Is there a link between an extremely poor response to ovarian hyperstimulation and early ovarian failure?
BACKGROUND
It has been previously reported that a group of 12 infertile women, who had a normal baseline hormonal profile and did not respond to repeated ovarian stimulation with gonadotrophins, developed ovarian failure within a few months. Based on this observation, we carried out a controlled retrospective cohort study to examine whether non-response to ovarian stimulation is linked to early ovarian failure.


METHODS
All patients aged 35-40 years who had cancelled IVF cycles for non-response between 1991 and 1993 in our centre were asked to report on the subsequent development of menopausal symptoms, menopause or commencement of hormone replacement therapy. A control group consisted of patients with the same age and similar medical history, who had IVF the same year and responded well.


RESULTS
Eleven out of the 12 patients of the non-response group developed menopausal symptoms within 7 years, compared with only four out of 24 in the control group. Similarly, eight out of 12 non-responders either went into menopause or started using hormone replacement therapy compared with one out of 24 in the control group. Using Fisher's exact test, the differences were highly significant (P < 0.0001). The median age at development of menopausal symptoms in the study group was 40 years (range 38-45). The median time between non-response and development of menopausal symptoms was 4 years (range 1-7).


CONCLUSIONS
We carried out a controlled retrospective cohort study that showed a strong association between an extremely poor response to ovarian hyperstimulation and early ovarian failure.
Nikolaou
D
D
IVF Unit, Hammersmith Hospital, Imperial College, London, UK. dnikolaou@talk21.com
Lavery
S
S
Turner
C
C
Margara
R
R
Trew
G
G
D000328:Adult; D000375:Aging / Q000502:physiology; D015331:Cohort Studies; D004351:Drug Resistance; D015914:Estrogen Replacement Therapy; D005260:Female; D006801:Humans; D008297:Male; D008593:Menopause / Q000502:physiology; D008594:Menopause, Premature / Q000502:physiology; D008596:Menotropins / Q000627:therapeutic use*; D010062:Ovulation Induction; D016649:Primary Ovarian Insufficiency / Q000209:etiology* / Q000503:physiopathology*; D012016:Reference Values; D012189:Retrospective Studies
D008596:Menotropins