Premature Ovarian Failure In Women Research Articles

Juvenile idiopathic arthritis and primary ovarian failure: a two-sample Mendelian randomization analysis in a mixed-gender cohort.

The causal relationship between juvenile idiopathic arthritis (JIA) and primary ovarian failure (POF) remains uncertain. To elucidate this relationship, we employed a two-sample Mendelian randomization analysis. The single nucleotide polymorphisms (SNPs) associated with JIA were obtained from a previously published genome-wide association study (GWAS), while the pooled data for POF originated from the FinnGen consortium. The study populations consisted exclusively of individuals of European descent. In our Mendelian randomization analysis, we performed inverse-variance weighted analysis, weighted-median analysis, weighted-mode analysis and Mendelian randomization-Egger regression analysis, supplemented by sensitivity analyses to validate the accuracy and robustness of the findings. The IVW (OR = 1.23, 95% CI 1.06-1.43; P = 0.007) and weighted median (OR = 1.25, 95% CI 1.06-1.47; P = 0.009), along with sensitivity analysis validation, provide compelling evidence of a significant causal association between JIA and POF. The study revealed a significant causal association between genetically predicted JIA and POF, indicating that JIA significantly elevates the risk of developing POF. Therefore, it is recommended to implement screening for premature ovarian failure in women diagnosed with JIA.

Perceptions and experiences of fertility preservation in female patients with cancer in Greece

BackgroundAs advances in oncology have led to remarkable and steady improvements in the survival rates of patients with cancer and anticancer treatment can cause premature ovarian failure in women, fertility preservation (FP) has become a global public health concern and an integral part of the care for women diagnosed with cancer during reproductive age. However, for various reasons, FP remains underutilized for patients with cancer. There are substantial gaps in our knowledge about women’s experiences and perceptions of the issue. This study aims to contribute to bridging that gap.MethodsThis prospective qualitative study was conducted from March 2018 to February 2023. A combination of purposive and snowball sampling was used. Data were collected by semistructured interviews with nineteen reproductive-age women who had been recently diagnosed with cancer. Data were classified and analysed with a thematic analysis approach.ResultsA variety of distinct themes and subthemes emerged from the analysis of the interview data. The cancer diagnosis emerged as a factor that considerably affects the women’s attitudes towards biological parenthood: It can further increase their (strong) previous desire or decrease their previous (weak) desire. Women with a recent cancer diagnosis had not received adequate and multidisciplinary counselling, including clear and sufficient information. However, participants felt satisfied with the information they received because they either received the information they requested or remained in denial about the need to be informed (i.e., because they felt overwhelmed after the cancer diagnosis). Embryo cryopreservation emerged as a less desirable FP option for women with cancer. Participants showed respect for human embryos, not always for religious reasons. Surrogacy emerged as the last resort for most participants. Religious, social or financial factors did play a secondary (if any) role in women’s decision-making about FP. Finally, male partners’ opinions played a secondary role in most participants’ decision-making about FP. If embryo cryopreservation was the selected option, partners would have a say because they were contributing their genetic material.ConclusionsThe findings that emerged from the data analysis were partly consistent with prior studies. However, we identified some interesting nuances that are of clinical importance. The results of this study may serve as a starting point for future research.

FRI283 Fragile X Gene Mutations Alter GnRH Neuron And Ovarian Innervation With Consequences On Reproductive Function

