Counting Down: Primary Ovarian Insufficiency

For most women, their supply of viable eggs begins to run out after the age of 40. Their menstrual periods become irregular, signaling the onset of menopause. But for some, this process begins early, before 40. This is known as primary ovarian insufficiency (POI) or premature ovarian failure (POF).

A woman is born with a certain number of eggs, and that’s all she’ll get for her entire life. Each month, a few of those eggs mature until eventually one — or rarely, several — are released, ready to be fertilized.

How can you tell if you are experiencing POI/POF or likely to develop the condition? How can this condition affect your chances of conceiving? Let’s take a look.

Symptoms & Causes

The symptoms of primary ovarian insufficiency are similar to those of normal menopause, many resulting from the imbalance of hormones like estrogen and progesterone:

  • Hot flashes
  • Irritability
  • Trouble concentrating
  • Lowered sex drive
  • Vaginal dryness
  • Higher likelihood of developing osteoporosis

The precise cause of POI/POF is unknown. Women with certain genetic disorders — such as Turner syndrome, where a woman has only one X chromosome — are more likely to develop the condition. Exposure to chemicals or radiation, including chemotherapy and radiation therapy, may damage the ovaries and lead to POI/POF. Finally, the condition may be caused by some autoimmune disorders, where the body’s immune system attacks its own tissue, including the ovaries.

Fertility & Treatment

Unfortunately, one of the first signs that women notice before they are even diagnosed with POI/POF is an inability to conceive. Periods can become irregular or stop altogether for some period of time. In most cases of POI/POF, unassisted pregnancy is not possible.

There is no treatment to reverse POI/POF. However, various treatments can reduce the symptoms of the condition, including those affecting fertility like irregular periods.

  • Hormone replacement therapy can eliminate hot flashes and may improve pregnancy rates by normalizing levels of luteinizing hormones (LH), though results are unclear on this count.
  • Calcium supplements and vitamin D strengthen bones. When used in conjunction with regular exercise, they lower the chances of osteoporosis.
  • Treatment for underlying conditions like genetic and autoimmune disorders — when possible — can slow POI/POF.

About 5% of women who have primary ovarian insufficiency may conceive without any fertility treatment. In these so-called “spontaneous remissions,” the ovaries begin functioning regularly on their own, though symptoms may return at any time.

For the majority of women, however, other forms of fertility treatment may be necessary. The only treatment that is highly likely to result in pregnancy is in vitro fertilization with a donor egg. In some cases, though, a course of estrogen replacement therapy followed by human menopausal gonadotropins has resulted in pregnancy in women with POI/POF.

If you are having trouble conceiving and start to experience the symptoms of POI/POF, consult your doctor about what tests and treatments may be in order. If you want more information about improving fertility or tips for conceiving, follow us on Facebook and Twitter, or sign up for our newsletter below.