Many women over the age of 40 experience reduced fertility and irregular periods. However, women with primary ovarian insufficiency (POI), also known as premature menopause, see these symptoms much earlier. POI affects 1% of women under the age of 40 and 0.1% of women under the age of 30. As a rare condition, POI might have caught you unprepared, especially if you’re still yet to start your family. The good news is that having children with POI is still possible and in this article, we will share more information about this condition:
- What POI is
- The causes of POI
- The signs and symptoms of POI to look out for
- Treatment options for POI
- Fertility treatment solutions for POI
What is POI, ie. Primary Ovarian Insufficiency?
POI is a condition where the number of follicles in the ovaries and the levels of the ovarian sex hormone oestrogen drop long before menopause is due to start, usually before the age of 40. Women who have reached menopause stop having periods and do not ovulate, while women with POI may still have periods, albeit irregular, and therefore might still be able to get pregnant. However, due to POI, both the follicle and egg numbers are much lower, which can cause difficulty in conceiving. 1
What causes POI?
POI affects the number of follicles – the little pockets in the ovaries that nurture and grow eggs. Normally, a woman is born with approximately 2 million follicles that run out at menopause. These follicles produce ovarian hormones, such as oestrogen, and these levels fluctuate throughout the menstrual cycle. 2 3 9
A woman with POI runs out of follicles (and eggs) much earlier than that, causing her oestrogen levels to be very low. The exact cause of this is unknown but the following factors are associated with POI:
- Family history and genetic disorders such as Fragile X syndrome and Turner syndrome. 4
- A low number of follicles at birth.
- Autoimmune diseases, such as Addison’s disease and Thyroiditis. 4
- Chemotherapy or radiation. 4
- Excessive tobacco and alcohol use. 4
- Other potential causes, e.g. diabetes mellitus type I, previous infection (for instance, mumps) 9
What are the signs and symptoms of POI?
For some women, the changes in hormone levels and the number of follicles are indicated by irregular or absent periods, making it difficult to conceive, whereas others experience menopause-like symptoms. These symptoms include hot flushes, painful intercourse, poor sleep, vaginal dryness and decreased libido.
However, it is important to note that up to 25% of women with POI can still have irregular periods, and therefore ovulate, which might complicate and delay the diagnosis (Torrealday et al., 2017).
The diagnosis usually includes a physical exam during a doctor consultation, evaluation of the frequency of your periods (over at least 4 months), blood tests for your hormone levels (such as AMH, oestrogen, FSH and LH) and a pelvic ultrasound to look at the ovaries and uterus. 5 9
Can POI be reversed or treated?
POI is irreversible (as women cannot produce new eggs). However, 5-10% of women with POI can become pregnant naturally when their ovaries do function in between irregular periods.
Currently, there is no cure for POI. 6 However symptoms of POI can be well managed with hormone replacement therapy (HRT), calcium and vitamin D supplements, maintaining a healthy weight, and emotional support. 7
A healthy lifestyle, such as a balanced diet, regular exercise, limited alcohol and stopping smoking, can greatly improve your well-being with POI. 9
Which fertility treatments can help women with POI?
Women with POI may have difficulty getting pregnant due to the low number of eggs and lack of ovulation, which means they may not be releasing healthy eggs that can be fertilised by sperm. As a result, in vitro fertilisation (IVF) with their own eggs may not be recommended or possible.
Fortunately, IVF treatment with donor eggs in women with POI results in high success rates, ranging from 40% to 50% per cycle. At Apricity we have an 86% cumulative pregnancy success rate for IVF with egg donation after 3 cycles. Since the success of treatment is dependent on the age and health of the egg donor, egg donation is a very successful treatment option in women with POI. 8
As the first organization of its type in the UK, we have set the ‘gold’ standard in terms of egg donation, which has resulted in hundreds of successful pregnancies, and families, from our amazingly kind altruistic UK donors.
Being diagnosed with POI is a life-changing moment which requires difficult decisions to be made, whether you are planning to start your family or not. However, solutions and support systems exist, from hormone replacement therapy for symptom management to fertility treatment via egg donation that grants high success rates for women with POI.
Becky Kearns, also known by her social media handle @definingmum, has been sharing her story of being diagnosed with POI at 28, going through egg donation treatment and becoming a mum. Her network Paths to ParentHub offers enormous support and guidance on the topic and is a great source of inspiration. Other sources of support include Fertility Network UK, Daisy Network, Donor Conception Network and the British Menopause Society.
Apricity is here to help you navigate your fertility journey in a caring and stress-free environment. We have one of the highest pregnancy rates in the UK which has led to many families who have been able to have genetically related children through egg donation. Our egg donors are young and healthy altruistic women from the UK who are carefully matched with you by our small dedicated team in 4-6 weeks.
Book a free call with one of our advisors.