Getting pregnant with Premature Ovarian Insufficiency

What is premature ovarian insufficiency?

Premature ovarian insufficiency (POI) is when your ovaries stop working normally before age 40. Eggs are released from the ovaries less frequently and at irregular times. It affects around one in 100 women, and can happen as young as in their teenage years. In the past, this was referred to as ‘premature menopause’ or ‘premature ovarian failure’, but POI is now the preferred term.

What is the difference between menopause and POI?

While both involve fewer eggs being released from the ovaries, POI and menopause are two different conditions. Menopause affects all women, usually between the ages 45 and 55. During this time, the ovaries stop producing eggs and menstruation stops completely.

POI is different from menopause as women with POI still ovulate, but inconsistently due to having a reduced number of eggs. Their eggs are also typically higher quality, so it’s still possible for them to conceive, although it may be more difficult for women with POI.

What causes POI?

In the majority of cases, there’s no clear cause of POI. However, several factors have been associated with the condition.

Women are born with around two million immature eggs called primordial follicles. These primordial follicles develop into primary follicles, which then develop into eggs that are released during ovulation. Some genetic conditions can affect the number of these follicles. Fragile X syndrome causes egg follicles to be depleted faster, while women with Turner syndrome are born with fewer follicles.

Some immune disorders, like thyroiditis or Addison’s disease, can damage either the follicles or the glands that produce hormones supporting normal ovarian function. This can lead to fewer eggs being released.

Follicles can also be depleted by chemotherapy or radiotherapy used in cancer treatment. There’s also some evidence suggesting that smoking can cause rapid depletion of follicles and lead to POI, but more evidence is needed to support this.

Premature ovarian insufficiency symptoms

Common premature ovarian insufficiency symptoms are very similar to those of menopause. The main symptom is irregular or missed periods, which can persist for years. Alongside this, common symptoms of premature ovarian insufficiency include:

• Hot flushes
• Night sweats
• Difficulty getting pregnant
• Headaches
• Mood changes and irritability
• Difficulty with concentration or memory
• Reduced sex drive
• Vaginal dryness

Premature ovarian insufficiency diagnosis

POI is diagnosed when someone has irregular or absent periods for at least four months and a raised level of follicle-stimulating hormone (FSH), typically above 25 IU/L. This is measured using two blood tests taken four to six weeks apart.

Premature ovarian insufficiency treatment

There are currently no treatments that can restore normal ovarian function after POI. Some centres do offer emerging treatments like in vitro activation, mitochondrial activation, stem cell therapy and platelet-rich plasma (PRP) intra-ovarian infusion. However, these are experimental treatments that haven’t yet been proven to be fully effective or widely used in clinical practice.

Treatments for premature ovarian insufficiency instead focus on managing its symptoms and protecting against the long-term effects of low oestrogen levels. Low oestrogen is associated with an increased risk of heart disease, osteoporosis, early on-set dementia and depression. To help reduce these risks, hormone replacement therapy (HRT) is often recommended to restore oestrogen levels. 

Alongside this, women with POI are advised to take 1,200 to 1,500 mg of elemental calcium and 1,000 IU of vitamin D every day to reduce their risk of osteoporosis.

Can POI be reversed?

Unfortunately, no available treatments can reverse POI. In around 5% of cases, the ovaries can start producing eggs again, but it’s very difficult to predict who this will happen to.

Can Clomid (clomiphene citrate) help with premature ovarian insufficiency?

Clomid (clomiphene citrate) is a fertility medication that’s used to treat infertility in women who don’t ovulate regularly. It works by making the pituitary gland produce more follicle-stimulating hormone (FSH).

Unfortunately, Clomid has not been shown to be effective in treating POI as the condition is caused by reduced ovarian function rather than a lack of hormonal signalling alone.

Stimulating the ovaries with FSH can be tried and can be successful in some cases. However, there’s a high chance that the ovaries do not respond to stimulation with FSH, meaning the likelihood of success is relatively low.

How can I get pregnant with POI?

Yes, it is possible to get pregnant with POI, but the chances are low due to irregular ovulation, which makes it difficult to plan timed sexual intercourse.

The most effective fertility treatment for women with premature ovarian insufficiency is egg donation.

How does egg donation treatment work?

At Lister Fertility Clinic, we run a successful egg sharing programme. Egg sharing is where eggs collected from a donor are used in another person’s IVF treatment to help them conceive.

The eggs used can be fresh eggs from a donor, including from someone you know, or frozen eggs from an egg bank. To make sure the eggs are suitable, the clinic checks the donor’s medical history, egg reserve and age, as well as performing tests to rule out any genetic or infectious diseases.

The donor eggs are fertilised outside of your body using either your partner’s sperm or donor sperm. The resulting embryo is then transferred to your womb so that you can carry the pregnancy.

Choosing to use donor eggs can be a big decision to make. Under UK legislation, any child born from donated eggs or sperm can find out the name and address of the donor once they turn 18. To help with the emotional impacts of using donor eggs, Lister Fertility Clinic offers counselling support for everyone undergoing fertility treatment with us.

What are my chances of getting pregnant using donor eggs?

Egg donation treatment is very successful, with your chance of conception being almost 50% per cycle. However, if you’re considering using eggs from someone you know, it might be lower due to the age and egg reserve of that person.

Are there any risks to the pregnancy?

If you conceive naturally with POI, the risks to your pregnancy are no higher than the general population.

Pregnancies from egg donation treatment are associated with a high risk of pre-eclampsia and are considered high risk pregnancies. This is a condition that causes high blood pressure during pregnancy, which can cause complications for both your baby and you. As such, you’ll need to be looked after by a specialist maternity unit and have regular blood pressure monitoring, and ultrasound checks to make sure you and your baby are healthy. You should always let your maternity team know if you used donor eggs to ensure you receive the care you need.