Premature Ovarian Failure: Fertility Challenge

Oestroprogestogens

Aspirin

Gonadotrophins

Nitric oxide

Clomiphene citrate

Prednisone

Aromatase inhibitors

Plasmapheresis

GnRH agonists

Pentoxifylline-tocopherol

GnRH antagonists

Apoptotic inhibitor

Recombinant LH

Sphyngosine-1-phosphate

Recombinant growth hormone

DHEA

Natural cycle or cycle modified with oestroprogestagens represents the method of choice nowadays with 5–15 % of success resulting in pregnancy.

Loutradis et al. [8] found that low-dose human chorionic gonadotrophin in the first days of the ovarian stimulation had promising results in grade I POI.

Oocytes of women with diminished ovarian reserve are prone to a high rate of meiosis errors leading to a high rate of aneuploidy [9].

It was found that GnRH does not improve the successful ovulation induction with exogenous gonadotrophins. van Kesteren et al. [10] gave 4 weeks intranasal buserelin 1,000 ug daily or placebo, the 3-week human menopausal gonadotrophin in weekly augmented dose, but no difference in pregnancy rate was found. Gonadotrophin therapy carries a theoretical risk for exacerbating autoimmune POI.

Dehydroepiandrosterone (DHEA) is converted to oestradiol which suppresses FSH. Increasing of the testosterone production by the very early follicles stimulates androgen receptors allowing more preantral follicles to progress to more mature antral follicles [11].

In a case of failure of all mentioned protocols, some new therapeutical options can be performed.

14.5 Modern Technique for Ovulation Induction in POI

Donor oocytes can be advised to a woman with POI failing to conceive under oestroprogestogens previously and with well-prepared endometrium (Table 14.2).

Table 14.2

Other approaches to pregnancy in POI

Donor oocyte

Embryo freezing

Freezing of mature eggs

Cryopreservation and tissue transplantation

Vitrification

In vitro activation

Cryopreservation is freezing of tissue or cells in order to preserve for the future [12]. Methods can be slow freezing or vitrification (ultrarapid freezing).

Vitrification is a process of converting something into a glasslike solid that is free of crystal form. By adding a cryoprotectant, water can be cooled until it hardens like glass without crystal formatting. It is important because ice crystal formate can damage frozen embryo.

Ovarian tissue cryopreservation can be performed in prepubertal girls at risk for POI, and this procedure is as feasible and safe as comparable operative procedures in children [13].

Ovary transplantation can be done with fresh cortical ovarian tissue transplantation, frozen cortical ovarian transplantation or whole ovary transplantation.

In vitro activation (IVA) requires ovaries to be removed from a woman, treated outside the body, then reimplanted near the fallopian tubes. The woman is then treated with hormones to stimulate the growth of specialized structures in ovaries called follin. These women still have very tiny primordial, primary and secondary follicles and may be treatable.

PTEN is a gene that encodes for a protein involved in several critical signalling pathways inside cells including metabolism, growth and survival. It controls follicular growth. Blocking the activity of PTEN in mouse and human ovary was enough to stir dominant follicles into growth and production of mature eggs. Ovaries can be treated with substances modulating the PTEN pathway.

Only gold members can continue reading. Log In or Register to continue