I remember my days as a Fellow at the Jones Institute in Norfolk, Virginia when the second year Fellows were in charge of the donor egg program. This was 1989, and the Jones Institute was the premier infertility clinic under the leadership of Drs Howard and Georgeanna Jones. In fact it was one of the handful of clinics in the US with a donor egg program. We had a waiting list of almost 200 patients from all over the world. It took a couple of years for these patients to be matched with a suitable egg donor. These were patients with a wide variety of diagnosis including premature ovarian failure. It was amazing as to the number of patients that used to get pregnant SPONTANEOUSLY while waiting for an egg donor.
This leads to the first point I would like to make “WOMEN WITH POF HAVE A 5 – 10% CHANCE OF CONCEIVING SPONTANEOUSLY AFTER DIAGNOSIS”
Having said that, I would like to reiterate that the only intervention that is consistently effective is in vitro fertilization and embryo transfer using donor eggs. This remains the fertility treatment of choice in patients with POF.
Who will get pregnant spontaneously?
It is difficult to predict which patient will resume ovulation and conceive spontaneously. In patients with autoimmune POF, ovarian function may recover with regression of the autoimmune status and control of the hormonal imbalances. These have been case reports of patients with myasthenia gravis resuming ovulation after removal of the thymus gland. Similar success stories have been reported in patients following treatment of thyroid and adrenal (Addison’s) disease.
What has been tried so far?
Here are some of the strategies that have been tried
Estrogen therapy
There have been several cases of spontaneous pregnancies in patients with POF taking estrogen as well as birth control pills! These pregnancies happen in patients with secondary amenorrhea (patients that used to get periods previously) and happen in the first three cycles of estrogen replacement. This treatment was found to be NOT effective in prospective randomized controlled trials.
Suppression with GnRH analogues
This was done in an effort to suppress FSH levels in an attempt to reverse POF. This did not work.
Ovulation induction
With high doses of gonadotropins both alone and in combination with clomiphene citrate. The results were not good.
Administration of Steroids
In patients with autoimmune disease. Prednisone 25 mg four times per day for 2 weeks was tried with success in a patient with polyglandular endocrinopathy syndrome. This does work in very select patients. Steroids can be associated with bone loss.
Pentoxyfylline with Vitamin E; growth hormone-releasing hormone
Have also been tried with limited success.
Egg freezing, ovarian tissue freezing and embryo freezing have all been tried successfully in cancer patients prior to chemo- or radiotherapy.
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