Diagnosis Of Premature Ovarian Failure Research Articles

Spontaneous pregnancy fifteen years after diagnosis of premature ovarian failure

We report an unusual case of spontaneous conception, occurring over fifteen years after the initial diagnosis of premature ovarian failure (POF). Her karyotype was 46XX. Following the diagnosis of POF, our patient was treated with hormone replacement therapy (HRT). Starting at the age of 31, she had several invitro fertilisation (IVF) cycles using donor eggs. She had two live births and one ectopic pregnancy for which she underwent laparoscopic salpingectomy. Between IVF treatment cycles she continued HRT. At the age of forty years she conceived spontaneously. The HRT was stopped at 10 weeks of amenorrhoea. She delivered a healthy baby boy at term. Following the delivery the patient had spontaneous periods every 2-3 months and did not suffer from menopausal symptoms. Her post delivery FSH and LH levels were high. We believe this is the longest interval reported between diagnosis of POF and a spontaneous conception.

Functional well-being is positively correlated with spiritual well-being in women who have spontaneous premature ovarian failure

To examine the relationship between spiritual well-being and functional well-being in women who have spontaneous premature ovarian failure. Cross-sectional. The Mark O. Hatfield Clinical Research Center at the US National Institutes of Health. Women diagnosed with spontaneous premature ovarian failure (N = 138) at a median age of 28 years. Administration of validated self-reporting instruments. Functional Well-Being, Spiritual Well-Being, Meaning/Peace, and Faith scores. We found a significant positive correlation between overall spiritual well-being and functional well-being scores. The Meaning/Peace subscale strongly correlated with functional well-being, explaining approximately 62% of the variance. In contrast, the Faith subscale was less strongly correlated with functional well-being, explaining only 7% of the variance. In multiple regression analysis evaluating the relative subscale contributions to functional well-being, only Meaning/Peace remained statistically significant. We found no significant associations between either spiritual well-being or functional well-being and age; age at diagnosis; time since diagnosis; or partner, children, or racial status. This study provides cross-sectional data supporting the need for prospective controlled studies. Strategies to improve spiritual well-being in the domains of meaning, purpose, and inner peace may provide a therapeutic approach to reduce the emotional suffering that accompanies the life-altering diagnosis of premature ovarian failure.

Mutational screening of FOXO3A and FOXO1A in women with premature ovarian failure

FOXO3A and FOXO1A are excellent candidate genes for the development of premature ovarian failure and have not been analyzed previously in POF patients. Potentially causal mutations in FOXO3A (2/90; 2.2%) and FOXO1A (1/90; 1.1%) were identified in POF patients; however, the pathological role of these mutations will be determined only by screening increased numbers of patients and controls, or by functional studies.

O-128: Symptoms of depression and their impact on daily functioning in women with spontaneous premature ovarian failure

To assess symptoms of depression in women with spontaneous premature ovarian failure and determine the perceived impact of these symptoms on their daily functioning. Learning the diagnosis of premature ovarian failure can induce sadness and grief at the loss of childbearing capacity, which in some cases can spiral into clinical depression.

Effectiveness of microlaparoscopy in the diagnosis of premature ovarian failure

Premature ovarian failure (POF) cases contain a mixture of cases possessing follicles (type A) and those depleted of follicles (type B). Differentiation between the two types is important because the treatment policy and pregnancy prognosis vary greatly. The objective of this study was to examine the usefulness of microlaparoscopy in the differentiation of types A and B. Among 66 patient with POF diagnosed at our department between May 1996 and April 2004, 47 patients who gave informed consent and underwent microlaparoscopy were studied. The cases were divided into four groups based on the laparoscopic ovarian morphology. These groups were analyzed with respect to patient background, blood hormone levels, antinuclear antibody positive rate, visualization of the ovary on transvaginal ultrasonography, presence or absence of follicles in biopsy specimen, and number of follicles. No significant differences in patient background and serum hormone levels were observed between groups. There was a tendency of increase in antinuclear antibody positive rate, increase in proportion of cases with follicles, and increase in number of follicles as the ovarian morphology approached normal. Transvaginal ultrasonography failed to identify the ovary in all the patients. Microlaparoscopy is useful in the differentiation between type A and B POF, and is further expected to become an indicator of response to treatment.

Bone loss in young women with premature ovarian failure

To evaluate the effect of premature ovarian failure on bone mineral density. Forty-five women with karyotypically normal spontaneous premature ovarian failure underwent hip and spinal bone density measurements by dual energy X-ray absorptiometry. Findings were compared with a control group of 61 women of similar age. The median (range) age of the women with premature ovarian failure was 33 (18-39) years. The median (range) time since diagnosis of premature ovarian failure was 2 years (0.5-7). Forty-one of the women (91%) had sought medical advice previously and had taken a variety of estrogen and progestin replacement regimens at least intermittently. Both the femoral neck bone mineral density measurements and the spinal bone mineral density measurements were significantly lower than measurements of the control group (P < 0.05). Our study shows that premature ovarian failure has significantly lower levels of bone mineral density than the control group of normal women. We suggest that hormone replacement therapy should be substituted early and consistently in affected patients. Our data also raise questions about whether preservation of bone mass in these patients will require replacement of additional gonadal steroids.

