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Conditions

IVF and reproductive medicine · Fertility

Primary ovarian insufficiency

Understand loss of ovarian function before age 40 and its effects on health and fertility.

Editorial publication · Medical review pending.

Understand

Primary ovarian insufficiency is loss of ovarian function before age 40, with irregular or absent cycles and biochemical confirmation. It differs from permanent menopause because intermittent ovarian activity may remain.

Possible symptoms

Infrequent or absent periods, hot flushes, night sweats, vaginal dryness, sleep disturbance and difficulty conceiving can occur.

Causes and associated factors

Genetic, autoimmune, surgical, chemotherapy- or radiotherapy-related causes exist, but the cause often remains unknown.

Diagnosis

Diagnosis requires symptoms or disrupted cycles and hormone measurements interpreted using guideline criteria. Pregnancy and other causes of amenorrhoea must be excluded.

Tests

Assessment may include FSH, estradiol, a pregnancy test, thyroid, genetic or autoimmune testing according to context. AMH should not replace the main diagnostic criteria.

Course of the condition

Intermittent ovulation and spontaneous pregnancy remain possible but unpredictable. Prolonged oestrogen deficiency also affects bone, cardiovascular, sexual and psychological health.

Care options

Hormone replacement is often discussed until the usual age of menopause if not contraindicated. Fertility, donor eggs, preservation before a high-risk treatment and psychological support require individual discussion.

When to consult

Seek assessment if periods become absent or very irregular before age 40, especially with hormone-deficiency symptoms or relevant family or treatment history.

Urgent help

POI is not usually an emergency. Very heavy bleeding, severe pain, collapse, major psychological distress or symptoms of a complicated pregnancy need prompt help.

Questions for your doctor

  • Which cause or combination of factors explains our fertility difficulty?
  • Which tests are genuinely useful before deciding?
  • Which options exist before or instead of IVF?
  • Which benefits, limits, risks and costs should we compare?
  • What support and reassessment timeline should we plan?

Continue reading

A procedure linked to a condition does not establish an indication for your individual situation.

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