Incidence Of Premature Ovarian Failure Research Articles

GnRH-analogues and oral contraceptives for fertility preservation in women during chemotherapy

For preserving fertility in women during chemotherapy, the character of invasive techniques, such as ovarian cryopreservation and other techniques, await further experience. Meanwhile, non-invasive techniques have attempted to minimize the gonadotoxic effect of chemotherapy, by using gonadotrophin-releasing hormone-analogues (GnRH-a) or oral contraceptives (OC). We performed a computerized MEDLINE search to identify articles published on fertility preservation using GnRH-a or OCs. Nine human-controlled studies reported the use of GnRH-a and four reported the use of OCs in parallel to chemotherapy. All nine studies analysing the effect of GnRH-a found lower rates of premature ovarian failure (POF) in patients receiving GnRH-a compared with the controls. Summarizing the studies resulted in 11.1% incidence of POF in patients who received GnRH-a compared with 55.5% incidence in the controls. Evidence using the fertility preserving effect of OC is limited. Two studies showed lower POF rates in OC-treated patients. The summarized data revealed a POF rate of 13.2% in patients who received OCs compared with that of 29.8% in the controls. The published clinical studies provide evidence, but do not prove statistically, that GnRH-a co-treatment reduces gonadotoxicity. Owing to the retrospective and non-randomized nature of most of the studies, definite conclusions concerning the reduction of POF by GnRH-a can still not be unequivocally drawn. As GnRH-a and OC have no serious side effects and as GnRH-a can even reduce chemotherapy-induced complications, such as severe menometrorrhagia, GnRH-a are considered by many clinicians as a clinically useful co-treatment in chemotherapy. The published clinical studies on OC also suggest a possible effect on the reduction of POF under certain conditions.

Identification of premature ovarian failure‐associated genes through whole‐genome genotyping with 100K SNPs

The clinical criterion for premature ovarian failure (POF) is the cessation of menstruation before the age of 40. It is a primary ovarian defect characterized by absent menarche (primary amenorrhea) or premature depletion of ovarian follicles (secondary amenorrhea). The incidence of POF is about 2% of women during their reproductive life. POF is one of the well known complex genetic diseases. However, causative genes or genomic regions are in mist. By using exon-centric 100K SNP microarray (Illumina¡¯s Infinium Assay I), we performed the whole-genome genotyping with POF and their matched controls. This microarray technology is based on the allele-specific primer extension. One hundred and fifty-two genes were associated with POF, including BCKDHB. Many of the genes we found were very new in the field of POF. This result may mean that unrevealed pathological pathways exist for POF. Many POF-associated haplotypes and their tagging SNPs were identified, also. In this study we found POF associated genes and haplotype blocks by using 100K SNP chips. Determination of causative SNPs and their functional role in the pathogenesis of POF is under way.

Premature ovarian failure

To summarize current knowledge about premature ovarian failure (POF) with an emphasis on recent developments regarding its management. The incidence of POF is increasing largely due to improved survival rates of cancer patients treated with radiation and chemotherapy. Delayed diagnosis and management of POF leads to suboptimal outcomes. Anticipation and early detection of this condition in high-risk women by means of ovarian function testing, followed by early institution of appropriate management could improve outcomes. Choice of strategies should vary depending on the age of onset, associated symptoms and fertility aspirations of the individual, and should change with the patient's advancing age. Early assessment of the individual's risk of developing POF, development of a strategic management plan, and timely commencement of infertility and hormone deficiency treatment, together with counselling in an integrated management plan should improve both the short and long-term health of those with POF.

FMR1 repeat sizes in the gray zone and high end of the normal range are associated with premature ovarian failure

Premature ovarian failure (POF) is the occurrence of menopause before the age of 40 and affects 1% of the female population. Whereas the etiology of POF is largely unexplained, FMR1 premutation carriers are known to be at increased risk of POF compared with the general population. The FMR1 premutation alleles have 55-200 copies of a CGG repeat in the 5' untranslated region of the FMR1 gene. However, functional effects on gene expression may occur even for repeat sizes in what has been considered the "normal" range. To evaluate the role of the FMR1 repeat in POF, repeat sizes were examined in 53 women with idiopathic POF, 161 control women from the general population, and 21 women with proven fertility at an advanced maternal age. A significant increase in the number of FMR1 alleles between and including 35 and 54 CGG repeats was found in the POF patient population; 15 of 106 (14.2%) POF alleles were between and including 35 and 54 repeats, whereas only 21 of 322 (6.5%) alleles in the general population (P=0.02) and 2 of 42 (4.8%) alleles from women with proven late fertility (P=0.09) were of this size (P=0.01 versus combined controls). The effect was also significant for comparisons of genotype repeat size (repeat size weighted by the relative activity of the two FMR1 alleles) and biallelic mean (average size of the two alleles). These results are clinically relevant and suggest that the FMR1 gene plays a more significant role in the incidence of POF than has previously been thought.

