A New Approach to Primary Ovarian Insufficiency

Rafique, Saima; Sterling, Evelina W.; Nelson, Lawrence M.

doi:10.1016/j.ogc.2012.09.007

Cited by 75 publications

(49 citation statements)

References 111 publications

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“…Indeed, if a woman with POI has sexual intercourse 2 or 3 times a week for > 2 years, the probability of ovulation and conception may be similar to that which occurs with close monitoring [24]. We routinely explain the evidence-based effectiveness of oocyte donation, although not readily available in Japan, and the possible benefits of expectant management without follicle monitoring.…”

Section: Discussionmentioning

confidence: 98%

Achievement of pregnancies in women with primary ovarian insufficiency using close monitoring of follicle development: case reports

et al. 2013

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Women with primary ovarian insufficiency (POI) or premature ovarian failure (POF) display hypergonadotropic hypogonadism due to follicle dysfunction and depletion before 40 years of age. Women with POI extremely rarely ovulate and achieve pregnancy spontaneously; however, it is believed that 5%-10% of such women will conceive and deliver a child after the diagnosis is established [1,2]. Numerous treatment protocols for follicular development and ovulation induction have been tested in women with POI; however, none have approached the success rate of utilizing donor oocytes [1,3]. Thus, for couples affected by POI the only practical alternatives for having a child are adopAchievement of pregnancies in women with primary ovarian insufficiency using close monitoring of follicle development: case reports Abstract. Women with primary ovarian insufficiency (POI)/premature ovarian failure exhibit hypergonadotropic hypogonadism due to follicle dysfunction and depletion before the age of 40 years. Because ovulation is extremely rare and thought to be unpredictable in women with POI and because no ovulation induction regimens have been shown to be efficacious, oocyte donation is the only evidence-based treatment for women with POI with desired fertility. Oocyte donation is, however, extremely limited in several countries including Japan. Here, we report four women with POI who achieved pregnancies resulting from timed intercourse or intrauterine insemination in combination with cyclic estrogen/progesterone therapy and close monitoring of follicle development. These four patients were diagnosed with POI at the mean age of 27.5 ± 8.5 (mean ± SD; range, 19-35), subjected to follicle monitoring at the mean age of 29. 8 ± 5.7 (23-35), and conceived at the mean age of 34.5 ± 3.9 (29-38). The interval between the initiation of follicle monitoring and pregnancy was 4.8 ± 2.8 (2-8) years. In one of the patients, her most recent ovulation occurred after a three-year interval. All four patients had uncomplicated pregnancies with term deliveries. In the event that oocyte donation and adoption are not available and/or various treatments with intensive ovulation induction have been unsuccessful, close and continuous monitoring of follicle growth to identify very rare ovulatory events might be considered for patients with POI and desired fertility.

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Section: Discussionmentioning

confidence: 98%

Achievement of pregnancies in women with primary ovarian insufficiency using close monitoring of follicle development: case reports

et al. 2013

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“…24,34 Furthermore, the present study is also of interest for the management and treatment of women with primary ovarian insufficiency. 35,36 Whereas E2 lost its efficacy on FMR after prolonged ovariectomy, HF arteries are able to develop hypertrophy so that the wall-to-lumen ratio was excessively high. This has been associated with the occurrence of vascular disorders, 37 strengthening the importance of E2 and timing in the protection of the vascular wall.…”

