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Premature ovarian failure (POF) is a condition in which your ovaries stop functioning properly before the age of 40. POF affects about 1% of females, and is also known as premature ovarian insufficiency (POI) or premature menopause. In this article, we'll discuss the causes, symptoms, diagnosis, treatment options for POF, and how it can affect your mental and emotional well-being.

What causes premature ovarian failure?

POF is a complex and multifactorial condition, with the exact cause remaining unknown in the vast majority (90%) of cases. However, research suggests that the problem is often related to issues with the follicles (the small sacs in the ovaries where the eggs mature). Some people with POF may run out of functional follicles earlier than expected, while others may have follicles that are not functioning properly. 

While the cause is often unknown, there are several factors that have been linked to POF. These include genetic disorders such as Fragile X syndrome and Turner syndrome, autoimmune diseases such as thyroiditis and Addison disease, exposure to toxins like cigarette smoke, chemicals, and pesticides, as well as certain metabolic disorders. Additionally, treatments such as chemotherapy or radiation therapy can also increase the risk of developing POF.

Symptoms of premature ovarian failure

The symptoms of POF are similar to those of menopause, and include irregular periods, hot flashes, vaginal dryness, and mood changes. Those with POF may also experience infertility or difficulty getting pregnant. In addition, POF can increase the risk of osteoporosis and heart disease. POF can also lead to a decrease in libido and sexual function, as well as depression and anxiety.

How do I know if I have premature ovarian failure? 

POF is diagnosed based on symptoms, medical history, and blood tests that measure levels of certain hormones. Females with POF typically have low levels of estrogen and high levels of follicle-stimulating hormone (FSH), which stimulates the ovaries to produce eggs. A pelvic exam and ultrasound may also be performed to evaluate the ovaries and determine if there are any structural abnormalities.

Premature ovarian failure and estrogen levels

POF can lead to low estrogen levels, which can cause a range of symptoms. Estrogen plays a vital role in the reproductive system and overall health. It helps regulate the menstrual cycle, maintains bone density, and supports vaginal and urinary health. When estrogen levels drop, you may experience symptoms like hot flashes, night sweats, vaginal dryness, mood changes, and difficulty sleeping. All of these are generally a result of lower estrogen levels.

Premature ovarian failure and FSH levels

Follicle-stimulating hormone (FSH) is a hormone that stimulates the growth of ovarian follicles and the production of estrogen. In those with premature ovarian failure, FSH levels are typically high due to the lack of viable follicles in the ovaries. High levels of FSH can be a useful tool in diagnosing POF.

Premature ovarian failure and AMH levels

Anti-Mullerian hormone (AMH) is a hormone that is produced by the ovarian follicles. Low levels of AMH can be a sign of a low ovarian reserve, which is a common characteristic of premature ovarian failure. While AMH levels can be useful in diagnosing POF, they are not always a reliable indicator of fertility potential.

Do you still have eggs with premature ovarian failure?

Premature ovarian failure is usually characterized by a decline in the number of eggs you have. However, some individuals with premature ovarian failure may still have a small number of eggs in their ovaries, especially early in the diagnosis. 

This can be determined through an ovarian reserve test, which measures the number of follicles (fluid-filled sacs that contain immature eggs) present in the ovaries.

However, for most individuals with premature ovarian failure, the number of eggs left may be too low for successful fertility treatment using their own eggs. In these cases, donor eggs may be a viable option for achieving a healthy pregnancy.

Can premature ovarian failure be cured?

There is no cure for POF, but there are several treatment options available. Hormone replacement therapy (HRT) can help alleviate symptoms of menopause and reduce the risk of osteoporosis and heart disease. Those with POF who wish to conceive can also explore fertility treatments like in vitro fertilization (IVF) with donor eggs. This can be a successful option for those with POF since the donor eggs come from women who are more likely to produce healthy embryos.

Can someone with premature ovarian failure get pregnant?

While premature ovarian failure can make it difficult to conceive unassisted, it is still possible for some people to get pregnant with the help of assisted reproductive technologies, like donor egg IVF.  In some cases, patients with POF may even be able to use their own eggs if they have enough viable follicles remaining. However, the success rates of these treatments are generally lower than for people without POF.

