Causes of infertility- premature ovarian failure
Premature ovarian failure is a condition diagnosed in about 12% of patients of infertility treatment clinics. It usually occurs in women aged 23-40.
How to diagnose premature ovarian failure?
Premature ovarian failure can be indicated by menstrual cycle disorders, such as excessively long cycles or irregular periods. In ultrasound examination, the disease is manifested by a small number of ovarian follicles and a reduced ovarian volume.
Laboratory tests detect a decrease in the level of AMH hormone in blood, followed by a decrease in the level of Inhibin B and, finally, an increase in follicle-stimulating hormone (FSH) and a decrease in oestradiol levels.
Causes of premature ovarian failure.
Premature ovarian failure may result from radiotherapy or chemotherapy as part of anticancer treatment. Ovarian damage may also be caused by surgeries in the area of the appendages, carried out in connection with the presence of cysts or tumours. If the cause of premature ovarian failure is different, the physician will refer a patient for karyotype and FRAX tests to exclude the genetic factor. The next step is to start the treatment appropriate to the patient's age and the degree of diminished ovarian function.
What are the treatment possibilities?
In young patients with patent ovaries and even a small ovarian response to stimulation, stimulated cycles are performed. The partner’s semen should have the parameters within the range of normal. The cumulative effectiveness of treatment with the use of stimulation protocols does not exceed 25% in this case. No pregnancy after 6 stimulated cycles may be an indication for in vitro fertilization.
Patients over 35 years of age or with a severely limited ovarian reserve (AMH hormone concentration below 0.25) should first attempt in vitro egg cell collection. The stimulation of ovarian activity is usually non-standard in their case, and the stimulation protocols used are combined with the so-called priming, i.e. preparation of the cycle (estrogen and androgens such as testosterone and DHEA are helpful here).
Statistics show that in about 35% of the cycles there are unsuccessful attempts to collect normal egg cells or embryos. In terms of a single transfer, the effectiveness of treatment is about 16%. When there is no chance of effective stimulation, and when in vitro fertilization does not work, the couple can join the egg cell adoption program.