One in a hundred women before the age of 40, one in a thousand before the age of 30. It is a difficult diagnosis, often delivered poorly, and one that leaves more questions unanswered than is usually acknowledged.
Premature ovarian failure is diagnosed when there is a combination, before the age of 40, of amenorrhoea or oligomenorrhoea lasting for at least four months, and of elevated FSH levels, above 25 IU/l, confirmed by two tests taken one month apart. AMH levels are generally very low. The term ‘early menopause’ is common but imprecise: unlike menopause, ovarian function may resume intermittently.
Identifying the cause influences the management and the information to be provided to the family:
In half to two-thirds of cases, no cause is identified.
They are not zero, and this is what is often overlooked. Around 5 to 10 per cent of affected women conceive spontaneously after diagnosis, sometimes years later, following a temporary resumption of ovarian function. This has two practical implications: contraception remains necessary if pregnancy is not desired, and the diagnosis should never be presented as a definitive impossibility.
On the other hand, no treatment has been shown to increase these chances. Neither high-dose stimulation, nor DHEA, nor so-called ovarian reactivation protocols. Experimental techniques — in vitro activation, intra-ovarian PRP — remain at the research stage and should not be marketed as solutions.
This is the most important and most overlooked point. Estrogen deficiency setting in at the age of 30 increases the risk of bone loss, heightened cardiovascular risk and symptoms that affect quality of life. Hormone replacement therapy is recommended until the normal age of the menopause, around 50, unless there are contraindications. This is not the same risk-benefit debate as for a woman who has reached the menopause at 52: in this case, we are replacing what should be there.
This is the approach offering the best chances, with pregnancy rates per transfer of 50–60 per cent, as the uterus normally responds to hormonal preparation. In France, the waiting time is around twenty-two months; in Greece, there is no waiting list and the legal age limit is 54. A comparison of waiting times and the Greek legal framework is detailed elsewhere.
An important caveat: in women with Turner syndrome, even in the mosaic form, pregnancy carries a serious cardiovascular risk. A specialist cardiac assessment and a multidisciplinary consultation are essential before any attempt is made, and certain conditions contraindicate pregnancy. This is non-negotiable.
There are two things worth doing straight away. Firstly: if ovarian function persists intermittently and you are young, discuss freezing your eggs without delay, even if the expected success rate is low. The second: do not face this news alone. This is one of the most difficult fertility diagnoses to come to terms with, because it affects your sense of identity as much as your plans to have children, and patient support groups and psychological counselling really do help.
Amenorrhoea or oligomenorrhoea lasting at least four months before the age of 40, associated with an FSH level above 25 IU/l in two tests taken one month apart. AMH levels are usually very low.
Yes, in 5 to 10 per cent of cases, sometimes years after diagnosis, due to temporary resumption of ovarian activity. Contraception is therefore still necessary if pregnancy is not desired.
Yes, unless there are contraindications, until the normal age of the menopause. Early oestrogen deficiency increases the risk of bone loss and cardiovascular disease.
Yes, with a 50–60 per cent pregnancy rate per embryo transfer, as the uterus normally responds to hormonal preparation. One major exception is Turner’s syndrome, which requires a specialist cardiac assessment beforehand.
Source: https://fertilitegrece.com/en/blog/premature-ovarian-insufficiency/ — Triada Baloukoudis, IVF patient coordination in Greece. General information, not medical or legal advice. Printed on
The first consultation is free and without obligation.
AMH, FSH, LH, antral follicle count: how to interpret an ovarian reserve test, when to have it done, and why a low AMH level does not necessarily mean infertility.
Read the articleActual waiting times for egg donation in France, according to the French Biomedicine Agency, and why Greece has virtually no waiting list. Figures and explanations.
Read the articleOocyte cryopreservation: a 12-month waiting period in France, a few weeks in Greece. Age, target number of eggs, actual cost, storage and subsequent transfer.
Read the article