Diagnosis Of Premature Ovarian Insufficiency Research Articles

Pregnancy following diagnosis of premature ovarian insufficiency: a systematic review.

The aim of this review is to report the occurrence of pregnancies in women with premature ovarian insufficiency (POI), naturally or with different treatments (hormonal replacement therapy, IVF, in-vitro maturation and stem cell therapy). This study involved an exhaustive search of the electronic databases MEDLINE, PubMed and Embase covering the period January 2000 to January 2018. A combination of Medical Subject Heading and text words was used to generate a subset of citations, including studies involving POI ('premature menopause' or 'premature ovarian failure' or 'POI' or 'hypergonadotrophic amenorrhoea'). This subset of citations was then combined with 'AND' to the Medical Subject Heading term 'pregnancy'. Fifteen studies were included in this review. Two randomized controlled trials, two observational studies, and 11 interventional studies reporting cases of pregnancy in women with POI were included. This review reports pregnancy rates across studies ranging from 2.2% to 14.2%. Mean age in patients who achieved a pregnancy was 30 years, highlighting that oocyte quality in these patients is likely unaffected. No treatment has thus far shown its superiority in improving fertility in women with POI. Recent advances in options such as in-vitro maturation and stem-cell therapy, however, are likely to be the future of treatment and may generate new hope for these patients.

Survey of Canadian PGY-4 and PGY-5 Obstetrics and Gynaecology Residents on Knowledge of and Exposure to Premature Ovarian Insufficiency.

(1) To determine exposure to and general knowledge on premature ovarian insufficiency (POI) among Canadian senior obstetrics and gynaecology residents. (2) To identify opportunity to improve trainee exposure to POI. Canadian PGY-4 and PGY-5 obstetrics and gynaecology residents were approached to complete an electronic survey. The questions in the survey included the basic POI knowledge, previous exposure to POI, and comfort level in managing POI patients. Data from the survey was summarized descriptively and compared between two trainee groups (PGY-4 and PGY-5) using chi-square or Fisher exact tests. Responses were received from trainees in all Canadian residency programs with an overall response rate of 45% (95/210 residents). Most respondents (79%, 75/95 residents) identified correct age for POI diagnosis, and 65% (62/95 residents) recognized the most common aetiology. A majority (99%, 92/93 residents) would prescribe hormone therapy for POI patients. Most trainees (62%, 59/95 residents) lack access to a POI clinic at their centre and 63% (59/94 residents) have seen less than six POI patients during residency training. Most feel somewhat comfortable managing POI patients (67%, 64/95 residents), but 22% (21/95 residents) feel totally uncomfortable with a majority of respondents (83%, 78/94 residents), indicating they would benefit from additional training. Compared with PGY-4 residents, the proportion of trainees who could identify the correct age for diagnosis of POI was significantly higher in PGY-5 residents (89% vs. 70%, P = 0.024). Many senior obstetrics and gynaecology residents in Canada lack knowledge around POI, and most indicate need for further exposure to POI during residency training. We identified an opportunity for improved POI curricula.

Mood disorders in women with premature ovarian insufficiency.

Premature ovarian insufficiency (POI) and related oestrogen deficiency is a cause of many psychological symptoms, including: depression, psychological tension, anxiety, mood lability, loss of libido, feelings of loss of femininity and attractiveness, and decreased self- and sexual esteem. Distress related to POI diagnosis may be even more confusing when POI is diagnosed in relation to serious health complications such as cancer, due to surgery or chemotherapy. Every case of POI requires coordinated medical advice with special attendance of a gynaecological endocrinologist, psychotherapist, and sometimes even a psychiatrist.

Utility of complete blood count parameters to detect premature ovarian insufficiency in cases with oligomenorrhea/amenorrhea.

There are very few biomarkers available to diagnose cases with premature ovarian failure. Some complete blood count parameters have been introduced to be diagnostic biomarkers for several disorders associated with inflammatory process. Due to the evidence that indicated chronic inflammatory process to be underlying pathophysiology in premature ovarian insufficiency (POI), we aimed to assess the predictive value of complete blood count parameters for POI diagnosis. A total of 96 women diagnosed to have premature ovarian failure were compared with 110 otherwise healthy women in terms of some basal hormone levels and complete blood count parameters. Mean age was similar between groups. Neutrophil/lymphocyte and mean platelet volume/lymphocyte ratios were significantly higher in group with POI (P<.001, P<.003, respectively). In group with POI, there were significant correlations between anti-Mullerian hormone and follicle stimulating hormone (r=-.30, P<.05), anti-Mullerian hormone and white blood cell count (r=.23, P<.05). Mean platelet volume/lymphocyte ratio significantly predicted cases with POI (AUC=0.607, %95 CI: 0.529-0.684; P<.001). Neutrophil/lymphocyte and mean platelet volume/lymphocyte ratios are elevated in POI. There have been some controversies about the value of neutrophil/lymphocyte in POI diagnosis. We suggest mean platelet volume/lymphocyte ratio as a new biomarker in early POI because it is cheap and easily accessible compared to anti-Mullerian hormone.