Abstract Disclosure: P.A. Villa: None. N. Lainez: None. C.R. Jonak: None. S. Berlin: None. I. Ethell: None. D. Coss: None. Mutations in the Fragile X messenger ribonucleoprotein 1 gene (FMR1) cause Fragile X syndrome, the most common cause of inherited mental disability, attributed to the loss of the Fragile X messenger ribonucleoprotein (FMRP). FMR1 mutations also comprise a majority of the genetic causes of premature ovarian failure (POF) in women, mechanisms of which are unknown. We utilized the Fmr1KO mouse model to determine the role of the FMR1 gene in the reproductive system in females. Similarly to what occurs in women harboring the mutation, our data demonstrate that Fmr1KO female mice experienced premature reproductive senescence, where reproductive function stopped at p163; in contrast, wild type controls stopped reproducing at p263. Since POF in women can occur due to either an insufficient pool of primordial follicles or early depletion of follicles, we quantified primordial follicles in 3 week old females and determined there was no difference between KO and controls. We then determined that Fmr1KO females had a higher number of corpora lutea at 8 weeks of age and gave birth to larger litters, suggesting that KO females recruit more follicles in each estrus cycle. Given that follicle stimulating hormone (FSH) and luteinizing hormone (LH) are essential in ovarian function, we analyzed gonadotropin levels in Fmr1KO females and determined they have higher serum LH and FSH. Inhibin b, progesterone, and testosterone levels were also higher, suggesting that high gonadotropins do not result from the lack of feedback. Ovariectomy determined that the hypothalamus drives high LH in KO females, while increased FSH is dependent on the ovaries. Increased vasculature in the corpora lutea and higher sympathetic innervation of developing follicles may increase steroid hormone production and drive increased serum FSH levels. To investigate the hypothalamic role in increased LH, we determined that a majority of gonadotropin-releasing hormone (GnRH) neurons express FMRP, which also have a higher number of GABAergic synapses in Fmr1KO females. Given that GABA is excitatory to GnRH neurons, alterations in afferent synaptic input can affect GnRH and LH secretion. LH pulsatile analysis determined higher LH pulse frequency in both unmodified and ovariectomized females, indicating an increase in GnRH neuron activity. In summary, our results reveal hypothalamic and ovarian contributions to the reproductive phenotype of Fragile X mutation carriers that may lead to early menopause. Presentation: Friday, June 16, 2023

Analysis of the benefit of gonadotropin-releasing hormone agonist treatment in premenopausal women undergoing hematopoietic cell transplantation

Gonadotropin-releasing hormone agonist (GnRHa) appears to exhibit ovarian protection during chemotherapy for malignant tumors. The purpose of this study was to analyze the benefits of GnRHa in premenopausal women undergoing hematopoietic cell transplantation (HSCT). Candidates for myeloablative chemotherapy HSCT requiring fertility preservation in the Gynecological Endocrinology Clinic of Peking University People’s Hospital from December 2011 to December 2021 were retrospectively analyzed. Patients who chose to receive GnRHa treatment were given at least 2 courses of a 3.75-mg dose of a GnRHa before myeloablative chemotherapy, and patients who chose not to receive GnRHa treatment were included in the control group. All patients were monitored for menstruation return and menopause-related symptoms, and ovarian function tests [follicle-stimulating hormone (FSH), luteinizing hormone, and estradiol] were performed 6–12 months after HSCT. In addition, we assessed the vaginal bleeding of patients in the laminar air-flow room (LAFR). A total of 234 cases were included in this study: 77 cases in the treatment group and 157 cases in the control group. The incidence of vaginal bleeding in the LAFR in the treatment group was significantly lower than that in the control group (24.68% vs. 79.62%, P < 0.001). The menopausal symptoms of the patients in the treatment group were reduced after transplantation (46.75% vs. 19.75%, P < 0.001). There was no difference in visible follicles by follow-up ultrasound in the two groups after HSCT (16.88% vs. 13.38%, P = 0.474). The level of FSH at 6–12 months after transplantation was lower (98.00 mIU/ml vs. 117.53 mIU/ml, P = 0.001). The proportion of patients with FSH < 40 mIU/ml did not differ between the two groups. One patient in the treatment group recovered spontaneous menstruation, while none recovered spontaneous menstruation in the control group (1.30% vs. 0%, P = 0.329). The use of GnRHa may relieve menopause-related symptoms and reduce vaginal bleeding in the LAFR and breakthrough bleeding after transplantation. GnRHa treatment can reduce the level of FSH after myeloablative chemotherapy, but it cannot reduce the incidence of premature ovarian failure in women of reproductive age following myeloablative HSCT.