Assessing the emotional needs of women with spontaneous premature ovarian failure

To examine women's emotional responses to learning the diagnosis of premature ovarian failure (POF) and identify the sources of support used for coping. Observational study. National Institutes of Health Clinical Center. One hundred women previously diagnosed with POF of median age 28 years at diagnosis. Structured telephone interviews based on focus group findings. Manner informed of POF diagnosis, emotional response, and areas of emotional support. Overall, 71% were unsatisfied with the manner in which they were informed by their clinician, and 89% reported experiencing moderate to severe emotional distress at the time. The degree of emotional distress was positively correlated with the degree of dissatisfaction with the manner in which the women had been informed of the diagnosis. Thorough and accurate medical information on POF, support of others, and spirituality were perceived as helpful in coping. Learning the diagnosis of POF can be emotionally traumatic and difficult for women. The findings suggest that the manner in which patients are informed of this diagnosis can significantly impact their level of distress. Patients perceive a need for clinicians to spend more time with them and provide more information about POF.

Clinical characteristics of patients who conceive after the diagnosis of premature ovarian failure

Clinical characteristics of patients who conceive after the diagnosis of premature ovarian failure

Meeting the needs of young women with secondary amenorrhea and spontaneous premature ovarian failure

OBJECTIVE: To investigate the experiences of young women with spontaneous premature ovarian failure with regard to the initial presenting symptom, promptness of diagnosis, and patient education. METHODS: We asked 50 patients previously diagnosed with spontaneous premature ovarian failure to participate in a structured interview survey consisting of 38 true-or-false, multiple-choice, and open-ended questions. RESULTS: Disturbance in menstrual pattern was the most common initial symptom in the 48 women who completed the interview (44 of 48, 92%). Over half of the 44 women who presented with this complaint reported visiting a clinician’s office three or more times before laboratory testing was performed to determine the diagnosis. Over half of them reported seeing three or more different clinicians before diagnosis. In 25% of women it took longer than 5 years for the diagnosis of premature ovarian failure to be established. Patients who spent more than 5 minutes with the clinician discussing the diagnosis were significantly more likely to be satisfied with the manner in which they were informed ( P < .001). Ninety percent of participants were college graduates, and 40% had graduate degrees. CONCLUSION: Women with spontaneous premature ovarian failure perceived a need for more aggressive evaluation of secondary amenorrhea and oligomenorrhea. Loss of menstrual regularity can be a sign of ovarian insufficiency, and the associated estrogen deficiency is a well-established risk factor for osteoporosis.

MYOCARDIAL INFARCTION COMPLICATING HORMONE REPLACEMENT THERAPY IN A YOUNG WOMAN WITH NORMAL CORONARY ARTERIES

SUMMARYWe describe a 30‐year‐old Afro‐Caribbean woman with a history of secondary amenorrhoea, who had been treated with HRT because of a presumed diagnosis of premature ovarian failure, and subsequently presented with an acute infero‐lateral myocardial infarction. Subsequent coronary angiography demonstrated normal coronary arteries.

Premature ovarian failure is not premature menopause.

Normal menopause occurs at an average age of 50 and results from ovarian follicle depletion. Normal menopause is an irreversible condition, whereas premature ovarian failure is characterized by intermittent ovarian function in half of these young women. These young women produce estrogen intermittently and sometimes even ovulate despite the presence of high gonadotropin levels. Indeed, pregnancy has occurred after a diagnosis of premature ovarian failure. On pelvic ultrasound examination, follicles were equally likely to be detected in patients more than 6 years after a diagnosis of premature ovarian failure as in patients less than 6 years after the diagnosis. Thus, the probability of detecting a follicle appears to remain stable during the normal reproductive lifespan of these young women. Indeed, pregnancy was reported in a 44-year-old woman 16 years after a diagnosis of premature ovarian failure. No treatment to restore fertility in patients with premature ovarian failure has proved to be safe and effective in prospective controlled studies. Theoretically, these unproved therapies might even prevent one of these spontaneous pregnancies from occurring.

