Primary ovarian insufficiency is not equal to infertility

Primary ovarian insufficiency (POI) is a condition wherein young women present with menopausal-like symptoms. The symptoms range from irregular menstrual cycles, cessation of female hormone production, hot flashes, and yes – disruption of fertility. These young women – sometimes still in their teens or twenties – face loss of their reproductive potential rather early and become infertile. POI is actually quite common and is estimated to occur in 1 out of every 100 women under 40.

A recent study by researchers at the National Institutes of Health (NIH) reports some good for those women suffering from POI: most of them still have immature eggs in the ovaries! Thus, some of these women sometimes conceive unexpectedly. In fact, about 5 to 10% of women with POI can actually become fertile and get pregnant.

According to researcher Dr. Alan E. Guttmacher of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD):

“The discovery that most women with primary ovarian insufficiency have immature eggs remaining in their ovaries raises the possibility of developing treatments for the infertility that accompanies the condition.”

How does POI happen? Senior author Dr. Lawrence Nelson explains:

“…during a normal menstrual cycle, the pituitary gland releases follicle-stimulating hormone (FSH), which causes follicles to grow. While they are growing, follicles release the hormone estradiol, a form of estrogen. The pituitary also produces another hormone, called luteinizing hormone (LH), which remains at low levels during most of the cycle and then surges when it is time to ovulate. This LH surge gives the follicle a signal to break open and release the egg… in women with primary ovarian insufficiency, both FSH and LH levels are higher than in women without the condition. “The high LH levels indicate that the pituitary is continually sending the ovaries the message to ovulate. The follicles get the message to mature before they are ready, and so they don’t grow normally, and in most cases, fail to release the egg.”

POI is treated by hormone replacement therapy to alleviate menopause-like symptoms such as the use of a patch which releases the hormone estradiol that lowers the LH levels to normal. Dr. Nelson and colleagues observed that although this therapy addresses the menopause symptoms, many of those who had the therapy became pregnant. It seems that the estradiol patch normalizes LH levels thus allowing the maturation of follicles.

The researchers are planning to pursue further studies to determine the real effects of the estradiol hormone therapy on ovulation.

Dr. Nelson continues

“The body needs estradiol both to prepare the lining of the uterus to support pregnancy and also to regulate FSH and LH levels in a feedback loop. We hope to test whether giving estradiol via a skin patch to women with primary ovarian insufficiency will tamp down their LH level, allow the follicles to mature at an appropriate time, and help women with this condition to ovulate.”