Preservation of fertility in patients with testicular germ cell tumors: oncological, legal, and religious aspects

Survival rates for cancer patients continue to steadily increase due to improvement of effectiveness of current treatments. However, despite significant oncological results, one should not forget about the quality of life of this cohort of patients, in particular those who undergo gonadotoxic cancer therapy with development of premature ovarian failure in women and azoospermia in men. Preservation of fertility in both women and men with cancer is currently possible and should be integrated at all levels of cancer care. In this regard, the main purpose of this review is to consider the topic of fertility in men treated for cancer in the context of various aspects of human life.

Impact of Violence against Women on Sexual and Reproductive Health: Research Protocol and Results from a Pilot Study

Objectives: Violence against women (VAW) is associated with a deterioration of endocrine function with consequences similar to those of premature ovarian failure in women. The main objective of this study is to evaluate the hormonal repercussions of VAW and, secondly, to analyse the cardio-metabolic, bone, cognitive, psychological, and psychosexual consequences of hypoestrogenism secondary to VAW. Materials and Methods: A cross-sectional study will be conducted on women of any age who have suffered VAW at some point in their lifespan, whether psychological, sexual, or physical. Clinical, hormonal, cardio-metabolic, bone, psychological, and psychosexual parameters will be analysed. Results: The pilot study from the first 23 women show that all of them are suffering from severe sexual dysfunction. In addition, all women reported menstrual irregularity and hypoestrogenism (including two cases of premature ovarian failure) since the VAW episode. Conclusions: VAW is a pandemic that affects all women equally, regardless of their age, status, social background, or education. Despite the claims made by certain groups, VAW does not depend on women, but rather it affects women and is clearly harmful to their sexual, reproductive, and general health.

Incidence of amenorrhea and premature ovarian failure in women who underwent uterine fibroid embolization: single centre study

Purpose: To retrospectively determine the incidence of amenorrhea and premature ovarian failure in women who underwent uterine fibroid embolization (UFE) in King Fahad Specialist Hospital in Dammam (KFSH-D).&#x0D; Patients and methods: All women who had undergone UFE in KFSH-D from August 2007 to October 2015 were included for a total of 82 patients. Follow up consisted of a questionnaire inquiring about symptoms, improvement after the procedure and whether menstruation resumed or not. The pre-procedure and post-procedure pelvis MRI as well as UFE images and reports were reviewed for all patients. &#x0D; Results: One patient (1.5 %) was found to have amenorrhea out of the 67 patients we were able to contact. She was 52 years old at the time of UFE and had irregular period. Menstruation did not resume following UFE along with menopausal symptoms including night sweats, mood swings and irritability, likely due to premature ovarian failure (POF). The rest of patients had normal resumption of menses. &#x0D; Conclusion: The incidence of amenorrhea is less than what’s reported in the literature could be due to advances in UFE since its introduction as a treatment for uterine fibroids, likely due to advances in image quality, tans-catheter embolization equipments/techniques and embolic material used in UFE.

Clinical Application Potential of Umbilical Cord Mesenchymal Stem Cells in Chemotherapeutic Ovarian Failure

Abstract Chemotherapy is often used for female malignancies, but it can increase the risk of premature ovarian failure in women of reproductive age through different mechanisms. Therefore, how to protect ovarian function and preserve fertility has attracted great attention of oncologists and gynecologists. Recently, umbilical cord mesenchymal stem cells (UCMSCs) have been extensively studied in the field of regenerative medicine. Compared with mesenchymal stem cells (MSCs) from other sources, UCMSCs have a broader application potential due to their properties of lower immunogenicity, fewer ethical issues, and non-invasive collection. Paracrine is one of the most important therapeutic mechanisms of UCMSCs, which can exert anti-inflammatory, anti-fibrosis, anti-oxidative stress, immune regulation, and other therapeutic effects. Studies in animal models have shown that UCMSCs can restore ovarian function after chemotherapy injury. However, most of the relevant researches are still in the preclinical stage. In this article, the mechanism of chemotherapy-induced ovarian failure will be overviewed, and the clinical application potential of UCMSCs in chemotherapeutic ovarian injury will be discussed.

