gynecology and obstetrics
Primary Ovarian Insufficiency
Treatment of Primary Ovarian Insufficiency
Estrogen/progestogen contraceptives or hormone therapy (combination hormone therapy or hormone replacement therapy) In vitro fertilization if pregnancy is desired Women who have primary ovarian insufficiency and do not desire pregnancy may be treated with estrogen/progestin contraceptives (cyclical or extended cycle) or estrogen/progestin therapy (cyclical or continuous). Cyclical Menopausal Hormone Therapy is given until about age 51 (the average age for menopause) unless these hormones are contraindicated ( For women who desire pregnancy, one option is In vitro fertilization (IVF) of donated oocytes plus exogenous estrogen and a progestogen, which enable the endometrium to support the transferred embryo. The age of the oocyte donor is more important than the age of the recipient. This technique is fairly successful, but even without this technique, some women with diagnosed primary ovarian insufficiency become pregnant. No treatment has been proved to increase the ovulation rate or restore fertility in women with primary ovarian insufficiency. However, fertility restoration is being studied. Other options for women who desire pregnancy include cryopreservation of ovarian tissue, oocytes, or embryos and embryo donation. These techniques may be used before or during ovarian failure, especially in cancer patients. Neonatal and adult ovaries possess a small number of oogonial stem cells that can stably proliferate for months and produce mature oocytes in vitro; these cells may be used to develop infertility treatments in the future. Ovarian tissue transplantation has been successful and, in the future, may become an option for women who are no longer fertile ( Treatment references ). About 5 to 10% of women with primary ovarian insufficiency eventually become pregnant on their own, without fertility treatments. Unless contraindicated, hormonal therapy or estrogen/progestin contraceptives are recommended rather than other bone-specific treatments (eg, bisphosphonates) to prevent bone loss in women with premature ovarian insufficiency; these treatments are given until women reach the average age for menopause (about age 51), when treatment may be reassessed. To help prevent Antiresorptive medications , women with primary ovarian insufficiency should consume an adequate amount of calcium and Women with a Y chromosome require bilateral oophorectomy via laparotomy or laparoscopy because risk of ovarian germ cell cancer is increased. 1.Committee on Gynecologic Practice: Committee Opinion No. 698: Hormone therapy in primary ovarian insufficiency.Obstet Gynecol129 (5):e134–e141, 2017. doi: 10.1097/AOG.0000000000002044 2.Sheshpari, S., Shahnazi, M., Mobarak, H. et al: Ovarian function and reproductive outcome after ovarian tissue transplantation: A systematic review.J Transl Med17:396, 2019. 