How polymorphic markers contribute to genetic diseases in different populations? The study of inhibin A for premature ovarian insufficiency.

ABSTRACTObjective To verify the incidence of the G679A mutation in exon 2 of the gene inhibin alpha (INHA), in women with secondary amenorrhea and diagnosis of premature ovarian insufficiency, and in controls.Methods A 5mL sample of peripheral blood was collected from all study participants in an EDTA tube and was used for DNA extraction. For the patient group, 5mL of blood were also collected in a tube containing heparin for karyotype, and 5mL were collected in a dry tube for follicle stimulant hormone dosage. All patient and control samples were initially submitted to analysis of the G679A variant in exon 2 of the INHA gene by PCR-RFLP technique. Samples from patients with premature ovarian insufficiency after PCR-RFLP were submitted to Sanger sequencing of the encoding exons 2 and 3. Sequencing was performed on ABI 3500 GeneticAnalyzer equipment and the results were evaluated by SeqA and Variant Reporter software.Results Samples of 70 women with premature ovarian insufficiency and 97 fertile controls were evaluated. The G769A variant was found in only one patient in the Premature Ovarian Insufficiency Group and in no control, and it appears to be rare in Brazilian patients with premature ovarian insufficiency. This polymorphism was previously associated to premature ovarian insufficiency in several populations worldwide.Conclusion There is genetic heterogeneity regarding the INHA gene in different populations, and among the causes of premature ovarian insufficiency.

Premature Ovarian Insufficiency in Childhood Cancer Survivors: A Report From the St. Jude Lifetime Cohort.

Long-term follow-up data on premature ovarian insufficiency (POI) in childhood cancer survivors are limited. To describe the prevalence of POI, its risk factors, and associated long-term adverse health outcomes. Cross-sectional. The St. Jude Lifetime Cohort Study, an established cohort in a tertiary care center. Nine hundred twenty-one participants (median age, 31.7 years) were evaluated at a median of 24.0 years after cancer diagnosis. POI was defined by persistent amenorrhea combined with a follicle-stimulating hormone level >30 IU/L before age 40. Multivariable Cox regression was used to study associations between demographic or treatment-related risk factors and POI. Multivariable logistic regression was used to study associations between POI and markers for cardiovascular disease, bone mineral density (BMD), and frailty. Exposure to alkylating agents was quantified using the validated cyclophosphamide equivalent dose (CED). The prevalence of POI was 10.9%. Independent risk factors for POI included ovarian radiotherapy at any dose and CED ≥8000 mg/m2. Patients with a body mass index ≥30 kg/m2 at the time of the St. Jude Lifetime Cohort assessment were less likely to have a diagnosis of POI. Low BMD and frailty were independently associated with POI. High-dose alkylating agents and ovarian radiotherapy at any dose are associated with POI. Patients at the highest risk should be offered fertility preservation whenever feasible. POI contributes to poor general health outcomes in childhood cancer survivors; further studies are needed to investigate the role of sex hormone replacement in improving such outcomes.

Premature ovarian insufficiency: from pathogenesis to clinical management.

Premature ovarian insufficiency (POI) represents a condition characterized by the absence of normal ovarian function due to an incipient (by 3-10 years) ovarian aging. In most of the women affected there are no signs or symptoms that precede the interruption of menstruation and the onset of POI and the majority of women have a normal history of menarche, regular menstrual cycles and normal fertility. The possible genetic role in the development of POI has been largely demonstrated and many genes have been involved; on the other hand, ovary is not protected immunologically and the detection of autoantibodies directed against various ovarian targets strongly support the hypothesis of an autoimmune etiology. In approximately 5-10% of women with a diagnosis of POI with a normal karyotype, a spontaneous pregnancy could occur even if the recovery of ovarian function is temporary and poorly predictable. Embryo donation and adoption are other alternatives that should be considered. POI and subsequent loss of reproductive capacity is a devastating condition and a difficult diagnosis for women to accept so it requires an individualized and a multidisciplinary approach. Hormonal replacement therapy (HRT) should be commenced as soon as possible to prevent and to contrast the onset of the symptoms related to hypoestrogenism and to improve the quality of life for these women.

