Resumption of ovarian function and pregnancies in 358 patients with premature ovarian failure.
ABSTRACT Resumption of ovarian activity and spontaneous pregnancies are described in patients with premature ovarian failure (POF), but there is a lack of data concerning the prevalence of and predictive factors for these phenomena.
The aim of the study was to determine both the prevalence of and predictive factors for spontaneous resumption of ovarian function in POF patients.
A mixed retrospective and prospective study was performed at a referral center for reproductive endocrinology.
A total of 358 consecutive POF patients were followed from 1997 to 2010 in our center.
The cumulative incidence of resumption of ovarian function was determined, and predictive factors were identified by univariate and multivariate analysis.
Of 358 patients with idiopathic POF, 86 (24%) patients presented features indicating resumption of ovarian function, and in 77 cases (88%) within 1 yr of diagnosis. Twenty-one spontaneous pregnancies (16 births, five miscarriages) occurred in 15 (4.4%) patients. Multivariate analysis (Cox model) showed that a familial history of POF, secondary amenorrhea, presence of follicles at ultrasound, and inhibin B and estradiol levels were significantly predictive of resumption of ovarian function (P < 0.01), whereas association with an autoimmune disease, anti-mullerian hormone level, the presence of follicles on biopsy, and/or genetic abnormalities did not appear predictive. We created a predictive score for resumption of ovarian function comprising age at diagnosis, presence of follicles at ultrasound, and inhibin B level.
Intermittent ovarian activity in patients with POF is not a rare phenomenon. The predictive score described in this study may help us to identify POF patients most likely to recover intermittent ovarian function.
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ABSTRACT: Context:Cyclophosphamide is used for renal and major extrarenal involvement in systemic lupus erythematosus (SLE), and is associated with a risk of premature ovarian failure. There is no data available about the relation between anti-müllerian hormone (AMH) serum levels and the probability of subsequent pregnancy in SLE patients.Objective:We analysed AMH levels and probability of pregnancy in SLE women exposed to cyclophosphamide.Design:Matched cohort study.Setting:Referral centers for SLEPatients:56 cyclophosphamide-exposed SLE women aged younger than 40 and 56 control SLE women matched for age within 6 months.Main outcome measures:AMH was measured in samples from the PLUS study (ClinicalTrials.gov NCT00413361). All patients were interviewed in May 2012 regarding their obstetric status.Results:The mean age of the 112 patients was 31.6±5.8 years. The mean AMH level was low (1.21±1.01 ng/mL) and was significantly lower in patients exposed to cyclophosphamide (p=0.03) and in patients older than 30 years (p=0.02). During a median follow-up (interval between sampling and the interview) period of 4.2 [2.5-4.8] years, 38 patients sought to become pregnant and 32 succeeded (84.2%). In the univariate analysis, the risk of failure was associated with cumulative cyclophosphamide dose (p=0.007) and older age (p=0.02), but not with AMH.Conclusion:We confirmed that AMH levels are low in SLE patients and decrease significantly with age and cyclophosphamide exposure. Nonetheless, the risk of failure to conceive was low and was predicted by cyclophosphamide exposure and age, but not by AMH levels.The Journal of Clinical Endocrinology and Metabolism 07/2013; · 6.31 Impact Factor
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ABSTRACT: Abstract At present, there are no proven therapies to improve ovarian function in women with premature ovarian insufficiency (POI) or in those with extremely low ovarian reserve (LOR). We report successful IVF outcomes achieved with continuous high-dose estrogen supplementation in patients with LOR. Patients were 33- and 42-year-old nulligravidae with high-serum FSH (over 30 IU/L) and undetectable serum AMH (under 0.1 ng/mL) levels; however, neither patient fulfilled the diagnostic criteria for POI. After cycle cancellation and unsuccessful IVF treatment, both patients received conjugated estrogen (CE) supplementation (2.5-3.75 mg/day) from day 2 of their menstrual cycle to the day of HCG administration in their IVF treatment cycles. Following continuous high-dose estrogen supplementation, oocytes were successfully retrieved from both patients and fertilized. Both patients also achieved ongoing pregnancy through frozen-thawed embryo transfer cycles. In conclusion, high-dose estrogen supplementation down-regulated serum FSH and LH within their physiological ranges, which led to functional follicle growth and prevented early luteinization. Further studies will be needed to confirm the effect of this treatment on POI patients and to establish a new and individualized protocol for LOR patients.Gynecological Endocrinology 01/2014; · 1.14 Impact Factor
Article: [Premature ovarian failures.][Show abstract] [Hide abstract]
ABSTRACT: Premature ovarian failure (POF) is clinically suspected by amenorrhea and confirmed by an elevated FSH serum level above 40mUI/L (even 20mUI/L) twice, in a woman before the age of 40. Prevalence of POF is between 1 to 2% in women. In 90% of cases, no aetiology is identified. Obvious causes are chemotherapy, pelvic radiotherapy, ovarian surgery and diethylstilbestrol exposure in utero. A karyotype should be performed as Turner Syndrome is the most frequent genetic cause of POF. Some X abnormalities such as X deletion or X autosome translocation can be found. FMR1 pre-mutation (fragile X syndrome) should be searched for, even though no cases of mental retardation are known, in the family. Other genetic abnormalities can be suggested by associated symptoms (i.e.: FOXL2, SF1 mutations). Auto-immune aetiology can be suspected if other auto-immune features are present, however, there are no reliable auto-antibodies to confirm auto-immunity in POF. Treatment of POF is based on hormonal replacement therapy in order to avoid estrogen deficiency, suppress vasomotor symptoms and avoid bone loss as well as cardiovascular risk. Estrogens should be associated with progesterone or a progestin, at least up to the age of 51. Patients with POF should be informed that spontaneous pregnancies may occur (in 5% of cases). In case of desire of pregnancy, the patient should be oriented to a specialized unit for in vitro fertilization with oocyte donation. Psychological support is essential and should be part of the treatment. POF is associated with an increased risk of emotional distress and depression. No preventive treatment of POF is available so far.La Presse Médicale 10/2013; · 1.17 Impact Factor