title: Premature ovarian insufficiency: how to improve reproductive outcome?
abstract: Premature ovarian insufficiency (POI) is a life-changing condition that affects women in their reproductive age. The condition is not necessarily permanent but is associated with intermittent and unpredictable ovarian activity. Hence, spontaneous pregnancies have been reported to be 5-10%. However, pregnancy in patients with POI is still unlikely and rare. Although, there are reviews on POI in the literature, there is a lack of reports which focus on how to improve the reproductive outcome of these women who wish to conceive spontaneously or use assisted conception with their own oocytes. We found that there is no conclusive evidence of which treatment is optimal for women with POI who wish to conceive using their own gametes. However, one could surmise that it is important to lower gonadotropin levels into the physiological range before embarking on any treatment, even if natural conception is the only choice for the woman/couple. In the future, multi-center, randomized, double-blind, placebo-controlled trials should be carried out, which may entail recruitment of patients from various centers nationally and internationally to increase the sample size and therefore achieve a powered study. This may standardize the treatment of women with POI who wish to conceive and ultimately have their biological child.
authors.affiliation: * West London Menopause & PMS Centre, Chelsea and Westminster Hospital , 369 Fulham Road, London.
authors.forename: J
authors.initials: J
authors.lastname: Ben-Nagi
authors.forename: N
authors.initials: N
authors.lastname: Panay
mesh_terms: D000276:Adjuvants, Immunologic / Q000627:therapeutic use; D002996:Clomiphene / Q000627:therapeutic use; D003277:Contraceptives, Oral, Combined / Q000627:therapeutic use; D003687:Dehydroepiandrosterone / Q000627:therapeutic use; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists / Q000037:antagonists & inhibitors; D006062:Gonadotropins / Q000627:therapeutic use; D020249:Hormone Replacement Therapy; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy* / Q000209:etiology; D011247:Pregnancy; D018873:Pregnancy Rate; D016649:Primary Ovarian Insufficiency / Q000150:complications / Q000188:drug therapy*
chemical_list: D000276:Adjuvants, Immunologic; D003277:Contraceptives, Oral, Combined; D005300:Fertility Agents, Female; D006062:Gonadotropins; D002996:Clomiphene; D007987:Gonadotropin-Releasing Hormone; D003687:Dehydroepiandrosterone
keywords: CONTRACEPTIVE PILL; HORMONE REPLACEMENT THERAPY; PREMATURE OVARIAN INSUFFICIENCY