Premature ovarian insufficiency in young girls: repercussions on uterine volume and bone mineral density

Study objective: To evaluate biological differences among young subjects with premature ovarian insufficiency (POI) commencing at different stages of life.Design: Retrospective observational study.Setting: Careggi University HospitalParticipants: One hundred sixty-two females aged between 15 and 29 years with premature ovarian insufficiency.Methods: Data were collected as a retrospective chart review of baseline evaluation at diagnosis of premature ovarian insufficiency (POI). About 162 participants were divided into four groups based on gynecological age. Two primary outcome variables (uterine development and bone mineral density (BMD)) were analyzed in terms of differences among groups and in a multivariate logistic regression analysis.Results: Uterine development was clearly jeopardized when estrogen insufficiency started at a very young age. Total body BMD showed significant differences among the four groups studied, clearly corresponding to the duration of ovarian function. Data were discussed in relation to the choice of hormone replacement therapy regimens.

Elevated LH levels draw a stronger distinction than AMH in premature ovarian insufficiency

Objectives A significant number of individuals have high serum follicle stimulating hormone (FSH) levels but do not meet the criteria for diagnosis of premature ovarian insufficiency (POI) due to ongoing menstruation. We compared a group of women with elevated FSH levels and POI with a control group in terms of biochemical markers.Methods In this cross-sectional retrospective study, 38 POI cases and 48 cases of elevated FSH were compared to 89 individuals in a control arm in terms of biochemical markers. The receiver operating characteristics curve was calculated to assess the utility of anti-Müllerian hormone (AMH) levels to discriminate women with elevated FSH levels accompanied by POI from those women with elevated FSH levels but not defineable as having POI.Results A multiple regression analysis revealed that only the AMH level was significantly different for the discrimination between the control and elevated FSH groups. AMH and estradiol levels were found to be statistically significant for the discrimination between control and POI cases. However, only luteinizing hormone (LH) was found to be significant for distinguishing between women with elevated FSH and POI, interestingly excluding the serum AMH level in this context.Conclusions AMH was the most important and superior marker to differentiate both POI cases and patients with an elevated FSH level from the controls; however, it did not show the same resolution for differentiating POI cases from those with elevated FSH. Moreover, we conclude that the serum LH level is the most useful marker for differentiating POI cases from women with elevated FSH levels.

POI: Premature ovarian insufficiency/pregnancy or infertility?

Dear Editor, Premature ovarian insufficiency (POI) is a condition associated with female infertility that affects approximately 1% of women under the age of 40.[1] It is characterized by amenorrhea, hypoestrogenism and elevated level of gonadotropins. Although the causes of POI are largely unknown, autoimmune diseases, chromosomal abnormalities and environmental factors seem to play an important role in the etiopathology.[2] Most women have normal menstrual history, age of menarche and possible fertility prior the onset of POI symptoms (i.e., vaginal dryness, night sweats, or hot flushes). A definitive diagnosis of POI is difficult to make, and the diagnostic criteria are not always standard.[3] Most clinicians would make the diagnosis based on (i) 3-6 months of amenorrhea, (ii) Follicular Stimulating Hormone (FSH) levels above 40 mIU/ml and (iii) low estrogens levels.[2] In this syndrome, the ovarian failure is not permanent. Indeed, some women experience intermittent and unpredictable ovarian function and in some cases may even conceive spontaneously.[4] We report a case of a 28-year-old woman, who was presented to our infertility unit, with 16 months of primary infertility. Her personal history for previous surgery or other relevant pathologies was negative. Menarche occurred at age of 12, followed by regular menstrual bleeding. At 22, she commenced on birth-control pill that stopped 2 years later. Before starting any treatment, hormonal profile of the couple and a sperm test for the partner were planned. They all resulted normal. After 4 failed intrauterine insemination (IUI) cycles, the couple underwent 2 in vitro fertilization (IVF) cycles preceded by a karyotype analysis that resulted normal. They both ended with few oocytes retrieved (3 and 1 respectively) and none fertilized. Before all procedures, the patient was stimulated with high doses of recombinant-FSH, followed by daily dose of GnRH antagonist ganirelix when at least two follicles had reached 14 mm diameter. Ovulation triggering was performed using a subcutaneous injection of corio gonadotropin alpha. Five months after the last IVF-cycle, the patient came back referring amenorrhea. Laboratory tests revealed FSH level at 65 and 75 mUI/mL (menopause > 40 mUI/mL), estradiol (E2) at 33 and 26 pg/mL (menopause < 40 pg/mL) and anti-mullerian hormone (AMH) at 0.0 ng/mL in two serial determinations. A diagnosis of POI was made. The couple was then listed for oocyte donation. One year later, the patient experienced a menstrual bleeding and a month after a pregnancy test resulted positive. Nine months later a healthy baby was delivered. Although pregnancy in POI patients is a rare event, it should be always taken into consideration, given the possibility of spontaneous resumption of the ovarian function.