Possibilities of reproductive function realization in patients with premature ovarian insufficiency

Abstract

Premature ovarian insufficiency (POI) directly affects the reproductive health of women all over the world. Currently, the study of this pathology is becoming an increasingly important issue due to the widespread prevalence of premature menopause in the female population. In addition to genetic predisposition, an important role in the development of premature menopause is played by the increasing number of ovarian surgeries due to the development of surgery, as well as radiation and chemotherapy for cancer, leading to premature depletion of the follicular reserve in the ovaries. An important component of treatment for women with POI is not only the management of undesirable symptoms of menopause, prevention of cardiovascular complications and fractures due to decreased bone mineral density, but also the possibility of realizing their reproductive function in the future. Therefore, other treatment options may be offered to women with POI in the absence of spontaneous pregnancy in the natural cycle. Oocyte donation may be recommended for such women, but this treatment option may not be suitable if the patient wishes to have genetically related children. In such a case, oogonal stem cell transplantation, ovarian cortex fragmentation or PRP therapy are possible. In women who will undergo chemotherapy and radiation therapy for cancer, reimplantation of ovarian cortical tissue is recommended to preserve fertility. If there is a risk of malignant cell transfer with this treatment modality, primordial follicles can be isolated from ovarian tissue, cultured and activated in vitro, fertilized, and transferred into the uterine cavity. IVF with surrogate embryo transfer may be an alternative choice for a woman with NPT, which allows her to realize her reproductive plans.