The good news, though,  is that people with POF are generally able to carry a healthy pregnancy!

Can you do IVF with premature ovarian failure?

Yes! IVF may be an option for those with premature ovarian failure who still have a small number of eggs in their ovaries. In some cases, these eggs can be retrieved and used for IVF. But it may take higher doses of medications, and more cycles to achieve success.

However, if you have very few or no eggs remaining, IVF with donor eggs may be recommended instead. 

Mental and emotional well-being, and coping strategies

POF can have a significant impact on your mental and emotional well-being. The diagnosis of POF can be devastating, and you may experience a range of emotions, including grief, anger, and depression. It is so important to seek support from a mental health professional and to connect with others who have experienced POF. 

There are several coping strategies to manage your symptoms and improve your quality of life. Focus on maintaining a healthy lifestyle by eating a balanced diet, getting regular exercise, and reducing stress. Those with POF can also explore alternative therapies such as yoga, meditation, or massage to help manage symptoms and gain a sense of inner peace. Those with POF should also be proactive about their healthcare by staying up to date on their medical appointments and advocating for themselves.

Bottom line

Premature ovarian failure can be a challenging condition to manage, but there are options available to help alleviate symptoms and increase the chances of starting a family. If you suspect you may have POF, it's important to speak with your doctor to start an evaluation.

Cofertility is a human-first fertility ecosystem rewriting the egg freezing and egg donation experience. Our Family by Co platform serves as a more transparent, ethical egg donor matching platform. We are obsessed with improving the family-building journey — today or in the future — and are in an endless pursuit to make these experiences more positive. Create a free account today! 

Diminished Ovarian Reserve (DOR) is a condition that affects many women, often catching them off guard as they embark on their journey to parenthood. While receiving a DOR diagnosis can be challenging, understanding the condition is the first step in navigating your reproductive options. This article aims to demystify DOR, explore its prevalence, discuss the chances of conception, and outline the available options for those diagnosed with this condition.

What is diminished ovarian reserve (DOR?)

Diminished ovarian reserve refers to a reduction in the quantity of your remaining eggs. Every female is born with all the eggs she'll ever have, and this number naturally declines with age. However, some experience a faster decline than expected for their age, leading to a diagnosis of DOR.

DOR is not the same as infertility. While it can make conception more challenging, it doesn't necessarily mean pregnancy is impossible. Instead, think of DOR as a warning sign that your reproductive window may be shorter than anticipated. The sooner you get a DOR diagnosis. The sooner you can begin to explore your reproductive options, including treatments like in vitro fertilization (IVF) or egg freezing, and potentially increase your chances of achieving a successful pregnancy.

How common is diminished ovarian reserve?

The prevalence of DOR increases with age, but it can affect women of all ages. According to one study, approximately 10% of women seeking fertility treatment are diagnosed with DOR. However, this number may not accurately represent the general population, as many women with DOR may not seek fertility treatment or may remain undiagnosed.

Age is the most significant risk factor for DOR. As women approach their late 30s and early 40s, the likelihood of experiencing DOR increases significantly. However, DOR can also occur in younger women too, sometimes due to genetic factors, medical treatments like chemotherapy, or unknown causes.

Some lifestyle factors have also been known to contribute to a diminished ovarian reserve. Smoking is one of the most significant factors, as a history of heavy smoking can accelerate the loss of eggs and may lead to earlier menopause. 

Diagnosing diminished ovarian reserve

Diagnosis of DOR typically involves a combination of blood tests and ultrasound imaging. The most common blood tests measure levels of follicle-stimulating hormone (FSH) and anti-Müllerian hormone (AMH). High FSH levels or low AMH levels can indicate DOR. Additionally, an ultrasound to count antral follicles (small follicles in the ovaries) can provide further insight into ovarian reserve.

It's worth noting that these tests provide a snapshot of your current ovarian reserve, not a prediction of your ability to conceive. A low ovarian reserve doesn't necessarily mean you can't get pregnant, just as a high reserve doesn't guarantee conception.

