating hormone (recFSH) and hMG (recFSH/hMG) combined with GnRH-a under estrogen replacement may be effective as infertility treatment in some patients with POI. To our knowledge, no large-scale retrospective cohort studies have been conducted on pregnancy and LB rates among patients with POI who wish to have their own biological child during long-term follow-up on hormone replacement (HR) therapy with and without OS with recFSH/hMG and GnRH-a. Given this background, the present study aimed to investigate CP and LB rates in 466 patients with POI who wished to conceive while under HR therapy with or without OS with recFSH/hMG and a GnRH-a
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