A prospective evaluation of antral follicle function in women with 46,XX spontaneous primary ovarian insufficiency

Hubayter, Z.R.; Popat, Vaishali B.; Vanderhoof, Vien H.; Ndubizu, Obioma; Johnson, D. L.; Mao, Edie; Calis, Karim A.; Troendle, James; Nelson, Lawrence M.

doi:10.1016/j.fertnstert.2009.10.023

Cited by 42 publications

(32 citation statements)

References 44 publications

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“…One possible explanation for this observation is that the estrogen included in the HRT regimens may reduce the serum FSH level and thereby trigger follicle growth by inhibiting FSH-mediated down-regulation of the FSH receptor [3,21,22]. This hypothetical mechanism, however, has been recently questioned [23]. Regardless, we treat patients with POI and desired fertility with cyclic EPT similar to conventional HRT.…”

Section: Discussionmentioning

confidence: 99%

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: 99%

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

et al. 2013

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“…There are two main aetiological mechanisms, which give rise to a heterogeneous spectrum of ovarian manifestations. The first is follicle depletion resulting in ovaries devoid of follicles (afollicular POI) and the second mechanism is follicle dysfunction, resulting in a spectrum of follicle development, from the presence of a variable population of follicles, including antral follicles, that fail to develop or the presence of only primordial follicles (follicular POI) (Nelson et al 1994, Meskhi & Seif 2006, Nelson 2009, Hubayter et al 2010, Suzuki et al 2015). Follicular POI accounts for around 50% of cases (Mehta et al 1992, Nelson et al 1994, Massin et al 2004, Suzuki et al 2015).…”

Section: Introductionmentioning

confidence: 99%

Dysregulation of follicle development in a mouse model of premature ovarian insufficiency

Grasa¹,

Sheikh²,

Krzys³

et al. 2016

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Premature ovarian insufficiency (POI) occurs in 1% of reproductive-age women. The ovarian manifestation ranges from the presence of a variable population of follicles (follicular) to the absence of follicles (afollicular), and in the majority of cases the cause is unknown. A transgenic mouse model of follicular POI, the Double Mutant (DM), arises from oocyte-specific deletion of Mgat1 and C1galt1 required for the generation of O- and N-glycans. DM females are subfertile at 6 weeks, infertile by 9 weeks and exhibit POI by 12 weeks of age. In this study we investigate the cause of the reduced fertility at 6 weeks and infertility at 9 weeks of DM females. Ovary sections were used to analyse follicle and corpora lutea (CL) numbers, apoptosis, and levels of laminin and 3β-hydroxysteroid dehydrogenase using immunohistochemistry. After POI, DM females unexpectedly remained sexually receptive. At both 6 and 9 weeks, DM ovaries contained more primary follicles, however, at 9 weeks DM follicles were proportionally healthier, revealed by TUNEL analysis compared with Controls. In 9 week DM ovaries (collected post-mating), secondary follicles had theca and basal lamina structure abnormalities, whilst preovulatory follicles failed to ovulate resulting in the presence of numerous luteinised unruptured follicles, indicative of ovulation failure. Finally, DM ovaries contained more regressing CL with decreased luteal cell apoptosis indicative of a defect in CL regression. Identifying these follicular modifications have provided insight into the aetiology of a model of POI and highlight targets to investigate with the hope of developing new fertility treatments.

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“…Nearly 3 out of 4 women with POI have ovarian follicles remaining in the ovary (63). It is clear that POI in most cases is not a “failure” of the ovary, but rather intermittent and unpredictable ovarian function that can persist for decades.…”

Section: Benefits and Risks Of Hrt In Women With Poi And Early Menopausementioning

confidence: 99%

Hormone replacement therapy in young women with primary ovarian insufficiency and early menopause

Sullivan

Sarrel

Nelson

2016

Fertility and Sterility

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355

233

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Primary ovarian insufficiency (POI) is a rare but important cause of ovarian hormone deficiency and infertility in women. In addition to causing infertility, POI is associated with multiple health risks, including bothersome menopausal symptoms, decreased bone density and increased risk of fractures, early progression of cardiovascular disease, psychological impact that may include depression, anxiety, and decreased perceived psychosocial support, potential early decline in cognition, and dry eye syndrome. Appropriate hormone replacement therapy to replace premenopausal levels of ovarian sex steroids is paramount to increasing quality of life for women with POI and ameliorating associated health risks. In this review, we discuss POI and complications associated with this disorder, as well as safe and effective hormone replacement therapy options. To decrease morbidity associated with POI, we recommend using HRT formulations that most closely mimic normal ovarian hormone production and continuing HRT until the normal age of natural menopause, ~50 years. We address special populations of women with POI, including women with Turner Syndrome, women with increased risk of breast or ovarian cancer, women approaching the age of natural menopause, and breastfeeding women.

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A prospective evaluation of antral follicle function in women with 46,XX spontaneous primary ovarian insufficiency

Cited by 42 publications

References 44 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

Dysregulation of follicle development in a mouse model of premature ovarian insufficiency

Hormone replacement therapy in young women with primary ovarian insufficiency and early menopause

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