Premature Ovarian Ageing

What is premature ovarian ageing (POA)?

Premature ovarian ageing (POA) means that your ovaries are producing a lower number of follicles and eggs compared to most of the women your age. This is also referred to as POA, or premature ovarian ageing.

How do I know if I have POA?

A POA diagnosis is very difficult to define prior to having symptoms. Patients with premature ovarian ageing usually show signs of early (premature) menopause, you no longer menstruate (amenorrhea), or have irregular cycles and reduced fertility is determined at a young age (typically younger than 40).
These symptoms allow us to deduce that your ovaries have stopped working properly at a younger age.
Women with POA may have a normal menstrual cycle at a younger age but they have less follicles in their ovaries compared with women of their age.

How can I test whether I have POA?

The evaluation of specific markers can predict with a high accuracy whether you have premature ovarian ageing. The three major markers are:

  1. AMH levels (Anti-Müller hormone).
    AMH is a biochemical biomarker, which can be determined by simple blood analysis. AMH is produced by the small follicles in your ovaries. These follicles can produce oocytes once you’ve received the injections to stimulate your ovaries for IVF/ICSI.
    Based on the blood analysis we can predict your chances of producing a good number of oocytes. Women with premature ovarian ageing have very low levels of AMH despite their young age.
  2. 1 Day one of your menstrual cycle is the day you get up with bright red menstrual blood loss

    The number of antral follicles (AFC — Antral Follicle Count)
    Antral follicles are a preliminary stage of the actual oocytes. The injections you receive for IVF/ICSI stimulate these follicles to produce oocytes. A vaginal ultrasound allows us to count the antral follicles in your ovaries. AFC is typically measured at the start of your menstrual cycle, between day 2 and day 41.
    Women with POA have a very low AFC, regardless of their age.

  3. FSH levels (follicle stimulating hormone)
    This biochemical marker can also be determined by a simple blood analysis and is able to predict your chances of producing a good number of oocytes. FSH is a hormone produced by a small gland in your brain called the pituitary which stimulates your reproductive organs to mature follicles. It is measured early in your menstrual cycle, on the second or third day. If you are younger than 40 and you have high values of this hormone (more than 20) it might indicate POA.

Why are my ovaries “older” compared to other women my age?

There are several reasons for POA. The most common are the following.

  • Genetic reasons
    • Turner syndrome
      Our sex (male or female) is determined by a combination of 2 chromosomes: X and Y. Women normally have two X chromosomes, while men have one X chromosome and one Y chromosome.
      Turner syndrome is a condition whereby women have only one X chromosome and the other one is missing. The lack of this second X chromosome causes abnormalities in the reproductive system and can result in premature menopause.
    • Fragile X syndrome
      People who have this syndrome have a bad or defective gene on the X chromosome. It is a frequently occurring cause of intellectual disability (mental retardation) but not all people with this defective gene show an intellectual disability.
      Women with POA may have changes in the fragile X gene which does not cause any mental retardation.
      However, the genetic abnormality can worsen with each successive generation and these women may be at risk of having an intellectually disabled baby. If genetic analysis shows that your POA is caused by a defect in the fragile X gene, we advise genetic counselling before you try to get pregnant.
  • Autoimmune reasons
    Your body’s immune system attacks foreign or abnormal cells that can cause infection, cancer, or other problems. In some cases, it may mistakenly attack hormone-producing organs, such as the ovaries, the adrenal glands or the thyroid gland which may affect your “ovarian age”.
  • Medical procedures
    Women who had cancer and underwent chemotherapy or radiotherapy are at higher risk of POA.
  • Lifestyle: smoking
    Several studies indicate that smokers reach menopause earlier than non-smokers. There is evidence that smoking can reduce the number of follicles in your ovaries.

Despite the many causes that can be linked with POA, in approximately 90% of the cases we cannot explain advanced ovarian ageing. NEXT LEVEL IVF clinic studies these causes and offers advice on your specific condition.

What should I do if I have or I am at risk of having premature ovarian ageing, what should I do if (one day) I want to get pregnant?

If tests indicate you might have premature ovarian ageing you should proceed accordingly in relation to the underlying cause.

  1. Natural conception
    Natural conception can be considered for all women with POA in case they don’t have a genetic cause that can be transmitted to their offspring. If all the tests are negative, women should not wait too long to start family planning as the risk of entering early menopause can be higher.
  2. Preimplantation genetic diagnosis (PGD)
    This option can be a solution in case of a specific genetic cause for the POA. PGD means preimplantation genetic diagnosis: this is an IVF/ICSI treatment with genetic testing of the embryos before they are transferred. This is the only way to find out whether your embryos have the same genetic defect and to prevent transmission of the condition to your offspring.
    Unfortunately PGD is not always possible: women with POI often have too few embryos to be tested.
  3. Fertility preservation
    This option can be considered for single women or women who don’t want to start a family yet. These patients should be informed that their POA means early (premature) menopause is likely. To safeguard their future fertility these women could choose to have their eggs collected and frozen for use in the future, following ovarian stimulation.
    CRG has a fertility preservation programme.

Can I find out what the reason is of (my) premature ovarian ageing?

Our aim as Next Level IVF clinic is to find out why you suffer POA? If all genetic tests of known risks for POA are negative, and irrespective of your choice of treatment, we keep your blood sample for further in-depth genetic analyses, free of charge. The data of this analysis is strictly confidential and anonymous. We aim to find the genetic reasons (unknown to date) of POA.
The ultimate goal is to find potential drugs that may help prevent or treat this condition. Although this process might take years to reach the development of a treatment, it might help other people with this condition in the future or potentially your children in case you have a daughter.