Mutations and Variants Analysis of Inhibin Gene Subunits in Women with Premature Ovarian Failure

This study aimed to illustrate the role of inhibin gene as a candidate gene in women with premature ovarian failure (POF) . In this studysixty women who suffered from POF ; and have menopause at least 8 months after the last period , whose ages range between (20-39) years, venous blood samples were collected from these patients who are admitting to the Children and Maternity Hospital and Al-Hilla teaching hospital in Hilla city/Iraq . Also, forty women with no history of menopause with age range approximately matched to that of patients were included as control group . The genotyping was carried out by using PCR , RFLP and SCCP techniques to identify variants in some of candidates genes associated with POF . So regarding to INHα1 gene , the result showed that there is a significant differences between patients and control groups that related to the presence this subunit .The result of RFLP to investigate the variant in this gene showed that most of patients and all control were homozygous for the wild type G allele , and G allele frequency was (92.8%) in patients group and (100%) in control group whereas A allele frequency was (7.2%) POF patients group and (0%) in the control group . The GG genotypes have frequency (85.7%) in POF and (100%) in control group, whereas the AG was found to be (14.3%) and (0%) in patients and control respectively . The results of INHβA1, INHβB1and INHβB2 mutational screening , it was found that there is a significant differences between presence and absence of this gene in patients and control group at (P value 0.01) for INHβA1. , while no one of patients and control groups show missing of INHβB1and INHβB2 subunits . Using SSCP technique to investigate the presence of variants in INHβA1, INHβB1and INHβB2 genes . The results illustrate that there is a significant differences in comformational changes of these gene subunits in patients and control subjected to this study. And this gave an indicator to relationship of the variants in these subunits with arising of POF in women in our population .

Predictors of Premature Ovarian Failure (POF) in Young Women with Locally Advanced Rectal Cancer (LARC) Treated with Pelvic Radiation Therapy (RT)

Pelvic RT is standard of care for patients with LARC. POF in pre-menopausal women is a possible side effect of this treatment. The predicted rise in rectal cancer in 2030 is 124% for patients 20-34 and 6% for patients 35-49 yrs. The purpose of our study was to evaluate the clinical and dosimetric predictors of POF in women younger than 50 years, treated with pelvic RT for LARC, including those who underwent ovarian transposition (OT). We retrospectively reviewed the medical records of women younger than 50 treated with pelvic RT for LARC at our institution between 2001-2019. Clinical [date of last menstrual period], and hormonal data [FSH, LH, and estradiol levels] were used to determine ovarian function. The ovaries and uterine body/fundus were contoured on the simulation scans by a single dosimetrist, and dose volume histograms were generated. Association of factors with POF was evaluated using Cox regression and optimal dosimetry cut-offs were based on maximum log rank statistic. The study identified 76 women who were premenopausal at time of RT. Median age at RT was 43 years [range 20-49]. Fertility preservation [FP] referral was done for 53% of the women, and 34% underwent OT. Neoadjuvant, concurrent and adjuvant chemotherapy was administered in 74%, 91%, and 34% of women respectively. Median RT dose was 50Gy in 25 fractions. Intensity modulated RT was used in 61% and 39% had 3D-RT. Only 26% had preservation of ovarian function, all in the OT group, and 1 woman carried a high-risk pregnancy 15 years after end of treatments, with premature birth at 25 weeks. Ovarian function was preserved in 77% of women who underwent OT. Median time from start of RT to POF was 17 days [7-54 days], and those patients did not resume menses >1 year after competing treatments. Compared to patients who underwent OT, those who haven’t had significantly higher means of ovarian doses (p<0.001): maximum dose [Right (R): 47.1 vs. 2.7 Gy, Left (L): 46.9 vs. 5.8 Gy], minimum dose [R: 40.6 vs. 0.5 Gy, L: 30.6 vs. 0.8 Gy], and mean dose [R: 45.1 vs. 1.1 Gy, L: 43.7 vs. 1.5 Gy]. Uterine doses were similar [medians >40Gy in both groups]. On univariable analysis, OT (HR: 0.05) and age at RT (HR: 1.18) were significantly associated with POF (p <0.001). At the optimal threshold for ovarian doses, patients with mean R ovarian dose >5.322 Gy had L>4.90 and bilateral >4.12 Gy and were significantly associated with higher risk of POF (HR 16.9, p<.001). However, on multivariable analysis, only OT remained independently associated with risk of POF. RT modality and chemotherapy had no significant effect. OT significantly reduced the risk of POF in our cohort, and should be considered in premenopausal women undergoing pelvic RT. Even with OT, ovarian doses approached 6Gy in some patients. We are currently investigating the role of protons therapy in further sparing the ovaries and uterus.

