Struggling with Infertility? The Problem Could Be Premature Ovarian Aging

Premature ovarian aging (POA) is an infertility condition that affects women of all ages. As one of the most overlooked causes of female infertility, POA is commonly misdiagnosed as “unexplained infertility.”

Women with POA have a low or poor ovarian reserve. In spite of this diagnosis, new technology and research surrounding DHEA supplementation and egg quality classification means that today – with correct management – more and more women with low ovarian reserve are conceiving children with their own eggs. 

What Is Premature Ovarian Aging?

POA affects a woman’s ovarian reserve – the ability of the ovaries to produce quality eggs. As a woman ages, her ovarian function begins to decline in a predictable way. This is considered a natural process, but about 10% of women experience this decline in ovarian function early. This is known as premature ovarian aging.

It is important to note that premature ovarian aging differs from early menopause.  Menopause is considered to be the last step in the premature ovarian aging process, and once menopause is reached fertility treatment becomes very difficult.  Women who have premature ovarian aging are not in the menopausal state and can still be helped with fertility treatment. 

How Does Low or Poor Ovarian Reserve Affect Fertility?

If left untreated, POA causes the highest miscarriage rate of any infertility diagnosis. As the quantity of eggs declines in a woman who has POA, so will the quality – and the low pregnancy rate is related to the quality of the eggs.

95% of embryo quality depends on the original oocyte quality, so a poor-quality egg will lead to development of a poor-quality embryo. Women with POA also have a higher chance of producing embryos with chromosomal abnormalities (aneuploid embryos).

In this video, internationally-recognized fertility specialist Dr. David H. Barad explains the significance of egg quality in the fertility treatment process:

 

How Is POA Diagnosed – and Why Is it Misdiagnosed So Often?

POA is primarily diagnosed by blood tests. There are two types of hormonal blood tests that can indicate if a woman’s ovaries are aging prematurely. The first blood test is taken on day 2-3 of the menstrual cycle and is called a follicle stimulating hormone level (FSH level). The second test is an anti-Müllerian hormone level (AMH level). This test can be taken at any stage of a woman’s cycle.

Many fertility centers tend to overlook or misdiagnose POA.  The two primary reasons for this are:

1. They don’t factor in age when interpreting FSH levels.
2. They ignore AMH levels.

FSH is a hormone released by the pituitary gland. It stimulates the growth of follicles and has a role in the maturation of oocytes.  Though it may sound contradictory, high FSH levels are not a good sign of fertility – they are actually linked to poor ovarian reserve. FSH levels increase naturally with age, so it’s important to take a woman’s age into account when interpreting her FSH. Many fertility centers make the mistake of setting a “normal” FSH level parameter that applies to all women regardless of how old they are (a figure of under 10.0mIU/ml) – when the truth is that there’s no reason for a woman of 20 and a woman of 35 to have the same FSH levels. The measurement of non-age related FSH levels is one of the main reasons poor ovarian reserve goes undiagnosed in young women.

CHR also considers a woman’s AMH levels when evaluating her case. AMH reflects a woman’s smaller follicles and represents the majority of her ovarian reserve. A low AMH level indicates low ovarian reserve. According to research carried out by physicians at New York fertility clinic Center for Human Reproduction, AMH was actually found to be more specific in determining a woman’s ovarian reserve than FSH levels. (Once a woman reaches age 42, AMH levels have been found to lose predictability in measuring poor ovarian reserve.)

While both FSH levels and AMH levels are important when assessing a woman’s ovarian reserve, they cannot conclusively convey whether or not a woman can conceive. Though these tests won’t provide a black-and-white answer, the practice of measuring these two levels side-by-side can give physicians a more accurate picture of a woman’s ovarian reserve than measuring FSH levels alone.

Stay turned for part two where we will interview a fertility specialist about Premature Ovarian Aging.