Premature Ovarian Failure
Premature Ovarian Failure is the loss of ovarian function by a woman under the age of 40. As a result a woman does not ovulate (release an egg) each month.
Some women will have other menopause-like symptoms that may include: hot flashes and night sweats, irritability, poor concentration, decreased interest in sex or pain during sex, drying of the vagina and infertility. Other complications, some of which can be tested for, include: low thyroid function, autoimmune disorder, genetic disorder, osteoporosis or heart disease.
Premature Ovarian Failure Fertility Tests
Anti-Mullerian Hormone (AMH)
A Hormone produced by cells located in developing eggs (preantral and early antral follicles). As the follicles develop into mature eggs or die off (a normal process called atresia), they no longer produce AMH. By measuring the amount of this hormone in a woman’s body, a physician can get a good estimate as to supply of eggs remaining or ovarian reserve. This information can be used to determine odds for success with various IVF procedures and help to determine the optimal ovarian stimulation protocol. This test is different from other tests used to measure ovarian reserve since it does not fluctuate throughout a woman’s menstrual cycle. It has also shown to be a tool that can aid in the diagnosis of PCOS (Polycystic Ovarian Syndrome).
Anti-Ovarian Antibodies (AOA)
Antibodies directed towards the various parts of the ovary. This test measures the amount of AOA in the blood of a patient. AOA is most often found in cases of premature ovarian failure (POF), but has also been associated with unexplained infertility, PCOS and endometriosis. Elevated levels of AOA may impair the body’s ability to respond to attempts at ovulation induction.
Clomiphene Citrate Challenge Test (CCCT)
Provides an additional assessment of ovarian reserve. On day 3 FSH and estradiol levels are measured. On days 5-9 Clomiphene citrate, a drug prescribed to stimulate or regulate ovulation, is taken. FSH levels are measured again on day 10. An elevated FSH level on either day 3 or 10 is considered abnormal. This indicates a reduced ovarian reserve and a decreased response to ovarian stimulation by FSH injection during an assisted reproductive cycle attempt.
Chromosome Analysis Karyotyping
One or both of the parents may be the carrier of an abnormal chromosome. Karyotyping is the analysis of the number and shapes of chromosomes in individual cells. Abnormal karyotypes are a significant cause of recurrent miscarriage, or infertility. Chromosomal abnormalities include: extra or missing chromosomes, alterations to the normal structure of specific chromosomes or cases where sections of one chromosome will be relocated to another chromosome where it does not belong (translocation). A chromosome analysis can identify these abnormalities and determine the anatomical, physical and physiological problems associated with it.
Estradiol
A hormone produced in the ovaries by cells that surround a developing egg (follicle). In terms of ovarian reserve, this test is used to confirm the results of a day 3 FSH. A high estradiol level may artificially lower (or mask) what otherwise would be a higher (potentially abnormal) FSH. The other two uses of this test are: 1.) for the diagnosis of amenorrhea (the absence of a menstrual period) and 2.) to monitor progress during ovulation induction.
Follicle Stimulating Hormone (FSH-female)
A hormone produced by the pituitary gland that is located in the brain. It plays a key role in the development of follicles (immature eggs) into mature eggs. FSH also plays an important role in telling the ovaries when it is time to release a mature egg (ovulation). A normal FSH level indicates a woman has a good supply of eggs (ovarian reserve) and is a good candidate for ovarian stimulation in IVF. As a woman gets older and the number of eggs she has remaining becomes low it takes more FSH to produce an egg. Therefore a high FSH score indicates a low or declining egg supply (ovarian reserve). FSH values can fluctuate from one cycle to the next, so when looking at multiple FSH values the highest value is the one that is considered to be the most accurate. For example if a woman had an initial FSH of 9 and had another FSH a month later with an FSH of 5 it does not mean her ovarian reserve had improved. Her true score is still considered to be an FSH of 9.
Fragile X Syndrome
A genetic mutation found exclusively on the X chromosome, Fragile X is the most common inherited form of mental retardation. There are various degrees of this mutation: mild (premutation) and severe (full mutation). About 20-30% of women carrying the milder premutation will have premature ovarian failure (POF). Each child of a woman carrying the premutation has a 50% chance of receiving an X chromosome with the premutation. There is also a chance a child will inherit a more severe version of the X chromosome resulting in the full mutation. The full mutation affects approximately 1 in 4,000 males and 1 in 8,000 females resulting in mental retardation ranging from borderline to severe. A DNA test can be performed to determine if a woman carries the genetic mutation and which form (premutation or full mutation).
LH (Luteinizing Hormone, lutropin – female)
Serum LH determinations have been very useful in the diagnosis and treatment of infertility in women. A midcycle rise is a good indication that ovulation will occur approximately 24 hours later. Subfertile couples, and women being treated with gonadotropin for infertility, can be informed that ovulation is imminent. In the woman LH is necessary for the production of estrogen. When estrogen reaches a critical peak, the pituitary releases a surge of LH (the LH spike), which releases the egg from the follicle.