The etiology and therapeutic strategies of premature ovarian insufficiency in children and adolescents

Premature ovarian insufficiency(POI), previously known as premature ovarian failure(POF), is defined as the occurrence of premature ovarian failure in women under the age of 40 who may present with delayed puberty, primary or secondary(for 4 months or more)amenorrhea with two times and more of abnormal serum hormonal levels(low estradiol and raised gonadotrophins). And POI is not common in children and adolescents.It is generally believed that the etiologies of POI may be genetic, immunological, iatrogenic, etc.Hormone replacement therapy(HRT)is the primary treatment of POI in children and adolescents, and evaluation of therapeutic strategies to POI including cardiovascular, skeletal and emotional health is needed as well.Recently, the incidence of POI in children and adolescents has increased, therefore, early diagnosis and active treatment are urgent and necessary.Thus, this review will mainly be focused on the etiology and treatment of POI in children and adolescents. Key words: Children; Adolescents; Premature ovarian insufficiency; Etiology; Hormone replacement therapy

Exposure to polycyclic aromatic hydrocarbons and risk for premature ovarian failure and reproductive hormones imbalance

Polycyclic aromatic hydrocarbons (PAHs) are a typical class of persistent organic pollutants that is ubiquitous worldwide. Previous animal studies suggested that PAHs had adverse effects on female reproduction. However, the human data regarding relationship of PAHs exposure with women reproductive health, such as ovarian dysfunction, are scarce. In this case-control study, the associations of serum levels of PAHs with the risk of premature ovarian failure (POF) and reproductive hormones in Chinese women were investigated, with recruiting 157 POF patients and 217 healthy women. The serum levels of 12 types of PAHs, as well as reproductive hormones, including follicle-stimulating hormone, luteinizing hormone and anti-mullerian hormone, were determined. In the logistic regression models, most individual PAH congeners showed significantly positive correlations with the risk of POF (p < 0.05), except for fluorine and pyrene. Benzo(a)pyrene (BaP), as the most carcinogenic PAH congener, was observed to be significantly positively associated with the risk of POF. After adjustment for age, body mass index, educational levels and household income, per one-unit increase in the log-transformed BaP concentration was significantly correlated with 2.191-fold increased risk of POF (OR = 2.191, 95%CI: 1.634–2.938, p < 0.05). To the best of our knowledge, this is the first study to report an association between internal exposure levels of PAHs and the increased risk of POF in women.

Urinary levels of phthalate metabolites in women associated with risk of premature ovarian failure and reproductive hormones.

