Written by: Dr. Amy Beckley, PhD, Founder and Inventor of the Proov test — the first and only FDA-cleared test to confirm successful ovulation at home.
Written on 9/23/21
Keep reading to learn more about premature ovarian insufficiency and what it can mean for your fertility.
If you’re familiar with the fertility world, you’ve probably heard terms like, “ovarian reserve,” “diminished ovarian reserve,” or “premature ovarian failure.” And, if you’re anything like us, you may have wondered what all these terms mean.
While a single blog isn’t enough space to get into all these terms, we did want to cover an important one that we think is often overlooked: premature ovarian insufficiency (POI). Keep reading to learn more about premature ovarian insufficiency and what it can mean for your fertility.
What is premature ovarian insufficiency?
We are born with a certain ovarian reserve — a set number of eggs that diminishes as we age and approach perimenopause. Each cycle, our ovaries recruit many follicles to produce eggs, but only one of these eggs is actually released during ovulation. The rest no longer survive.
Over time, as we cycle and ovulate, our ovarian reserve gets smaller and smaller. A diminishing ovarian reserve is a normal process that comes with age and is something women usually experience gradually, starting in their late 30s and early 40s.
As our ovarian reserve decreases, our ovaries have a harder time growing an egg, until eventually there are no more eggs left. This is when we reach menopause.
In the United States, women get to menopause on average at 51 years old. The period preceding menopause is called perimenopause, and is characterized by hormonal changes, imbalances, and poor ovarian function.
Perimenopause can start many years before menopause and last for a long time. Menopause is not diagnosed until a woman has gone 12 months without a period and has hormonal tests indicating the ovaries have stopped working.
Sometimes, a woman’s ovaries may stop working properly much earlier in her life, even before the age of 40. This is called premature ovarian insufficiency (POI). Basically, POI is when you have a diminished ovarian reserve much earlier in life, typically before your late 30s. POI is not very common, only affecting less than 1% of people with ovaries.
By now you may be thinking, wait — isn’t this premature ovarian failure (POF)? Not exactly. While many people use POI and POF interchangeably, with POI your ovaries still work just not as well and you may ovulate sometimes. POF, on the other hand, means your ovaries are no longer functioning and you are not ovulating at all.
Can I get pregnant with premature ovarian insufficiency?
Premature ovarian insufficiency can be a cause of infertility. Although POI has also been called “premature menopause,” the truth is ovarian function can be unpredictable and it’s still possible to ovulate with POI. In fact, around 5 to 10% of the young women diagnosed with POI eventually experience spontaneous pregnancies.
Yet, severely diminished fertility is one of the biggest challenges of this condition because there are currently no treatments that can increase ovarian function in POI patients. Fertility preservation methods like egg and embryo freezing may sometimes help women who are at risk for POI.
Depending on the degree of ovarian insufficiency, POI patients are sometimes offered the possibility of doing in-vitro fertilization (IVF) with their own eggs, although extra medical stimulation may be required. Studies do show, however, that the IVF success rates are much higher for couples with POI when a donor egg is used.
To get a better understanding of your overall fertility and to determine which options are best for you, we always recommend consulting your doctor.
Depending on the degree of ovarian insufficiency, POI patients are sometimes offered the possibility of doing in-vitro fertilization with their own eggs.
What causes premature ovarian insufficiency?
As frustrating as it may be, there is no scientific explanation for the premature ovarian insufficiency in the vast majority of cases. Some patients have problems with follicle depletion (drastically diminished ovarian reserve) or follicle dysfunction (the remaining follicles not growing properly).
Some of the identified causes are:
- Genetic disorders like Turner Syndrome or Chromosome X
- Chemotherapy and radiotherapy in oncology treatments
- Genetically low ovarian reserve
- Metabolic disorders like galactosemia
- Auto-immune disorders like Addison’s disease or Thyroid dysfunctions
- Exposure to toxins like pesticides, chemicals and even cigarette smoke
What are the symptoms of premature ovarian insufficiency?
Since POI and POF are so similar in nature, it’s no surprise that the symptoms are also very similar. Here are just a few:
- Missed or irregular periods
- Decreased libido
- Vaginal dryness
- Hot flashes
- Night sweats
- Irritability, mild depression, or anxiety
- Sleeping issues
- Difficulty concentrating
- Discomfort during sexual intercourse
Premature ovarian insufficiency may occur all of a sudden with your periods stopping unexpectedly, or it may occur gradually, with symptoms such as those listed above.
If you suspect you might have POI or if you think you might be at risk for developing POI — based on your own medical or that of a close family member like your mother or sister — we recommend consulting your doctor to get a thorough assessment of your fertility.
How do I know if my ovaries are working properly?
Aside from obvious symptoms that might alert you that something is not quite right with your ovarian function, such as not having a period, there are a few tests that can be performed in order to check your ovarian status.
One of them is an FSH (follicle stimulating hormone) test. FSH is the hormone that stimulates our ovaries to grow and mature eggs each cycle.
When our ovarian reserve is optimal and our ovaries are functioning properly, only a small amount of FSH is required to mature eggs. As there are less and less follicles to stimulate, the ovary needs to work harder to select and prepare an egg for ovulation, meaning it requires higher amounts of FSH to get the job done.
You can measure your FSH levels at home via urine with Proov FSH tests. Together with the Proov Insight app (available on iPhone and Android), you can track your FSH levels across three critical days during your cycle and get quantitative results to help you better understand where you stand.
With Proov FSH tests and the Proov Insight app, you can track your FSH levels across three critical days during your cycle and get quantitative results to help you better understand where you stand.
If your test results show your levels are below 10, then you can feel confident that your ovaries are working properly. If two or more of your FSH tests each cycle are above 10, then we recommend consulting your doctor as this could be a sign that your ovaries are struggling just a little.
AMH (anti-mullerian hormone) is another important marker of the ovarian reserve. Each and every dormant follicle we are born with puts out a certain amount of AMH. As our ovarian reserve decreases over time, our AMH levels also go down. You can get an AMH test from your doctor or in a mail-away kit.
Some doctors may use FSH and AMH tests along with an ultrasound to get the most complete picture of your ovarian reserve. If you have concerns about POI, we absolutely recommend reaching out to your healthcare provider.
Although it can be more difficult to conceive with premature ovarian insufficiency, getting a better idea of where you stand now will help you make better decisions about your reproductive health in the future. We always believe that more information is better!