What is Premature Ovarian Aging (POA)?
POA, or premature ovarian aging, is defined as a younger woman having a low or poor ovarian reserve relative to what is expected at any given age. It is one of the major, often overlooked, causes of female infertility.
Premature Ovarian Aging vs. Early Menopause
Dr. Gleicher discusses the difference between POA and early menopause, and why women with premature ovarian aging still have a good chance of getting pregnant.
The ability of a woman's ovaries to produce high-quality eggs is known as ovarian reserve (OR). As women get older, their OR naturally declines, the number and quality of eggs go down, and it becomes harder to get pregnant. Women attempting pregnancy after age 40 often have difficulty getting pregnant for this reason.
In approximately 10 percent of women, however, this decline of ovarian function occurs much earlier than what is normal. These women are considered to suffer from premature ovarian aging (POA), a clinical term coined by CHR researchers. Other IVF centers frequently refer to POA as “occult primary ovarian insufficiency,” or “oPOI.”
Women with this condition have a hard time conceiving on their own, or even with fertility treatments like IUI, if the treatment is not appropriate for their ovarian reserve status. But with appropriate treatment, like IVF with pre-treatment with DHEA and/or CoQ10 and aggressive ovarian stimulation protocols, women with POA can conceive, as many of our patients can testify. Learn more about IVF after 40 here.
When it comes to determining the pregnancy chances for each patient, it is important to distinguish between POA and POF (premature ovarian failure). While POF refers to a complete loss of the ovaries’ ability to produce eggs, which makes pregnancy extremely difficult, patients with POA are still able to produce eggs, especially with specifically designed treatment.
Premature Ovarian Aging Causes
The causes of premature ovarian aging are still largely unknown. However, significant evidence from animal studies suggests that ovarian reserve is genetically controlled, and a genetic factor is most likely involved in POA, as it frequently runs in families.
Undergoing life-saving medical procedures like chemotherapy and radiation can cause POA (or sometimes even POF), which is why fertility preservation is recommended for young women with serious medical conditions requiring chemo and radiation. Surgeries involving the ovaries can also result in POA or POF when enough of the ovarian tissue is removed to reduce the ovary’s ability to produce eggs. For this reason, CHR physicians usually advise against avoidable pelvic surgeries when the patient is planning to build or expand their family.
There’s also evidence to suggest that having certain conditions (an autoimmune disease, endometriosis, pelvic infections, or tubal disease) can potentially cause POA. Autoimmunity can be a direct cause of premature ovarian aging, when the patient’s immune system attacks the ovaries; POA has also been associated with autoimmunity in general and hyperactive immune system. Endometriosis can result in POA when it infiltrates the ovaries, and especially when surgeries are performed to remove the endometriosis from the ovaries and surrounding areas.
Premature Ovarian Aging and Infertility
POA negatively affects female fertility primarily through sub-optimal number of eggs and poor quality of eggs. Smaller numbers of lower-quality eggs reduce women’s fertility in two ways: they make it more difficult to get pregnant, and once pregnant, miscarriages are more likely to happen. Unfortunately, the quality of eggs declines in parallel with the quantity of eggs. Therefore, women with untreated diminished ovarian reserve experience the highest miscarriage rates of any infertility diagnosis because approximately 95 percent of embryo quality comes from the egg, and poor-quality embryos are more likely to result in miscarriages.
POA's Effects on Female Infertility
- Leads to diminished ovarian reserve
- Poor response to ovarian stimulation in IVF cycles ("poor responder")
- Poor quality eggs
- Poor quality embryos
- Embryos with disproportionately high rate of chromosomal abnormalities (aneuploidy)
- Reduced number of euploid embryos (balanced set of chromosomes)
- Low pregnancy rates
- High miscarriage rates
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.