Phthalates, a class of high production-volume chemicals widely used as plasticizers, have been shown to impair ovarian functions in female animals, but epidemiological evidence is very limited. In this case-control study, the associations between phthalate exposure and premature ovarian failure (POF) in women were assessed. A total of 173 POF cases and 246 control women were recruited in Zhejiang, China. The urinary concentrations of 8 phthalate metabolites and the serum levels of ovary-related hormones were determined. Mono-isobutyl phthalate (MiBP) was the metabolite with the highest median concentration of 27.23 μg/g of creatinine in the whole group. Compared with the lowest quartile, higher urinary concentrations of MiBP were significantly associated with increased odds of POF (OR = 1.38, 95% CI: 0.73-2.61 for the fourth quartile; p for trend = 0.01). The estradiol/FSH ratio, a marker of ovarian function, in control women was significantly negatively associated with the urinary concentrations of most tested phthalate metabolites. Our results suggest that exposure to some phthalates may impair ovarian function and increase the odds of POF in women.

Ovarian Follicular Theca Cell Recruitment, Differentiation, and Impact on Fertility: 2017 Update.

The major goal of this review is to summarize recent exciting findings that have been published within the past 10 years that, to our knowledge, have not been presented in detail in previous reviews and that may impact altered follicular development in polycystic ovarian syndrome (PCOS) and premature ovarian failure in women. Specifically, we will cover the following: (1) mouse models that have led to discovery of the derivation of two precursor populations of theca cells in the embryonic gonad; (2) the key roles of the oocyte-derived factor growth differentiation factor 9 on the hedgehog (HH) signaling pathway and theca cell functions; and (3) the impact of the HH pathway on both the specification of theca endocrine cells and theca fibroblast and smooth muscle cells in developing follicles. We will also discuss the following: (1) other signaling pathways that impact the differentiation of theca cells, not only luteinizing hormone but also insulinlike 3, bone morphogenic proteins, the circadian clock genes, androgens, and estrogens; and (2) theca-associated vascular, immune, and fibroblast cells, as well as the cytokines and matrix factors that play key roles in follicle growth. Lastly, we will integrate what is known about theca cells from mouse models, human-derived theca cell lines from patients who have PCOS and patients who do not have PCOS, and microarray analyses of human and bovine theca to understand what pathways and factors contribute to follicle growth as well as to the abnormal function of theca.

Pharmacologic Ovarian Preservation in Young Women Undergoing Chemotherapy

The prognosis of malignancies in young women undergoing chemotherapy has dramatically improved recently, and more attention is given to the long term quality of life, including fertility and reproductive function preservation. Some chemotherapeutic drugs are known to be associated with gonadal toxicity (cyclophosphamide, L-phenylanine mustard, busulfan and nitrogen mustard) and others have less or un-quantified effects (doxorubicin, bleomycin, vinca alkaloids, as vincristine and vinblastin, cisplatin, nitrosoureas, cytosine arabinoside). Women are in need to identify best options to minimize ovarian damage during chemotherapy through the administration of protective drugs, better choice of therapy and with advocating oncofertility preservation. We reviewed the possible options focusing on the most studied gonadotrophin-releasing hormone agonists (GnRH-a) and the psychologically promising oral contraceptives (OC). Controversy exist on the benefit of gonadotrophin releasing hormone agonist (GnRH-a) or combined oral contraceptive administered at time of cancer therapy in preventing premature ovarian failure in women and the available data from both human and animal studies have been mixed. The best way to preserve fertility and ovarian function in young women undergoing chemotherapy still remains to be determined. In the absence of a best approach, each case should be evaluated individually, considering patient's wishes and expectations, the type of chemotherapy, age, obstetric history, ovarian reserve (combining multiple indicators such as basal hormone profile, anti müllerian hormone -AMH- and antral follicle count), family history of premature ovarian failure. We present a review of the available evidence on the value of administering GnRH-a and OC use to minimize or prevent the effect of chemotherapy agents on reproductive function.

