Occult Ovarian Failure: A Syndrome of Infertility, Regular Menses, and Elevated Follicle-Stimulating Hormone Concentrations

Abstract

Ten women with infertility, regular menses, and elevated plasma FSH concentrations after a failed in vitro fertilization attempt were studied throughout a spontaneous menstrual cycle. Plasma estradiol, progesterone, inhibin, LH, and FSH concentrations were measured by RIA on days 1, 8, 15, and 22 and compared with the ovarian steroid and gonadotropin profiles obtained from seven endocrine-normal women. The elevated FSH concentrations in the hypergonadotropic group were not associated with significant changes in E2 and P4, but an increase in LH concentrations was found on days 1, 8, and 22 (medians of 18 and 4, 17 and 6, and 7 and less than 3 U/L for the hypergonadotropic and normal groups, respectively; P less than 0.01). Their plasma inhibin concentrations [213, 242, 747, and 561 U/L (median values on days 1-7, 8-14, 15-21, and 22-28)] were normal. Autoantibodies to adrenal, thyroid, or ovary were present in five (50%) women, and antiovarian antibodies were present in 4. Two women gave a family history of thyroid disease, and one woman was hypothyroid. Repeat assessment 3-6 months revealed persistently elevated FSH concentrations in five (63%) of eight women; the other three had normal ovarian steroid and gonadotropin concentrations. The triad of infertility, regular menses, and elevated plasma FSH concentrations describes a group of women with occult ovarian failure, a condition of compensated granulosa cell function, which may be an early stage of premature ovarian failure. These women with occult ovarian failure had an impaired response to ovarian hyperstimulation and may be at increased risk of developing polyglandular autoimmunity.

FSH receptor gene polymorphisms have a role for different ovarian response to stimulation in patients entering IVF/ICSI-ET programs

“…A group of imminent ovarian failure (IOF) patients characterized by regular menstrual cycles and slightly elevated follicular phase FSH, has been previously described (23). These patients are often referred to as having imminent or incipient ovarian failure (24)(25)(26). In our study we named them "ovarian dysfunction" patients.…”

Occult form of premature ovarian insufficiency

“…However, most commonly, there is a prodromal period of oligomenorrhea. Occult ovarian failure, which may be an early stage of the POI, was first described by Cameron IT and colleagues in 1988 as the triad of infertility, regular menses and elevated plasma FSH concentrations [8]. Women with an occult form of POI may have spontaneous follicular activity, and if hormonal tests are performed during such episodes, levels of FSH and estradiol could be in the normal range, or FSH could be elevated only minimally.…”

Hormonal and sonographic assessment of ovarian reserve before and after laparoscopic ovarian drilling in polycystic ovary syndrome

“…It is a major determinant of human fertility potential. Diminished ovarian reserve reflects the process of follicular depletion and decline in oocyte quality 1,2 and can be considered as an accurate measure for ovarian function.…”