Premature Ovarian Failure

What is premature ovarian failure?

Premature ovarian failure, now more commonly called premature ovarian insufficiency (POI), is when the ovaries stop working normally before the age of 40. The ovaries produce fewer eggs and lower levels of estrogen, and periods become irregular or stop. It affects around 1 in 100 women, and possibly more. Unlike menopause, ovarian function in POI can be intermittent, so occasional ovulation and even spontaneous pregnancy can still happen in a small proportion of women.

Symptoms and signs

• Irregular, infrequent or absent periods
• Hot flushes and night sweats
• Vaginal dryness and discomfort during intercourse
• Low mood, irritability or poor concentration
• Sleep problems and tiredness
• Reduced sex drive
• Difficulty conceiving

Causes and risk factors

• Unknown cause (idiopathic) in most women
• Genetic causes, including Turner syndrome and Fragile X (FMR1) premutation
• Autoimmune conditions, such as thyroid disease and Addison's disease
• Chemotherapy, pelvic radiation or ovarian surgery
• Family history of early menopause
• Some infections and, possibly, smoking

How it is diagnosed

According to ESHRE guidance, POI is diagnosed in a woman under 40 with irregular or absent periods for at least four months and an elevated FSH level (above 25 IU/L). Further tests include:

• FSH and estradiol levels, repeated if uncertain
• AMH and antral follicle count on ultrasound
• Pregnancy test, thyroid function and prolactin to rule out other causes
• Karyotype and FMR1 premutation testing
• Thyroid and adrenal antibodies to check for autoimmune causes
• Bone density scan (DEXA) to check bone health

Treatment options

Hormone replacement therapy

Estrogen replacement, usually with progesterone, is recommended until at least the average age of natural menopause. It relieves symptoms and protects the bones, heart and brain. HRT does not prevent pregnancy, and it is not a contraceptive.

Donor egg IVF

For most women with established POI, IVF using eggs from a donor offers the best chance of pregnancy. The donor's eggs are fertilised with the partner's sperm, and the embryo is transferred to the recipient's uterus after hormone preparation.

IVF with own eggs

Women in the early stages, with some remaining follicles, may be offered IVF with their own eggs, although response is often low. Experimental treatments such as ovarian PRP or in-vitro activation lack proven benefit and should be undertaken only in research settings.

Fertility preservation

Women at high risk, for example with a family history, FMR1 premutation or planned chemotherapy, may consider egg or embryo freezing before ovarian function declines further.

Emotional support

A POI diagnosis can be distressing, and counselling is an important part of care.

Chances of pregnancy

Spontaneous pregnancy occurs in a small minority of women with POI, roughly 5 percent. Donor egg IVF offers considerably better chances, which depend on the donor's age, embryo quality and the recipient's uterus. No treatment can guarantee pregnancy.

When to see a fertility specialist

See a specialist if your periods have stopped or become irregular before 40, if you have menopausal symptoms at a young age, or if you have a family history of early menopause and want children. Iswarya Fertility has 91+ centres, with EMI options from ₹9,999 per month for eligible treatments.