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Primary ovarian failure is caused by a malformation or malfunction in the ovaries. In the healthy woman, ovarian failure occurs only after menopause, because the follicles are consumed and as a result the hormone production is stopped. If the menopause occurs before the age of 35, it is called a "climacteric praecox." About 1 to 4% of women suffer from premature ovarian failure, which is also referred to as hypergonadotropic ovarian failure, or hypergonadotropic hypogonadism.

A primary ovarian failure is characterized by the fact that either no follicles are present or a small follicle quantity in the ovaries is used up early and therefore no egg maturation or hormone production can take place. One of the main reason of this can be congenital chromosomal disorders, which are expressed in a lack of functional germ cells (gonadal dysgenesis). The ovaries of these patients are transformed into connective tissue, stubborn strands (streak gonads) and the follicle population of the ovaries is either absent or is influenced by accelerated degradation. Patients have a female appearance (phenotype). The female reproductive organs (tubes, uterus, vagina) are normal but not fully formed.

To make a certain an overview, gynaecologist always at the beginning of the diagnostic should clarificy a detailed medical history. Tell your doctor about changes in your menstrual cycle, symptoms such as hot flashes, ovarian surgery or family history. Subsequently, the gynecologist will examine the external appearance of the patient, a general physical examination and a gynecological vaginal and rectal examination.

If the ultrasound examination has no clear result, it makes sense to carry out a pregnancy test. If pregnancy first manifests itself in the absence of menstrual bleeding, falsely ovarian failure may be suspected.

In primary ovarian failure, FSH and LH concentrations in the blood are greatly increased. By quantifying it can be determined whether the values are in the normal range (10 to 15 mIU / ml) or increased (over 40 mIU / ml).

For simple diagnostic you can use a temperature journal that notes the daily basal body temperature. Because ovarian failure does not ovulate, the typical increase in temperature in the middle of the cycle is also absent.

Primary ovarian failure is inherently irreversible. With the onset of pregnancy can not be expected, exceptions are extremely rare. In women under the age of 40, hormone replacement therapy should be used to compensate for the lack of estrogen.

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Efficient treatment of primary ovarian insufficiency in Germany. Better pregnancy rates. Hormone replacement therapy and IVF without risks. Learn more 2020-04-01 Primary Ovarian Insufficiency (POI)
Primary Ovarian Insufficiency (POI)

Early ovarian failure is a condition, which is characterized either with the absence of menstruation (primary amenorrhea) or premature depletion of follicles (secondary amenorrhea) in young women. In medical circles this condition is also called “premature ovarian insufficiency” (POI) or premature failure (POF).

The difference of early ovary insufficiency (POI) from menopause is that the reproductive function of a woman in case of amenorrhea is reduced, but still persists. 5-10% of patients with the diagnosis of premature ovarian disorder can get pregnant. Nevertheless the chance to get pregnant with POF is too low, to wait for natural conception. It is important to diagnose the POI as early as possible and to start treatment at a fertility center with extra specialization in POI therapy.

What are the alarming signs of POI / POF?

The most common symptom of POI or POF in a woman is irregular menses or no menstruation during the period of at least 4 months. The other troubling sign of POF is lower estrogen level in women. Alarm signals, pointing at this syndrome are

  • emotional lability (due to lower estrogen level)
  • fatigue
  • difficulty with concentration
  • sleep disturbances
  • headaches
  • vaginal dryness

Lack of ovulation or sporadic ovulation as a result of estrogen disorder in a woman makes it almost impossible for a female patient to conceive. When the diagnosis is pronounced it is often psychologically devastating. It is important to stay calm and to apply to a specialized clinic for treatment. Premature insufficiency in a woman is in 60% reversible, i.e. it can be efficiently managed by a special medication. According to GMG statistics for the year 2013, around 40% of POF patients, who had had treatment at German, Austrian or Swiss centers, could get pregnant within the next two years.

Which tests can find out if a woman has POI?

The German fertility centers offer specific laboratory tests for diagnosing premature ovary insufficiency (POI). The patient has to go through several diagnosis steps, which will help to clear up, if the cause of infertility is POF syndrome.

Step 1: Laboratory tests to diagnose POI. The first step for POI diagnosis is to define the FSH level. FSH increases as the woman gets older. If the level of follicle stimulating hormone on repeated measures is elevated (<55) while the estrogen level is low (>50) it suggests that a patient may have premature ovarian insufficiency. Estrogen is a crucial marker for female fertility.

Step 2: Checking thyroid and adrenal function of a patient for POF syndrome. Hormone disorders are responsible for premature insufficiency in 70% of all cases.

Step 3: Genetic tests. These tests are performed at German fertility centers to confirm that a patient is not in risk of a rare form of cancer.

Infertility treatment in women with PОF syndrome

Hormone therapy in women: estrogen supplement for better pregnancy chances!

Treatment of patients with POI syndrome is aimed at the prevention of estrogen deficiency conditions (osteoporosis). In order to prevent urogenital disorders and metabolic problems special hormone replacement therapy for better estrogen level is indicated. Modern hormone medications contain natural female hormones (estrogen) and help to restore the menstrual cycle and ovulation, which contributes to better fertility characteristics. Besides estrogen replacement therapy helps to prevent osteoporosis, various urinary disorders and cardiovascular diseases.

DHEA: A promising treatment method in Germany! Better pregnancy rates

German clinicians successfully implement special male hormone dehydroepiandrosterone (DHEA) to treat patients with decreased egg reserve (Diminished Ovarian Reserve) due to premature ovarian aging. It has been found out that DHEA not only increases the number and quality of oocytes, but also shortens the period of fertility treatment and increases the chances of spontaneous conception. In addition, DHEA reduces the risk of spontaneous miscarriage - an important point, especially for older patients who want to have children. Pregnancy rates get increased by 10% after the DHEA treatment course.

IVF with egg donation

Assisted reproduction techniques are often viewed by patients with POF as the “last resort” in their struggle with infertility. It is important to keep in mind that standard IVF cycle will not work in women with ovary failure, since they cannot produce fertile eggs. Nevertheless you can think about the IVF with donor eggs. This procedure can be performed in Austria and some other EU countries and is absolutely safe. Preparing for an IVF cycle with a donor egg takes 2-3 weeks of hormone injections, both for donor and a recipient. It helps to stimulate the ovaries and to prepare the uterus lining for further embryo implantation.

Before the treatment, you and your egg donor will be asked to go through detailed medical examination, including hysteroscopy, ultrasound and blood tests. The costs of IVF with egg donation make up about 10 000-15 000 euro. The success rates of such treatment in Austria are high, making up about 45%-50% within an IVF cycle in women with ovary dysfunction.

We would be glad to provide you all the necessary information about the modern ways to treat premature ovarian syndrome in Germany, Austria or Switzerland. Being a reliable partner in health issues we will assist you in finding the experienced specialist as well as in planning your medical trip to Europe.

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