Twin gestation two years after the diagnosis of premature ovarian failure

International Journal of Gynecology & ObstetricsVolume 70, Issue S2 p. B147-B147 Menopause Twin gestation two years after the diagnosis of premature ovarian failure A.M.S. Fernandes, A.M.S. FernandesSearch for more papers by this authorM.S. Arruda, M.S. ArrudaSearch for more papers by this authorR. Deliza, R. DelizaSearch for more papers by this authorC. Menabo, C. MenaboSearch for more papers by this author A.M.S. Fernandes, A.M.S. FernandesSearch for more papers by this authorM.S. Arruda, M.S. ArrudaSearch for more papers by this authorR. Deliza, R. DelizaSearch for more papers by this authorC. Menabo, C. MenaboSearch for more papers by this author First published: 10 December 2003 https://doi.org/10.1016/S0020-7292(00)83190-2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume70, IssueS22000Pages B147-B147 RelatedInformation

PREMATURE OVARIAN FAILURE

In 1% of women, premature ovarian failure develops by 40 years of age, a condition causing amenorrhea, infertility, sex steroid deficiency, and elevated gonadotropins. Early loss of ovarian function has significant psychosocial sequelae and major health implications. These young women have a nearly two-fold age-specific increase in mortality rate. Among women with spontaneous premature ovarian failure who have a normal karyotype, half have ovarian follicles remaining in the ovary that function intermittently. Indeed, pregnancies have occurred after the diagnosis of premature ovarian failure. Thus, premature ovarian failure should not be considered as a premature menopause. Young women with this disorder have a 5% to 10% chance for spontaneous pregnancy. Attempts at ovulation induction using various regimens fail to induce ovulation rates greater than those seen in untreated patients; however, oocyte donation for women desiring fertility is an option. Young women with premature ovarian failure need a thorough assessment, sex steroid replacement, and long-term surveillance to monitor therapy. Estrogen-progestin replacement therapy should be instituted as soon as the diagnosis is made. Androgen replacement should also be considered for women with low libido, persistent fatigue, and poor well-being despite taking adequate estrogen replacement. Women with premature ovarian failure should be followed up for the presence of associated autoimmune endocrine disorders such as hypothyroidism, adrenal insufficiency, and diabetes mellitus.

Onset of menopause in women exposed to diethylstilbestrol in utero

OBJECTIVES: As part of a larger health survey, we sought to determine whether prenatal exposure to diethylstilbestrol is associated with onset of early menopause or menopausal symptoms. STUDY DESIGN: Diagnosis of premature ovarian failure and symptoms of menopause were determined in a telephone interview with 542 women whose mothers participated in a randomized clinical trial of the use of diethylstilbestrol in pregnancy in the early 1950s. These women were aged 37 to 39 at the time of the interview. Medical records were obtained to confirm diagnosis of premature ovarian failure. RESULTS: The prevalence of menopausal symptoms (specifically hot flashes and night sweats) did not differ for exposed and unexposed women. One exposed woman and no unexposed women had a medically confirmed diagnosis of premature ovarian failure. CONCLUSIONS: Prenatal diethylstilbestrol exposure was not related to diagnosis or symptoms of menopause in this study. Further follow-up will be necessary to determine if a difference in age at menopause emerges as these women become older.

A new, laparoscopic full-thickness slice ovarian biopsy (from antimesenteric to mesenteric margin).

This article introduces a new laparoscopic surgical technique of full-thickness slice biopsy, from antimesenteric margin to mesenteric area, of the ovary. The uteroovarian ligament with mesenteric vasculature and the infundibulopelvic ligament with its artery and veins are transitionally obliterated with atraumatic 5-mm laparoscopic clamps. This part of the operation stabilizes and decreases the blood supply to the ovary. A desirable width of full-thickness slice in the middle part of the ovary is excised from antimesenteric to mesenteric region with 5-mm laparoscopic scissors. The full-thickness slice ovarian excision stops before the mesenteric vasculature to avoid surgical injury to that area that may compromise the ovarian blood supply or return. The presence of primordial follicles in the ovary differentiates the resistant ovary syndrome from premature ovarian failure. In hypergonadotropic hypogonadism, a classic minilaparotomy is performed to obtain enough ovarian tissue for the definitive histologic diagnosis of premature ovarian failure versus resistant ovary syndrome. Simplicity and good outcome make this laparoscopic technique suitable for many clinical predicaments when a deep lesion in the ovary must be removed.

Organ-specific autoimmunity in patients with premature ovarian failure

The diagnosis of premature ovarian failure (POF) was made in 45 women (aged 14 to 39 yr) with high concentrations of FSH and LH. Sera from these patients and a control group of 28 women were used to detect organ-specific autoantibodies. Eighteen patients with POF (40%) were positive for at least one autoantibody. In the control group only one woman (3.6%) showed autoimmunity. Antithyroid was the most representative autoimmunity (20%) in the POF group. By indirect immunofluorescence, only one patient was positive for antiovarian and antiadrenal antibodies. In summary, the results of this study are consistent with previous immunohistochemical data which indicate that autoimmune disorders are common in patients with POF. Furthermore, the detection of antiovarian antibodies in only one patient confirms that they are probably detectable in a short period of the disease.