Premature Ovarian Insufficiency and Fertility

Premature ovarian insufficiency, the term now generally preferred over premature ovarian failure, means the ovaries stop working normally before the age of 40. It makes conception considerably harder, but not impossible: ovarian function can fluctuate, and spontaneous ovulation and pregnancy do occur in a minority of women with the diagnosis. That is precisely why "failure" is the wrong word. Where conception with your own eggs is not achievable, other routes exist, and which apply depends on the cause and on how much ovarian function remains.

What is premature ovarian insufficiency?

The ovaries produce eggs and the hormones, principally estrogen, that drive the menstrual cycle. In premature ovarian insufficiency this function declines before 40, so cycles become irregular or stop and estrogen falls.

It differs from early menopause in an important way: function is not necessarily permanently and completely absent. It can fluctuate, which is why some women ovulate intermittently after the diagnosis.

Signs

• Periods becoming irregular, lighter, or stopping.
• Symptoms associated with low estrogen, such as hot flushes, night sweats, disturbed sleep or vaginal dryness.
• Difficulty conceiving.

What causes it?

• Genetic and chromosomal causes, including Turner syndrome and Fragile X premutation carriers. Our article on genetic causes of infertility covers these.
• Autoimmune conditions, where the immune system affects ovarian tissue.
• Cancer treatment, particularly chemotherapy and pelvic radiotherapy. This is why fertility preservation should be raised before treatment begins. See our articles on fertility preservation and fertility and cancer.
• Ovarian surgery.
• No identifiable cause, which is common and can be frustrating in itself.

How is it diagnosed?

Through history, examination and blood tests, typically including FSH, estrogen and AMH, often repeated to confirm. Where a cause is suspected, genetic testing and screening for autoimmune conditions may follow. Our article on fertility blood tests explains what these measure.

A diagnosis has implications beyond fertility. Low estrogen affects bone and cardiovascular health over time, so management usually involves hormone replacement as well as any fertility discussion. Ask about that side of it, because it is easy for it to be overlooked when the focus is on conceiving.

Can you conceive with it?

Sometimes, and this is where clarity matters more than either false hope or false finality.

• Spontaneous pregnancy does occur in a minority of women with the diagnosis, because function can fluctuate. It is not something that can be reliably induced, but it is a reason contraception is still discussed with women who do not want to conceive.
• Where eggs were frozen beforehand, for example before cancer treatment, they can be used with IVF.
• Where an underlying condition is contributing, treating it is worthwhile, though it should not be presented as reliably restoring ovarian function.
• Where conception with your own eggs is not achievable, your specialist should discuss the remaining options honestly, including what is and is not permitted under local regulation.

Be cautious of anything presented as restoring ovarian reserve or raising AMH. No treatment has been shown to do this. Our article on low AMH and ovarian reserve covers that.

We at Millennium IVF Clinic will explain what your results mean and what options exist. You can arrange a consultation with our team.

Frequently asked questions

Is premature ovarian insufficiency the same as early menopause?

Not quite. In menopause ovarian function has ended. In premature ovarian insufficiency it can fluctuate, which is why occasional ovulation and pregnancy remain possible.

Do I still need contraception?

If you do not wish to conceive, yes, discuss it. Because ovulation can occur unpredictably, a diagnosis is not a guarantee against pregnancy.

Can ovarian function be restored?

No treatment reliably restores it. Where an underlying condition such as an autoimmune disease is contributing, treating it is worthwhile, but it should not be presented as a route back to normal function.

Does the diagnosis affect anything besides fertility?

Yes. Low estrogen has longer-term implications for bone and cardiovascular health, which is why management usually includes hormone replacement. Raise it if your care has focused only on conceiving.