Section: Discussionmentioning

confidence: 99%

Determinants of Flow-Mediated Outward Remodeling in Female Rodents

Tarhouni

Guihot

Vessières

et al. 2014

ATVB

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Objective-Flow (shear stress)-mediated outward remodeling (FMR) of resistance arteries is a key adaptive process allowing collateral growth after arterial occlusion but declining with age. 17-β-estradiol (E2) has a key role in this process through activation of estrogen receptor α (ERα). Thus, we investigated the impact of age and timing for estrogen efficacy on FMR. Approach and Results-Female rats, 3 to 18 months old, were submitted to surgery to increase blood flow locally in 1 mesenteric artery in vivo. High-flow and normal-flow arteries were collected 2 weeks later for in vitro analysis. Diameter increased by 27% in high-flow arteries compared with normal-flow arteries in 3-month-old rats. The amplitude of remodeling declined with age (12% in 18-month-old rats) in parallel with E2 blood level and E2 substitution failed restoring remodeling in 18-month-old rats. Ovariectomy of 3-, 9-, and 12-month-old rats abolished FMR, which was restored by immediate E2 replacement. Nevertheless, this effect of E2 was absent 9 months after ovariectomy. In this latter group, ERα and endothelial nitric oxide synthase expression were reduced by half compared with age-matched rats recently ovariectomized. FMR did not occur in ERα −/− mice, whereas it was decreased by 50% in ERα +/− mice, emphasizing the importance of gene dosage in high-flow remodeling. Conclusions-E2 deprivation, rather than age, leads to decline in FMR, which can be prevented by early exogenous E2.However, delayed E2 replacement was ineffective on FMR, underlining the importance of timing of this estrogen action. 15 The initial results suggested a negative impact of the treatment, leading to a worldwide reduction in the use of substitution therapies. Nevertheless, recent publications with a more detailed analysis of the data countermanded the initial conclusion. Interestingly, a major difference in the effect of hormones between younger and older women has been shown. Indeed, the treatment tended to confer coronary protection in women treated within 10 years after menopause, whereas a latter treatment may induce deleterious effects. 24 The mechanisms accounting for the impact of timing in the atheroprotective action of estrogens has been recently reviewed. 15 In particular, it has been described, in the atheroma plaque, a decreased ERα expression 16,25 and an increase in 27-hydroxycholesterol (27HC) production. 26 Indeed, 27HC is a competitive antagonist of ER action, which can counteract the protective action of 17-β-estradiol (E2). 26To better understand to which extent a timing effect also can impact the function of arterioles, we investigated FMR of resistance arteries in young and old female rats and then in young ovariectomized rats as a model of surgical menopause. Materials and MethodsMaterials and Methods are available in the online-only Supplement. Results Estradiol Blood Level and FMRFourteen days after arterial ligation, arterial diameter was determined in vitro in response to stepwise increases in intraluminal pressure. Passive arterial diamet...

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“…A transvaginal ultrasound imaging of the ovaries is one of the relevant diagnostic tests in patients with POI. Findings of a normal ovarian size/volume and the presence of a high antral ovarian follicle count (46) make the diagnosis of POI less likely [9]. In patients with occult POI, spontaneous pregnancy and IVF programs with their own oocytes are still possible.…”

Section: Introductionmentioning

confidence: 99%

Occult form of premature ovarian insufficiency

Shestakova

Radzinsky

Хамошина

2016

Gynecological Endocrinology

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Premature ovarian insufficiency (POI) is a life-changing diagnosis, with profound physical and psychological consequences. Despite the description of different genetic, immune and iatrogenic factors of POI, the etiology of most cases of this disease are unexplained, and optimal management strategies are still unclear. Recent data showed that POI may have a long period of oligomenorrhea before the fully developed form (complete ovarian failure stage), with the occurrence of amenorrhea and climacteric symptoms. The main problem in the recognition of early stages of POI is the lack of proper diagnostic criteria. Patients with an undiagnosed occult form of POI may present with menstrual irregularities, unexplained infertility or repeated IVF failures. We evaluated 23 patients with unexplained oligomenorrhea and/or infertility. After a proper evaluation of these patients, a low ovarian reserve was identified, and an occult form of POI was diagnosed. KeywordsAmenorrhea, antral follicle count (AFC), infertility, occult premature ovarian insufficiency, oligomenorrhea, ovarian reserve, premature ovarian failure, premature ovarian insufficiency (POI), premature menopause

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A New Approach to Primary Ovarian Insufficiency

Cited by 75 publications

References 111 publications

Achievement of pregnancies in women with primary ovarian insufficiency using close monitoring of follicle development: case reports

Achievement of pregnancies in women with primary ovarian insufficiency using close monitoring of follicle development: case reports

Determinants of Flow-Mediated Outward Remodeling in Female Rodents

Occult form of premature ovarian insufficiency

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