Combinación de 2 técnicas de transposición ovárica laparoscópica previa al tratamiento radioterápico de neoplasias pélvicas

Treatment of pelvic masses with radiotherapy in young women causes a high incidence of premature ovarian failure. Transposing the ovaries out of the radiation field aims to avoid this situation. We report the cases of 2 women treated for Ewing’s sarcoma and recurrent Hodgkin’s disease, respectively, who underwent laparoscopic bilateral ovarian transposition in the paracolic gutters; the left ovary was transposed to a lower level to keep it connected to its tube. This technique allows preservation of ovarian function and the possibility of a spontaneous pregnancy in the future

Ovarian Protection by Occlusion of Uteroovarian Collateral Vessels before Uterine Fibroid Embolization

In an attempt to decrease the incidence of premature ovarian failure, three patients with prominent ovarian collateral vessels from the uterine artery (UA) underwent collateral vessel embolization before uterine fibroid embolization. UA anatomy and collateral pathways are reviewed.

Autotransplantation of intact cryopreserved-thawed ovary: a minimally invasive approach

Objective: Aggressive cancer chemotherapy and radiotherapy is associated with high incidence of premature ovarian failure. Cryopreservation and grafting of ovarian cortical pieces is being used to preserve fertility. Delayed establishment of blood supply led to progressive loss of follicles and limited functional capacity of these pieces. The objective of this study is to develop a protocol for the long-term storage of an entire ovary followed by autotransplantation followed by microvascular anastomosis.

Premature ovarian failure in women with epilepsy.

Women with epilepsy (WWE) have an increased risk for several reproductive endocrine disorders that may affect their fertility. The incidence of premature ovarian failure (POF) in women with epilepsy has not been systematically studied. This study examined the incidence of POF in women with epilepsy. Fifty consecutively evaluated cognitively normal women with epilepsy, aged 38-64 years, whose seizures began before age 41 years, were interviewed for symptoms of perimenopause and menopause. Endocrine studies, performed in women aged 45 years or younger at the time of evaluation, included serum follicle-stimulating hormone (FSH; done on menstrual cycle day 3 in menstruating women), inhibin A levels when FSH was normal, thyroid-stimulating hormone (TSH), prolactin, and, in menstruating women, menstrual cycle day 20 serum progesterone level. Nonsurgical premature menopause was defined as secondary amenorrhea of >12 months' duration with FSH levels of >14 International Units (IU) in women younger than 42 years. Premature perimenopause was defined by the presence of one or more of the following: somatic perimenopausal symptoms; change in previously regular menstrual cycles without evidence of other reproductive endocrine disturbance; and FSH level of >14 IU or inhibin A level of <7 pg/ml. Similarly aged neurologically normal women seen in the menopause and sleep clinics served as control subjects. Statistical analysis included Fisher's exact test, Kruskal-Wallis test, t test, and multivariate logistic regression analysis with significance set at p < 0.05. Seven (14%) of 50 women with epilepsy had nonsurgical premature perimenopause (six of seven) or menopause (one of seven), compared with three of 82 control (p=0.042). Five of 41 women with localization-related epilepsy (LRE) had POF compared with two of nine women with primary generalized epilepsy (PGE; p=0.595). Mean age of POF was 39.6 years (range, 37-42 years). Seizure duration, age at seizure onset, seizure severity and lateralization, smoking history, age of menarche, body mass index and incidence of depression was not statistically different between women with and without POF. There was no statistically significant association between POF and antiepileptic drugs (AEDs). Women with POF were more likely to have had catamenial exacerbation of their seizures than were women without POF (p=0.02). Women with epilepsy have an increased risk for developing POF. This finding should be considered in counseling women with epilepsy on family planning.

Du constat pathologique à l’obtention de l’ovulation. Le cas des déficiences ovariennes

The incidence of premature ovarian failure (POF) is around 1 to 3 %. This pathology occurs in young women, who often wish to become pregnant. Theoretically, two mechanisms could be involved: initial follicle depletion and follicle dysfunction. However, in some cases, mixed mechanisms are involved. Initially, PFO was considered irreversible. In fact, signs of intermittent ovarian function in normal karyotypically women have been described, but predicting the probability of spontaneous remission in a specific woman is impossible. Therefore, various treatments for ovulation induction have been proposed to these patients. Most of the pregnancies occur after hormone replacement therapy. The action of this treatment is unclear and the cause-and-effect relation has not been proven by prospective, randomized studies. The benefit of suppressing endogen gonadotropins by GnRH agonists is not proven either. Estrogen supplementation and high-dose gonadotropin ovarian stimulation protocols have been proposed. Even so, this therapy cannot be recommended because of the lack of controlled studies. Finally, numerous case reports have described the return of ovarian function after using immunosuppressive therapies. The lack of particular criteria for the diagnosis of autoimmune mechanisms have lead to treat heterogeneous groups of patients. No randomized controlled studies with immunologic monitorage have been performed that could establish the success of this therapy. Therefore, in order to find effective treatments, basic pathophysiologic mechanisms must be better understood. For those women who want to become pregnant, the lack of prospective, randomized studies cannot lead to formal conclusions. Depending on the patients'age and history, it appears reasonable to attempt a corrective therapy based on defined etiology, before entering in a donor oocyte program.