Chances of getting pregnant with diminished ovarian reserve

The probability of achieving pregnancy without assistance (meaning “the old fashioned way”) when diagnosed with DOR varies widely depending on individual factors, including age, the severity of the condition, and overall health. A study published in JAMA found that women aged 30-44 with low AMH (an indicator of DOR) did not have a significantly different probability of conceiving after six months of trying.

However, these statistics don't tell the whole story. Some women with DOR do conceive unassisted, while others may require IVF or donor egg IVF. Every woman's fertility journey is unique, and statistics can't predict individual outcomes.

Options for women diagnosed with DOR

If you are facing infertility due to DOR or other reasons, the good news is that there are options. Here are some paths you might consider:

1. Fertility treatments

For women with DOR who wish to conceive using their own eggs, fertility treatments can potentially improve the chances of pregnancy. These may include:

• Ovulation Induction: Medications to stimulate egg production
• Intrauterine Insemination (IUI): A procedure where sperm is placed directly into the uterus
• In Vitro Fertilization (IVF): A process where eggs are fertilized outside the body and then transferred to the uterus

It's worth noting that success rates for these treatments may be lower in women with DOR compared to those with normal ovarian reserve. A fertility doctor can give you a better idea of your chances of success based on your unique health history. 

2. Egg donation

For some women with DOR, using donor eggs may offer the best chance of achieving pregnancy. This option allows for the experience of pregnancy and childbirth, even if the child isn't genetically related to the mother. Success rates with egg donation are generally higher than when using your own eggs

3. Adoption

Adoption is another path to parenthood for those diagnosed with DOR. While it doesn't involve a genetic connection or the experience of pregnancy, it offers the opportunity to provide a loving home to a child in need.

Conclusion

DOR is a challenging diagnosis, but it doesn't have to mean the end of your dreams of parenthood. By understanding your condition, exploring your options, and working closely with healthcare providers, you can make informed decisions about your fertility journey.

Remember, DOR is a medical condition, not a personal failing. It's okay to feel frustrated, sad, or anxious about this diagnosis. Many women find it helpful to seek emotional support, whether through counseling, support groups, or open conversations with loved ones.

Ultimately, the path you choose will depend on your personal circumstances, values, and goals. Whether you decide to pursue fertility treatments, consider egg donation, explore adoption, or take a different route entirely, know that there are multiple ways to build a family and experience the joys of parenthood.

Your fertility journey may not look exactly as you imagined, but with perseverance, support, and the right medical guidance, you can navigate the challenges of DOR and move forward with hope and determination.

Find an amazing egg donor at Cofertility

At Cofertility, our program is unique. After meeting with hundreds of intended parents, egg donors, and donor-conceived people, we decided on an egg donation model that we think best serves everyone involved: egg sharing.

Here’s how it works: our unique model empowers women to take control of their own reproductive health while giving you the gift of a lifetime. Our donors aren’t doing it for cash – they keep half the eggs retrieved for their own future use, and donate half to your family.

We aim to be the best egg-sharing program, providing an experience that honors, respects, and uplifts everyone involved. Here’s what sets us apart:

• Human-centered. We didn’t like the status quo in egg donation. So we’re doing things differently, starting with our human-centered matching platform.
• Donor empowerment. Our model empowers donors to preserve their own fertility, while lifting you up on your own journey. It’s a win-win.
• Diversity: We’re proud of the fact that the donors on our platform are as diverse as the intended parents seeking to match with them. We work with intended parents to understand their own cultural values — including regional nuances — in hopes of finding them the perfect match.
• Baby guarantee. We truly want to help you bring your baby home, and we will re-match you for free until that happens.
• Lifetime support: Historically, other egg donation options have treated egg donor matching as a one-and-done experience. Beyond matching, beyond a pregnancy, beyond a birth…we believe in supporting the donor-conceived family for life. Our resources and education provide intended parents with the guidance they need to raise happy, healthy kids and celebrate their origin stories.

We are obsessed with improving the family-building journey — today or in the future — and are in an endless pursuit to make these experiences more positive. Create a free account to get started today!