Medically reviewed by Norbert Gleicher, MD, FACOG, FACS - Written by CHR Staff - Updated on Dec 03, 2019
Fertility Treatment for POF
At CHR, it is always the patient who decides which treatment she wishes to use. Even in the best of hands, getting pregnant with POF is a rare event (as opposed to POA--premature ovarian aging--which is often misdiagnosed as POF), and most women with POF eventually end up having to use egg donation.
CHR does offer experimental fertility treatments for premature ovarian failure patients, but we usually recommend donor eggs as the treatment of choice. However, this does not mean that patients should be given egg donation as their only option during consultations for premature ovarian failure IVF.
Premature Ovarian Failure & Fertility Treatment Options
Dr. Barad explains premature ovarian failure and POF fertility treatments.
In our opinion, nobody with POF should enter an egg donation cycle without being absolutely convinced that it is their only realistic chance of having a child. That is the only way for patients to experience donor egg pregnancy as their personal POF success story. We, therefore, not only respect our patients' desire to "at least try once" with their own eggs, but actually encourage such attempts if patients still believe they have what looks to them like a reasonable chance.
The definition of "reasonable," of course, varies between patients, and chances that one patient considers reasonable may be too low for another. We do not feel that we can make these judgments for our patients; instead, we focus on giving our patients accurate and comprehensive information on IVF with POF so that they can make an informed decision about their fertility treatment for premature ovarian failure. Only the patients can decide what represents a "reasonable" chance for them! Once they decide, CHR will do its best to maximize pregnancy chances and avoid failed IVF, whatever treatment patients choose.
Premature Ovarian Failure IVF Success Rates: Donor Eggs vs. Own Eggs
Egg donation is, undoubtedly, the most successful treatment option for women with POF. With their own eggs, patients’ premature ovarian failure pregnancy chances are, at most, in the low single digits (even with aggressive fertility treatment). In CHR's egg donor program, the same POF patient will have a cumulative pregnancy rate in the high 80s to low 90s, from a single egg donation cycle.
Since about 95% of an embryo's quality derives from the egg, and egg donors are typically young, recipients of donated eggs will have the pregnancy chances and miscarriage risks of a young woman with normal ovarian reserve. Because of this, any fertility treatment for premature ovarian failure that uses donor eggs will usually have better chances of success than one that does not.
DHEA Supplementation
Unfortunately, DHEA supplementation, while showing remarkable results in patients with premature ovarian aging (POA), appears much less effective (and maybe even not effective at all) in patients with outright POF. Very low pregnancy rates in our past DHEA study in POF patients showed us that pregnancy chances in POF patients would, at best, be affected by DHEA only in a much more limited way, in comparison to POA patients.
HRT and POF Treatment
Hormone replacement therapy (HRT) is a therapy most commonly used to treat the symptoms of menopause in women, aside from pregnancy attempts. It usually involves using hormonal medications - like estrogens, progestogens, or some combination of the two - to relieve some of the discomfort commonly associated the natural rebalancing of hormones that occurs in the body during menopause. Treating POF with HRT is common, and it may also be prescribed for patients with functional hypothalamic amenorrhea. HRT can help patients effectively manage the symptoms of POF.
Predicting POF
Fortunately, technology and research have advanced to a point where there are now ways to detect if you are at high risk for developing POA, POF, and early menopause later in life. Recent infertility research into the FMR1 gene at CHR suggests that FMR1 genotypes may predict whether a woman is more likely to develop POA/POF later in life. FMR1 genotypes and sub-genotypes as genetic predictors of risk towards POA/POF represent another exciting new development at CHR.
Women diagnosed as at high risk for future POA/POF will have ways to proactively manage their reproductive life: they can decide to have children earlier in life; they can monitor their ovarian reserve periodically; they can decide to pursue fertility preservation. Early intervention treatments involving IVF and early menopause have been proven to have the best results. However, fertility preservation, whether through ovarian tissue cryopreservation, egg freezing or embryo freezing, is still a developing and largely experimental medical treatment (with the exception of embryo freezing, which has been in use for many decades and has a proven record). Fertility preservation may become a major part of proactive POA/POF treatment in the future.
POF Success Stories
If you’ve been diagnosed with premature ovarian failure, know that getting pregnant with POF treatment may still be possible. Although premature ovarian failure IVF success rates are generally low, there are experimental treatments like IVF with HGH (human growth hormone) and ovarian rejuvenation with PRP (platelet-rich plasma) for patients with POF.We regularly publish success stories on our website, and our yearly pregnancy outcomes, which include some patients with POF.
Norbert Gleicher, MD, FACOG, FACS
Norbert Gleicher, MD, leads CHR’s clinical and research efforts as Medical Director and Chief Scientist. A world-renowned specialist in reproductive endocrinology, Dr. Gleicher has published hundreds of peer-reviewed papers and lectured globally while keeping an active clinical career focused on ovarian aging, immunological issues and other difficult cases of infertility.