You are at risk for anovulatory dysfunction, diminished ovarian reserve, and premature ovarian failure (POF). Here is what you need to know.
The average age at which women become menopausal is 51 and it can range from 45 to 60. Women who become menopausal between 40 and 45 years of age are experiencing early menopause. In contrast, women who are in menopause by the age of 40 suffer from premature menopause.
Normally, women start having irregular periods several years before they become menopausal. During this time, the ovarian reserve (quality and number of eggs) declines precipitously, and along with it, their ability to get pregnant. If your mother went into early or premature menopause, you might be at increased risk of having the same problem. Therefore, make sure you are aware of your mother’s menstrual history and plan accordingly.
Modern women put careers first and as a result, motherhood comes second in their priorities. As a result, the average age of women when they decide to pursue pregnancy in western developed countries is close to 32 and rising. This means many such women might be at a disadvantage if they have any risks for premature ovarian failure.
Besides genetic predispositions, there are a lot of lifestyle factors as well as medical/gynecologic conditions that could affect the function of the ovaries and cause premature ovarian failure.
Conditions associated with increased risk for premature ovarian failure
- Family history: Women with a family history of premature ovarian failure are at increased risk to develop the condition
- Chemotherapy or radiation treatment for cancer: such treatments can cause damage to the ovaries and reduce fertility or even cause permanent premature menopause. Such patients should be advised to collect and freeze eggs prior to such treatments to preserve their ability to have a baby. Furthermore, chemotherapy can induce chromosomal defects in the eggs, and this is one more reason to save and freeze eggs before the treatment.
- Cigarette smoking: cigarette smoking is known to cause many health issues. One of them is premature ovarian failure. The precise mechanism is not known but the various chemicals in tobacco and oxidative stress might play a significant role. Quitting smoking is a must for patients struggling with fertility issues. The same is true for men in couples who are trying to conceive, and they should both stop smoking.
- Ovarian surgery for benign conditions: women who have ovarian surgery for benign ovarian conditions (ovarian cystectomy, endometriosis of the ovaries, benign ovarian tumors) might experience diminished ovarian reserve or even premature ovarian failure if the surgery was complicated and resulted in the removal of excessive ovarian tissue.
- Turner syndrome: women with Turner syndrome are missing one of their X chromosomes. Such women are at increased risk to have diminished ovarian tissue or even complete replacement of their ovaries with some scar tissue (streak ovaries). The same could happen in patients with gonadal dysgenesis from other etiologies.
- Autoimmune conditions and anti-ovarian antibodies: Various autoimmune conditions can cause excessive systemic inflammation. Inflammation causes oxidative stress and mitochondrial depletion/malfunction. Oxidative stress leads ultimately to diminished ovarian reserve (number and quality of eggs). Controlling autoimmune diseases is important to prevent premature ovarian failure in women of reproductive age.
- Endometriosis: Endometriosis is a chronic systemic autoimmune inflammatory disease that among other effects, causes severe oxidative stress in the ovaries leading to poor ovarian reserve and infertility. Endometriosis complicates infertility further by the production of scar tissue around the ovaries and the Fallopian tubes. One in three patients attending an infertility clinic suffers from endometriosis, unbeknown to them. Further, women who fail after IVF with a genetically normal embryo once, have a 50% probability of suffering from undiagnosed endometriosis and if they fail twice, the risk climbs to 80%. Managing endometriosis is very important in women seeking infertility treatment.
- Chronic infections (HIV and AIDS): women whose infections are not controlled with medication are at increased risk to develop premature ovarian failure.
- Chronic fatigue syndrome: Women with chronic fatigue syndrome (CFS) have extreme tiredness, weakness, muscle and joint pain, memory loss, headache, sleep problems, and other symptoms. Research has found that women with CFS are more likely to have early or premature ovarian failure.
- Insulin resistance: insulin resistance is a condition in which all tissues have a reduced response to insulin. As a result, the pancreas increases the production of insulin. This condition leads to the development of metabolic syndrome in the most severe cases. Unlike other tissues, ovarian tissue does not develop insulin resistance. As a result, excessive insulin production decreases ovarian levels of myoinositol (MI) by means of epimerization to dichiroinositol (DCI). This creates an imbalance in the ratio of MI/DCI which in turn reduces the production of eggs severely. This imbalance must be corrected with proper treatment prior to egg retrieval.
You must evaluate your ovarian reserve by obtaining a hormonal assessment with AMH and Inhibin B on the third day of your menstrual cycle (between day 2 and day 4). If you have diminished ovarian reserve, ask your doctor to look for the reason, among the conditions listed above, and treat you accordingly. Specific antioxidant and anti-aging supplements and medications can help many women, but it is best to first identify the reason behind your reduced ovarian reserve and then treat it accordingly for the best success. Dr. Kofinas treats his patients with supplements that rejuvenate ovarian function and improve egg quality in a period of three to six months. This benefit is confirmed based on the improvement of day 3 hormonal changes from baseline prior to the onset of supplementation. You may request such supplements if you wish, and we can order them for you.