FMR1 gene and fragile X syndrome.

Taxonomic features of fragile X syndrome (FXS) associated with the fragile X mutation have evolved over several decades. Males are more severely impacted cognitively than females, but both show declines in IQ scores as they age. Although many males with FXS exhibit autistic-like features, autism does not occur more frequently in males with FXS than among males with mental retardation (MR). FXS is caused by inactivation of the FMR1 gene located on Xq27.3. FMRP, the protein produced by FMR1, has been detected in most organs and in brain. In cells, it is located primarily in cytoplasm and contains motifs found in RNA-binding proteins. The FMRP N-terminal contains a functional nuclear localization signal which permits the protein to shuttle between cytoplasm and nucleus. FMR1 knockout mice show subtle behavioral and visual-spatial difficulties. Analysis of their brain tissue suggests absence of FMRP impairs synaptic maturation. Individuals with the fragile premutation produce FMRP, and the phenotype associated with the premutation has been controversial. However, there seems to be a higher incidence of premature ovarian failure in women with the premutation than is found in the general female population. This may be related to unusual increases in mRNA levels in premutation carriers.

A study of premature ovarian failure in Turkish women.

The parameters that could be responsible for or could be the end results of the premature ovarian failure were evaluated in 100 patients and compared with the same parameters of a control group consisting of 30 ovulatory healthy women with regular menstrual cycles. The incidence of premature ovarian failure was 6.6%. The mean age of the premature ovarian failure group was 39.2 +/- 4.1 years (range 30-58) whereas this was 45.6 +/- 3.1 years (range 39-52) for the control group. The mean menopausal age was 4.0 +/- 4.3 years (range 1-30). The prevalence of being a widow, divorcee or single was high in the premature ovarian failure group (p < 0.01). Of the hormonal and metabolic parameters, thyroid-stimulating hormone (TSH) and high-density lipoprotein (HDL) levels showed significant differences between the two groups (p < 0.01 and p < 0.05, respectively) and of the parameters reflecting bone metabolism, alkaline phosphatase levels showed a significant difference (p < 0.05). The bone mineral densitometric measurement values were lower in the premature ovarian failure group (p < 0.05). Because premature ovarian failure is not a rare disorder and because the patients have an early estrogen deficiency we concluded that, whatever the etiologic factor, hormone replacement therapy needs to be given as early as possible.

CORRELATION OF OVARIAN FUNCTION WITH GALACTOSE-l-PHOSPHATE URIDYL TRANSPERASE LEVELS IN GALACTOSEMIA

Galactosemia (G) is due to either partial or complete deficiency of the enzyme galactose-1-phosphate uridyl transferase (Ts). In females with G, there is a high incidence of premature ovarian failure. This study attempts to correlate the level of Ts activity in erythrocytes with ovarian function. In 28 patients (pts), ages 1-32 yrs, Ts by microassay technique, LH, FSH and estradiol levels were measured. Stimulation with gonadotropin-releasing hormone (GnRH) was performed to assess ovarian function in pts with basal LH and FSH levels 7.0 units) in 25 pts; 23 of these had evidence of ovarian insufficiency. In pts >13 yrs, there was a progressive rise of the gonadotropin levels as the ovary failed, although in 1 pt this occurred at 26 yrs of age after the birth of a normal infant. In pts <12 yrs, elevated basal FSH levels and an exaggerated gonadotropin response to GnRH was seen. Three pts, ages 30, 26, 24 yrs, had minimal Ts activity detected by microassay (0.15, 0.018, 0.004 units, respectively). These pts all had evidence of normal gonadal function by either normal response to GnRH stimulation in 2 pts and repeated fertility in 1 pt. CONCLUSION: Ovarian damage in G occurs in the complete absence of the Ts enzyme and minimal levels of Ts appear to be enough to preserve ovarian function.

Incidence of Premature Ovarian Failure

To assess the occurrence of premature ovarian failure, the age-specific incidence rates of natural menopause were determined for a cohort of 1858 women born between 1928 and 1932. These women were identified as Rochester, Minnesota residents in 1950 and were followed for date and type of menopause. A total of nine experienced natural menopause before age 40 years, which represents a 1% risk of natural menopause to age 40. The annual incidence rates of natural menopause per 100,000 person-years were ten for ages 15 to 29 and 76 for ages 30 to 39. In the age group 40 to 44, the incidence of natural menopause increased greatly to 881 per 100,000 person-years at risk.

Incidence of Premature Ovarian Failure

Incidence of Premature Ovarian Failure