Primary Ovary Insufficiency (POI)

What is primary ovarian insufficiency (POI)?
A premature ovarian failure is also termed as primary ovarian insufficiency. This is characterized by a loss of normal ovarian functioning before attaining the age of 40. With ovaries failing, they don’t produce normal amounts of the hormone oestrogen or release eggs regularly. And thus, infertility is a common result. Women with premature ovarian failure can have irregular or occasional periods for years and may not have a significant chance of becoming pregnant.

What causes premature ovarian insufficiency (POI)?
A primary ovarian insufficiency results from the loss of eggs (oocytes) and the ovaries, and this is a result of – possible defects in the chromosomes, exposure to toxins and chemicals, undergoing chemotherapy and radiation therapy, autoimmune conditions, and in some cases, the premature failure may be an idiopathic one (unknown cause).

Who is at risk for primary ovarian insufficiency (POI)?
Various factors contribute to the increased risk of developing primary ovarian insufficiency. These include age, history of ovarian failures in the family and previous ovarian surgeries.

What are the symptoms of primary ovarian insufficiency (POI)?
The symptoms associated with premature ovarian insufficiency include:

  • Irregular periods
  • Infertility
  • Difficulty to hold a pregnancy
  • Hot flashes
  • Night sweats
  • Decreased libido

What other problems can primary ovarian insufficiency (POI) cause?
Complications of primary ovarian insufficiency are osteoporosis, depression, anxiety, and others. The hormone oestrogen helps maintain strong bones, but POI results in reduced oestrogen production, increasing the risk of developing weak and brittle bones that are more likely to break than healthy bones.

Additionally, the risk of infertility and other complications arising from low oestrogen levels causes some women to become depressed or anxious. Lower oestrogen levels are also associated with increased heart disease cases in women.

How is primary ovarian insufficiency (POI) diagnosed?
Blood work is the primary mode of diagnosis for a premature ovarian failure; this will offer doctors an insight into hormonal levels and chromosomal analysis. Alongside blood work, the doctor will also seek a complete medical history. A pregnancy test is also taken to ascertain pregnancy, while an ovarian ultrasound can see whether the ovaries are enlarged or have multiple follicles.

How is primary ovarian insufficiency (POI) treated?
Specifically, for addressing ovarian insufficiency, there is no specific treatment; however, doctors can prescribe a wide range of treatment options for dealing with the symptoms associated with POI. These include hormone therapy to replenish oestrogen and other hormones that the ovaries may not produce adequately. Doctors will also prescribe a dosage of calcium and vitamin D supplements.

For pregnancy, IVF is one of the most viable treatment options. Additionally, other medication and lifestyle changes may be required for the treatment of obesity, osteoporosis, and heart diseases.

What are my fertility treatment options when I have POI?
The common course of treatment will include – oestrogen therapy, supplements for mineral and vitamin deficiency, and infertility treatment. Lifestyle modifications are also recommended, and these include – keeping weight in check, physical activity and sticking to a healthy diet. IVF remains the best treatment option for the treatment of infertility caused by POI. However, in some rare cases, there may be a necessity to opt for an egg donor program.

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