Premature Ovarian Failure.

SUNDBLAD V,; CHIAUZZI VA,; CHARREAU, EH

The Humana Press

Lugar: Weetman editor; Año: 2007 p. 1 - 1

Premature ovarian failure (POF) is defined as hypergonadotropic amenorrhea before the age of 40 years. Resistant ovary syndrome (ROS) is proposed as a follicular form of POF, characterized by the presence of numerous primordial follicles in the ovary. An autoimmune mechanism could be involved in the etiology of idiopathic POF. Several pieces of evidence support the concept that POF in the presence of adrenal autoimmunity (2–10% of cases) is almost certainly an endocrine autoimmune disorder. However, the question whether an eventual true autoimmune POF occurs in the absence of adrenal autoimmunity is controversial; data need to be confirmed and their relevance investigated. Finally, ROS may represent a rare case of autoimmune POF characterized by the presence of antibodies directed to the folliclestimulating hormone (FSH) receptor (immunoglobulin [Ig]-FSHR). Diagnosis of an autoimmune etiology remains difficult. Indeed, ovarian biopsy is not currently in use as a diagnostic tool in POF cases. The specificity and diagnostic significance of antiovarian antibodies need to be unanimously established. Determination of adrenal cortex antibodies (ACA) and/or steroid cell antibodies (SCA) should be evaluated as possible research markers to select POF women with autoimmune oophoritis—potential responders to immunosuppressive therapy—with reasonable certainty. Determination of Ig-FSHR by radio-receptor assay could be instrumental in diagnosing ROS, mainly on the basis of serological findings. Young women with POF need hormone replacement therapy. Regarding infertility-related therapy, immunosuppression through corticosteroids has long been used on an empirical basis; however, there is no definite proof of its efficacy in POF treatment. To date, oocyte donation is the only proven therapy for such patients.