Precocious ovarian failure or early ovarian failure consists of the reduction or lack of oocytes (eggs) in patients under 40 years of age. Prevention of POI depends on the cause of the failure, although most of the time the cause is unknown and, therefore, its prevention is not possible.
The following are possible causes of POI and their prevention:
- Genetic causes the most frequent are X chromosome alterations. There are several possible alterations ranging from numerical defects (monosomies, trisomies, mosaicisms) to partial structural defects such as translocations and deletions (eg, fragile X syndrome). There may also be alterations in the autosomes (non-sex chromosomes) such as translocations or alterations of a gene. In the case of early ovarian failure of genetic causes, prevention is not possible.
- Autoimmune cause It is estimated that autoimmune diseases are present in 15-30% of cases, whether of the endocrine origin or not. Among the first, we find diabetes mellitus, hypothyroidism, hypoparathyroidism and hypophysitis. Non-endocrine ones include chronic candidiasis, idiopathic thrombocytopenic purpura, vitiligo, alopecia, hemolytic anaemia, pernicious anaemia, systemic lupus erythematosus, rheumatoid arthritis, Crohn’s disease, Sjögren’s syndrome, or active chronic hepatitis. Early diagnosis of these diseases and proper treatment can reduce the risk of early ovarian failure.
- Metabolic cause Among them, galactosemia, 17 α-hydroxylase / 17,20 desmolase deficiency due to the CYP17 gene mutation, and aromatase gene mutations stand out. In these cases, proper diagnosis and treatment can minimize the risk of early ovarian failure.
- Infections 3-5% of patients with early ovarian failure have had a history of mumps, varicella infection, shigellosis or malaria. Recently, it has been suggested that HIV infection can lead to IOP. The prevention of these diseases and vaccination in the cases that it is possible would be the appropriate conduct to prevent ovarian failure.
- Toxic causes a reduction in ovarian reserve and an advance of 1-3 years in the age of natural menopause has been observed in smokers. The data on the influence of heavy metals, solvents, pesticides, plastics and industrial chemicals are not conclusive, although they have been attributed to endocrine or immunological disorders, DNA alterations, abnormal cell proliferation or inappropriate cell death.
- Drug causes (Iatrogenesis) radiotherapy and chemotherapy have a Gonadotoxic effect depending on the drug used, the dose and the age of the patient. Ovarian failure can also arise as a consequence of reduced functioning ovarian parenchyma or surgical ischemia produced in the pelvic organs. Another possible cause of IOP is the embolization of uterine artery, which is used for the treatment of various gynaecological problems (eg. Myomas) In all these cases the recommendation would be to perform a treatment of ovarian stimulation and vitrification of oocytes obtained (fertility preservation) prior to necessary treatment.
Although these causes are the most frequent, there are other factors that also influence IOP. Women with epilepsy have a higher risk of early ovarian failure (up to 14%), which is why reproductive advice is recommended that allows planning their birth desire. Preservation of fertility by oocyte vitrification is recommended in these patients.