In vitro exposure to cigarette smoke induces oxidative stress in follicular cells of F1 hybrid mice

This study assessed the influence of cigarette smoke condensate (CSC) and benzo(a)pyrene [B(a)P] on the levels of two oxidative stress biomarkers [8-isoprostane (8-IsoP) and 8-hydroxy-2-deoxy Guanosine (8-OH-dG)], in in-vitro spent media of follicle cells. Follicles (100-130 µm) isolated from ovaries of F₁ hybrid (C57Bl/6j × CBA/Ca) mice were cultured for 13 days in media exposed to B(a)P [0 ng ml⁻¹ (control) to 45 ng ml⁻¹] or CSC [0 µg ml⁻¹ (control) to 130 µg ml⁻¹]. The concentrations of oxidative stress biomarkers in spent media were quantified by enzyme-linked immune sorbent assays (ELISA). CSC and B(a)P treatment induced a significant, dose-dependent increase in the concentrations of 8-IsoP and 8-OH-dG in the spent media. We conclude that CSC and B(a)P exposure can induce oxidative stress in ovarian follicles, an effect that may contribute to the previously documented decline in follicle development and premature ovarian failure in women who smoke.

Premature ovarian failure in women with ANCA-associated vasculitis

Premature ovarian failure in women with ANCA-associated vasculitis

The silent grief: psychosocial aspects of premature ovarian failure

Objective Premature ovarian failure in women under 40 years is uncommon, but not rare (1–3%), with up to 2.5% of adolescents affected. This study aims to investigate women's experiences of diagnosis, perception of cause, treatment, main concerns, long-term consequences and impact on self-esteem, sexual functioning and health-related quality of life.Design This was a cross-sectional study, using a single-group design, including quantitative and qualitative measures. Two hundred and twenty questionnaires were sent to women recruited from the databases of two London specialist multidisciplinary clinics and from a national premature menopause self-help website. The questionnaire included the Rosenberg's Self Esteem Questionnaire, SF 36 Health Survey (quality of life), the Sexual Personal Experiences Questionnaire and the Young Menopause Assessment questionnaire, following a pilot to assess acceptability and feasibility.Results The response rate was 62% in women aged 19–61 years. The majority of women felt that they had been offered inadequate information; 53% did not know the reason for their condition, 30% obtained a diagnosis within 6 months, and the diagnosis for 22% took up to 3 years. Fertility and bone health were main concerns, followed by emotional well-being. Libido and vaginal dryness were perceived as the main long-term effects by 79% of the women. The internet was the main source of information. The majority requested more information targeted to their age group and 49% requested psychological support, citing a negative impact on their self-esteem.Conclusions This study examined women's perceptions of premature ovarian failure, its impact and the services they received. The results can be used to inform service reconfiguration and improvement.

Anti-müllerian hormone, inhibin B and antral follicle count as markers of premature ovarian failure in women with type I diabetes mellitus

Objective: To evaluate the different markers of ovarian reserve (AMH-Inhibin B , FSH and antral follicle count (AFC) in insulin dependent diabetes mellitus ( IDDM). Methods: We studied 30 patients with IDDM as study groups (10cases>32 years group IV and 20 cases 32 years group II) and 20 healthy women as control groups (8 cases >32 years group III and 12 cases 32 years group I . Serum levels of FSH, LH, inhibin B and AMH were measured at (days 1-7) of menstrual cycle and AFC was done by trans vaginal ultrasound. Results: AMH levels were lower in IDDM patients than in controls > 32 years (2.35 2.2 versus 7.79 difference in the levels of FSH .. AFC is valuable for the diagnoses of premature ovarian failure in IDDM. 1.73 p0.000). Also IDDM groups showed lower levels of inhibin B. While there is no Conclusion: Compared with FSH (AMH and inhibin B) are more valuable for the diagnosis of premature ovarian aging in IDDM patients which developed earlier decline in the ovarian follicle pool compared with the healthy women and also AMH is more valuable than AFC for detection of premature ovarian failure in IDDM.

Anti-müllerian hormone, inhibin B and antral follicle count as markers of premature ovarian failure in women with type I diabetes mellitus

To evaluate the different markers of ovarian reserve (AMH-Inhibin B , FSH and antral follicle count (AFC) in insulin dependent diabetes mellitus ( IDDM).