title: Prospectively assessing risk for premature ovarian senescence in young females: a new paradigm.
abstract: BACKGROUND
  Approximately 10% of women suffer from premature ovarian senescence (POS), ca. 9% as occult primary ovarian insufficiency (OPOI, also called premature ovarian aging, POA) and ca. 1% as primary ovarian insufficiency (POI, also called premature ovarian failure, POF). In a large majority of cases POS is currently only diagnosed at advanced clinical stages when women present with clinical infertility.
  
  
  METHODS
  We here, based on published evidence, suggest a new diagnostic paradigm, which is based on identifying young women at increased risk for POS at much earlier stages.
  
  
  RESULTS
  Risk factors for POS are known from the literature, and can be used to identify a sub-group of young women at increased risk, who then are followed sequentially with serial assessments of functional ovarian reserve (FOR) until a diagnosis of POS is either reached or refuted. At approximately 25% prevalence in general U.S. populations (and somewhat different prevalence rates in more homogenous Asian and African populations), so-called low (CGGn<26) mutations of the fragile X mental retardation 1 (FMR1) gene, likely, represents the most common known risk factor, including history-based risk factors from medical, genetic and family histories.
  
  
  CONCLUSIONS
  Women so affirmatively diagnosed with POS at relative young ages, then have the opportunity to reconsider their reproductive planning and/or choose fertility preservation via oocyte or ovarian tissue cryopreservation at ages when such procedures are clinically much more effective and, therefore, also more cost-effective. Appropriate validation studies will have to precede widespread utilization of this paradigm.
authors.affiliation: The Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA. ykizawa@thechr.com.|The Foundation for Reproductive Medicine, 21 East 69th Street, New York, NY, 10021, USA. ykizawa@thechr.com.
authors.forename: Norbert
authors.initials: N
authors.lastname: Gleicher
authors.affiliation: The Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA. vkushnir@thechr.com.
authors.forename: Vitaly A
authors.initials: VA
authors.lastname: Kushnir
authors.affiliation: The Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA. dbarad@thechr.com.|The Foundation for Reproductive Medicine, 21 East 69th Street, New York, NY, 10021, USA. dbarad@thechr.com.
authors.forename: David H
authors.initials: DH
authors.lastname: Barad
mesh_terms: D000293:Adolescent; D000328:Adult; D054304:Anti-Mullerian Hormone / Q000097:blood; D003362:Cost-Benefit Analysis; D005260:Female; D059247:Fertility Preservation; D051860:Fragile X Messenger Ribonucleoprotein 1 / Q000235:genetics; D006801:Humans; D008403:Mass Screening / Q000379:methods; D065851:Ovarian Reserve; D016649:Primary Ovarian Insufficiency / Q000175:diagnosis* / Q000453:epidemiology / Q000235:genetics; D012307:Risk Factors
chemical_list: D054304:Anti-Mullerian Hormone; D051860:Fragile X Messenger Ribonucleoprotein 1