Resumption of Ovarian Function and Pregnancies in 358 Patients with Premature Ovarian Failure

Abstract

Resumption of ovarian activity and spontaneous pregnancies are described in patients with premature ovarian failure (POF), but there is a lack of data concerning the prevalence of and predictive factors for these phenomena. The aim of the study was to determine both the prevalence of and predictive factors for spontaneous resumption of ovarian function in POF patients. A mixed retrospective and prospective study was performed at a referral center for reproductive endocrinology. A total of 358 consecutive POF patients were followed from 1997 to 2010 in our center. The cumulative incidence of resumption of ovarian function was determined, and predictive factors were identified by univariate and multivariate analysis. Of 358 patients with idiopathic POF, 86 (24%) patients presented features indicating resumption of ovarian function, and in 77 cases (88%) within 1 yr of diagnosis. Twenty-one spontaneous pregnancies (16 births, five miscarriages) occurred in 15 (4.4%) patients. Multivariate analysis (Cox model) showed that a familial history of POF, secondary amenorrhea, presence of follicles at ultrasound, and inhibin B and estradiol levels were significantly predictive of resumption of ovarian function (P < 0.01), whereas association with an autoimmune disease, anti-mullerian hormone level, the presence of follicles on biopsy, and/or genetic abnormalities did not appear predictive. We created a predictive score for resumption of ovarian function comprising age at diagnosis, presence of follicles at ultrasound, and inhibin B level. Intermittent ovarian activity in patients with POF is not a rare phenomenon. The predictive score described in this study may help us to identify POF patients most likely to recover intermittent ovarian function.