Clinical Management of Primary Ovarian Insufficiency

Primary ovarian insufficiency (POI) is typically used to describe ovarian dysfunction when the underlying mechanism is unknown, although genetic defects, chemotherapy, radiotherapy, or surgery is also known to be causative. The incidence is rare, affecting approximately 1 in 100 women under the age of 40 years. POI is characterized by a triad of amenorrhea, low serum estradiol levels, and elevated serum follicle-stimulating hormone levels. The condition leads not only to infertility but also to ovarian hormone deficiency that is associated with health risks that include menopausal symptoms, decreased bone mineral density, and increased cardiovascular risk. Hormone replacement therapy should therefore be commenced as soon as possible to prevent adverse health risks. In cancer patients who are to receive chemotherapy or radiotherapy, fertility preservation options should be offered, though embryo donation and adoption are considered as alternatives. Given that recent studies in genetically modified animal models have revealed that the underlying mechanism involves increased follicle activation and subsequent early follicle exhaustion, new therapeutic strategies are needed.