Premature Ovarian Failure
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, which is often misdiagnosed as POF), and most women with POF eventually end up having to use egg donation. CHR does offer experimental treatments to POF patients, but we usually recommend donor eggs as the treatment of choice. However, this does not mean that POF patients should be given egg donation as their only option.
In our opinion, nobody should enter an egg donation cycle without being absolutely convinced that it is their only realistic chance of having a child. 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 somebody else. We do not feel that we can make these judgments for our patients; instead, we focus on giving our patients accurate and comprehensive information so that they can make an informed decision. Only the patients can decide what represents a "reasonable" chance for them! Once they decide, CHR will do its best to maximize pregnancy chances, whatever treatment patients choose.
Egg donation is, undoubtedly, the most successful treatment option for women with POF. With their own eggs, POF patients have a pregnancy chance, at most, in the low single digits. 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.
Unfortunately, DHEA,DHEA, while showing remarkable results in patients with premature ovarian aging (POA),(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.
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 or POF later in life. Recent infertility research into the FMR1 gene at CHR suggests that FMR1 genotype 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. 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). However, fertility preservation may become a major part of proactive POA/POF treatment in the future.
Last Updated: November 15, 2014