Premature Ovarian Failure (POF) and Infertility

by National Institute of Health

(Page 5 of 5)

If you have POF, it will likely be very difficult for you to become pregnant because your ovaries aren't working correctly. At this time, there is no proven medical treatment that improves a woman's ability to have a baby naturally if she has POF.

There is a chance that you will become pregnant without fertility treatment. Between 5 percent and 10 percent of women with POF do become pregnant, even though they have not had fertility treatment. Sometimes pregnancy can occur decades after the initial diagnosis. Researchers cannot explain why some women with POF get pregnant, while others do not.

Because pregnancy is still possible for women who have POF, those who do not want to become pregnant should take steps to prevent pregnancy. In some women with POF, oral contraception may not be as effective for pregnancy prevention as it is in women who don't have POF. In some cases, using a "barrier" method of contraception, such as a diaphragm or a condom, may be a better option for women with POF who don't want to become pregnant. Discuss your contraception needs with your health care provider, if you have POF and don't want to become pregnant.

If you have POF and want to become pregnant, you and your family have some options, explained below. You should also know, however, that some medical therapies for infertility have been proven ineffective, through randomized clinical trials. These therapies include high-dose estrogen therapy, gonadotropin-releasing hormone (GnRH) agonist therapy, corticosteroid therapy, high-dose GnRH therapy, and treatment with danocrine. Health care providers recommend avoiding unproven fertility treatments because such methods may actually reduce your chances of getting pregnant naturally.

A special note about infertility associated with POF

Many women involved in POF support groups reported that, when they were diagnosed with POF, they felt a sense of loss or grief, not unlike the sadness associated with the death of a loved one. Others reported that they felt guilty about not trying to have children earlier in their lives. They noted that the diagnosis also affected their partners, spouses, and families. For women with POF and their families, then, emotional support may be as important as medical treatment for dealing with POF.

Health care providers who care for women with POF often have to reassure their patients that these emotional responses are perfectly natural reactions to the news of POF. Some health care providers suggest taking time to deal with the diagnosis and the emotions that surround it, before making any decisions about having a family.

Many providers recommend that women with POF and their families work with a "professional listener" to help deal with the powerful and sometimes painful emotions associated with this diagnosis. A social worker, a psychologist, a psychiatrist, or another mental health professional can work with a woman individually, together with a spouse, partner, or a family member, or in some combination of these arrangements.

Many women in support group settings reported that talking to other women who had POF was helpful in coming to terms with their diagnosis. Many hospitals and health clinics offer support groups for women and families affected by POF.

What are my options for having a child?

Families affected by POF do have options for having a child. As mentioned earlier, avoid unproven fertility treatments and treatments that have been proven ineffective because such methods may actually reduce your chances of getting pregnant naturally.

Adopting a child is one option for starting a family if you have POF. Adoption can be one of the most rewarding experiences of a lifetime; but the process is not without risks. Many health care providers recommend that families considering adoption learn about the process, its benefits and risks, and its legal aspects, in addition to the possible emotional effects, before making a decision.

A certain type of assisted reproductive technology (ART), known as egg donation, may also be an option for having a child. In POF, the problem is in producing healthy eggs; the condition does not affect a woman's uterus, which means she may be able to carry a child. Egg donation makes it possible to combine donor eggs and sperm in a laboratory, and then place the resulting embryos into the uterus of a woman who has POF.

All forms of ART are complex, and each carries its own benefits and risks, some of them serious. Because few insurance companies currently provide coverage for this procedure, families may have to cover the entire cost of the process. And, many families have to try ART several times before it is successful. The Centers for Disease Control and Prevention (CDC) provides statistics on success rates of ART procedures based on different factors.

If you and your family are considering ART, talking with a health care provider and/or a fertility specialist about the risks and benefits may help you make your final decision. In addition, researchers are actively working to develop methods that improve fertility in women with POF and other conditions. As such methods and treatments improve, women with POF and their families may have more options for having children naturally.

What are researchers doing to learn more about POF?

Currently, the NICHD is conducting and sponsoring a number of studies on POF:

Some researchers are exploring whether a low dose of a certain steroid can treat POF in cases caused by an autoimmune disorder. The steroid, called prednisone, decreases the function of the body's immune system, which is thought to be attacking the ovary follicles in some women with POF.

Researchers are trying to determine the best combination and dosage of HRT for treating POF. Some work is trying to learn whether adding testosterone to a woman's HRT can help to prevent bone loss. Other studies are trying to find the amount of estrogen and progestin that best treats POF without causing too many side effects.

Other research focuses on what happens in an ovary that is working normally. This information may help scientists develop a test for early detection of POF.

Clinical trials to explore these topics are already underway. To find out more about these studies, contact the NICHD's Unit on Gynecologic Endocrinology, at 1-877-206-0911. You can also learn more about all studies on POF by going to http://clinicaltrials.gov, and doing a search for "premature ovarian failure." Or, you can call the NIH Patient Recruitment and Public Liaison Office at 1-800-411-1222.

In addition to these studies, the NICHD has a Reproductive Medicine Gynecology Program in its Reproductive Sciences Branch that supports research on women's health conditions that aren't cancerous, including POF. In 1998, the NICHD joined other Institutes at the NIH in setting up 12 Women's Reproductive Health Research Career Development Centers. These Centers support obstetricians and gynecologists in becoming researchers, so that they can study topics on women's health. Eight additional Centers, started in 1999, will allow this vital research to continue until scientists know the causes and treatments for POF and other reproductive diseases.

The NICHD's Reproductive Sciences Branch also has other programs that support research on POF, and on other topics that affect women's health. The Specialized Cooperative Centers Program in Reproductive Research (SCCPRR), established in the late 1990s, relies on multidisciplinary approaches to research on reproductive health topics. SCCPRR has a number of basic, translational, and clinical scientific studies in progress at 14 sites around the country that are aimed at finding the cause of POF, including genetics and the factors that cause follicle depletion and dysfunction.

About the Author

NIH is the nation's medical research agency - making important medical discoveries that improve health and save lives. The National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services, is the primary Federal agency for conducting and supporting medical research.