Premature Ovarian Failure (POF)

Also called as Primary Ovarian Insufficiency, premature ovarian failure denotes the cessation of normal ovarian function before the age of 40 years. Now as one would know the ovaries have two basic functions -

1. Production and release of eggs and
2. Production and release of female sex hormones like Estrogen. Thus, it would be obvious that if ovaries fail not only a woman would have a pre-menopause or irregular periods, but also Infertility.

Premature ovarian failure is not the same as Premature menopause, but a milder form of it. In premature menopause, there is complete cessation of all ovarian functions to a complete halt. The woman attains menopause and there is no menstruation and there are no follicles left. Whereas in Premature Ovarian Failure, there is an abnormal destruction of ovarian follicles such that only very few remain. The woman suffering from POF might get irregular, scant periods. Both conditions have low circulating Estrogen levels and both conditions have infertility.

Symptoms of Premature Ovarian Failure

Depending on the severity of ovarian tissue destruction, the symptoms would vary from none at all to full blown menopausal. Some of the symptoms of POF include :-

Causes of Premature Ovarian Failure

• The most common cause of POF is idiopathic - i.e. no cause is found. There is no apparent explanation why the woman lost most or all of her ovarian tissue.
• Auto-immune conditions like anti-thyroid antibodies or anti-parathyroid
• Hepatitis B or HIV infections
• Galactosemia (genetic disease)
• Karyotypical problems - i.e. chromosomal disorders. This is a relatively common cause and could be hereditary so the woman might have a family history of her mother or sisters having similar trends.
• Renal or Hepatic diseases
• Iatrogenic - i.e. when during previous operations like Ovarian Drilling or Ovarian Cystectomy there is a destruction of significant ovarian tissue.

Testing for Premature Ovarian Failure

A thorough and careful medical history will go a long way in clinching the right diagnosis for the patient. Tests are only to confirm the diagnosis, and some of them include :-

• Serum baseline FSH - done on day 2 or 3 of menses, serum FSH more than 10 indicates low ovarian reserve and if more than 15 indicate impending ovarian failure.
• Serum AMH - low AMH levels indicate Poor Ovarian Reserve which is a common finding in patients with Premature Ovarian Failure.
• Immunological tests - like Anti-thyroid bodies, etc. can sometimes be done but the clinical utility of these tests is limited.
• Karyotyping - this is basically taking a photography of the patient’s chromosomes laid out in order. This is a useful test to see if there is any genetic cause of POF.

When should you consult an IVF centre or visit a Fertility specialist?

It is a norm that after the age of 37 you shouldn’t wait more than 3 months of trying before seeing a doctor. Between 35 to 37 years you can try for 6 months. Waiting and trying for natural conception makes sense only if you have no symptoms. If you have problems like irregular menses or scanty periods you should visit a good fertility specialist and at least have yourself evaluated. Investigations might reveal an impending ovarian failure with low reserve and this is the crucial time when assisted conception can help you conceive with your own eggs. Delaying or missing out on this time can prove hazardous.

Treatment of Premature Ovarian Failure at Janini IVF

• Premature Ovarian Failure is an irreversible condition. In other words, until now there were no magic pills or injections that could bring about a new production of eggs in the ovaries. The Gonadotropic injections that we give during IVF/ICSI only increase the size of the follicles - they do not produce new follicles.
• Having said that, once you are diagnosed with POF, there is no time to waste. We will do an AFC test via Ultrasound and also serum AMH and determine whether we can go for IVF with your own eggs. Our extensive experience with women with poor ovarian reserve is testament to the fact that Janini IVF, providing the best ivf treatment center in Delhi, is the preferred destination for these challenges cases.
• Dr Dalal at Janini IVF uses individualised treatment protocols to ensure maximal harvest of good quality oocytes from you. By the skilful handling of our Lab Director - Dr Akanksha Mishra we can freeze your oocytes or embryos and go for Cryo-accumulation. This would maximise your chances of successful conception with your own eggs, and this is what we excel in doing.
• If however the AMH is too low or there are hardly any follicles left, Donor egg IVF remains as the only viable option. Donor egg IVF program has excellent success rates
• Stem cell treatment - this can be a new ray of hope for patients with Premature Ovarian Failure. There are newer studies being done wherein scientists have injected patient’s own stem cells or PRP (Platelet Rich Plasma) inside the ovaries by laparoscopy. Although a new approach, there are encouraging reports coming out in medical literature wherein people have observed new follicles growing even in the most severe cases of POF.