Abstract
In the context of a continuously increased delay of motherhood and of an increase of the incidence of premature ovarian failure, it is of the greatest interest to dispose of a predictive marker of the duration of the fertility window. Unfortunately, current available markers of women’s fertility (hormonal rates or echography count of small follicles) have a poor predictive value of premature ovarian failure. In the last ten years, some studies have suggested that telomere length may be correlated with premature ovarian failure, but the results of these studies are contradictory.In accordance with guidelines from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), this systematic review of the literature selected studies evaluating telomere length or telomerase activity in granulosa cells and/or in leukocytes as a premature ovarian failure marker.Five publications (252 premature ovarian failure patients) were included in this review of experimental evidence. Two of them studied telomere length and/or telomerase activity in granulosa cells and 4 in leukocytes in women with premature ovarian failure. For each study, authors determined if there was a positive or a negative correlation between telomeric parameters and premature ovarian failure.3 studies (178 premature ovarian failure patients) found shorter telomere length in granulosa cells and/or leukocytes and/or lower telomerase activity in premature ovarian failure patients. 2 studies (74 premature ovarian failure patients) presented contradictory results about the correlation of leucocyte telomere length with premature ovarian failure.Shorter telomeres and diminished telomerase activity in granulosa cells appear to be associated with ovarian insufficiency. However, the number of studies and of subjects within are low and the methodology questionable. The confirmation of these results is essential with more subjects, better defined populations and more adapted methodology, in order to consider telomere length in granulosa cells and/or in leucocytes as an early and reliable marker for the decline of ovarian function.
Highlights
IntroductionOver the past thirty years, in most developed countries, women are having children later and later
Premature Ovarian Failure (POF), first described in the 1930s, is a clinical syndrome characterized by a loss of ovarian function before the age of 40 [2] with three sequential stages called occult, biochemical and clinical [3]; corresponding to fertility decline, an increase in Follicle Stimulating Hormone (FSH) release rate, and oligo or amenorrhea [4] respectively
In 2 of them Leukocyte telomere length (LTL) was shorter in POF patients than in controls whereas the 2 other studies reported longer LTL in POF patients
Summary
Over the past thirty years, in most developed countries, women are having children later and later. At the same time, they are becoming more aware that their fertility declines with age. Premature Ovarian Failure (POF), first described in the 1930s, is a clinical syndrome characterized by a loss of ovarian function before the age of 40 [2] with three sequential stages called occult, biochemical and clinical [3]; corresponding to fertility decline, an increase in Follicle Stimulating Hormone (FSH) release rate (twice), and oligo or amenorrhea [4] respectively. The prevalence of POF among women under 40 years of age is about 1%. It is estimated at 1/1000 for those under 30 years and 1/10,000 for those under 20 [5, 6]. The frequency is higher among Caucasian and African than Asian women [6]. The definition of POF is incomplete, the European Society of Human Reproduction and Embryology (ESHRE) working group recommends as diagnostic criteria [4]: Oligo/amenorrhea for at least 4 months and FSH > 25 IU/L at twice 4 months apart
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