Aetiological profile of women presenting with premature ovarian failure to a single tertiary care center in Oman

Abstract

Background

Premature ovarian failure is estimated to affect at least 1%–3% of adult women. There are several aetio-pathogenic factors that may cause premature ovarian failure including iatrogenic causes, genetic, autoimmune, infectious and idiopathic. The aim of this study was to identify the aetiological profile of women with premature ovarian failure presenting to Sultan Qaboos University hospital.

Method

A retrospective medical record review was conducted from June 2006 to October 2012. All women diagnosed with symptoms and/or laboratory evidence of premature ovarian failure (follicle stimulating hormone ≥40 UI/L and less than 40 years of age) were enrolled in this study. Possible causes of premature ovarian failure were obtained and classified into main aetiological factors.

Results

There were 90 patients during the study period, of which, 39 (43%) were following chemotherapy and bone marrow transplant. The second most common reason was idiopathic (n = 29; 31%) followed by autoimmune diseases (n = 8; 9%) and genetic disorders (n = 7; 8%). Most chemotherapy cases (69%) were among the young age group, while in the older age group idiopathic was the commonest (48%).

Conclusion

Compared to the world literature, the most common cause of premature ovarian failure in this study was chemotherapy induced, especially in young girls undergoing bone marrow transplantation. This is due to high prevalence of transplantable hereditary haematological disorders like thalassemia and sickle-cell disease in this part of the world. Current standard of care recommends cryopreservation of ovarian tissue to preserve ovarian function in young girls undergoing bone marrow transplantation for such disorders.

Keywords

Amenorrhea idiopathic menopause premature ovarian failure

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References

Baronchelli Bannatyne

Russell

. Autoimmune oophoritis: a clinicopathologic assessment of 12 cases. Int J Gynecol Pathol 1990; 9: 191–207.

Burton

van Ee

Purcell

. Autosomal translocation associated with premature ovarian failure. J Med Genet 2000; 37: 1136.

Deepti

Gerard

. Premature ovarian failure. Human Reprod Update 2005; 11: 391–410.

Vujovic

. Aetiology of premature ovarian failure. Menopause Int 2009; 15: 72–75.

Persani

Rossetti

Cacciatore

. Primary ovarian insufficiency: X chromosome defects and autoimmunity. J Autoimmunity 2009; 33: 35–41.

Andrew

. Premature ovarian failure. Soc Reprod Fertility 2010; 140: 1470–1626.

De Baere

Lemercier

Christin-Maitre

. FOXL2 mutation screening in a large panel of POF patients and XX males. J Med Genet 2002; 39: 43–45.

Waggoner

Buist

Donnell

. Long-term prognosis in galactosaemia: results of a survey of 350 cases. J Inherit Metab Dis 1990; 13: 802–818.

Laml

Preyer

Umek

. Genetic disorders in premature ovarian failure. Hum Reprod Update 2002; 8: 483–491.

10.

Beysen

Vandesompele

Messiaen

. The human FOXL2 mutation database. Hum Mutat 2004; 24: 189–193.

11.

Bedaiwy

. Strategies for fertility preservation and gonadal protection during gonadotoxic chemotherapy and radiotherapy. Middle East Fertility Soc J 2005; 10: 1–21.

12.

Blumenfeld

Avivi

Ritter

. Preservation of fertility and ovarian function and minimizing chemotherapy-induced gonadotoxicity in young women. J Soc Gynecol Investig 1999; 6: 229–239.

13.

Bines

Oleske

Cobleigh

. Ovarian function in premenopausal women treated with adjuvant chemotherapy for breast cancer. J Clin Oncol 1996; 14: 1718–1729.

14.

Damewood

Grochow

. Prospects for fertility after chemotherapy or radiation for neoplastic disease. Fertil Steril 1986; 45: 443–459.

15.

Goswami

Conway

. Premature ovarian failure review. Human Reprod Update 2005; 11: 391–410.

16.

Amato

Roberts

. Transient ovarian failure: a complication of uterine artery embolization. Fertil Steril 2001; 75: 438–439.

17.

Kauffman

Castracane

. Premature ovarian failure associated with autoimmune polyglandular syndrome: pathophysiological mechanisms and future fertility. J Womens Health 2003; 12: 513–520.

18.

Hoek

Schoemaker

Drexhage

. Premature ovarian failure and ovarian autoimmunity. Endocr Rev 1997; 18: 107–134.

19.

Rebar

Cedars

. Hypergonadotropic forms of amenorrhea in young women. Endocrinol Metab Clin North Am 1992; 21: 173–191.

20.

Betterle

Dal Pra

Mantero

. Autoimmune adrenal insufficiency and autoimmune polyendocrine syndromes: autoantibodies, autoantigens, and their applicability in diagnosis and disease prediction. Endocr Rev 2002; 23: 327–364.

21.

Morrison

Givens

Wiser

. Mumps oophoritis: a cause of premature menopause. Fertil Steril 1975; 26: 655–659.

22.

Rebar

. Premature ovarian failure, clinical expert series. Obstet Gynecol 2009; 113: 1355–1363.

23.

Coulam

Adamson

Annegers

. Incidence of premature ovarian failure. Obstet Gynecol 1986; 67: 604–606.

24.

Maclaran

Horner

Panay

. Premature ovarian failure: long-term sequelae. Menopause Int 2010; 16: 38–41.

25.

Alkindi

Al Zadjali

Al Madhani

. Forecasting hemoglobinopathy burden through neonatal screening in Omani neonates. Hemoglobin 2010; 34: 135–144.

26.

al Lamki

Wali

Shah

. Relapsed acute leukemia in children: Oman experience. Pediatr Hematol Oncol 2004; 21: 167–173.

27.

Massin

Czernichow

Thibaud

. Idiopathic premature ovarian failure in 63 young women. Horm Res 2006; 65: 89–95.

28.

Wheatcroft

Salt

Milford-Ward

. Identification of ovarian antibodies by immunofluorescence, enzyme-linked immunosorbent assay or immunoblotting in premature ovarian failure. Human Reprod 1997; 12: 2617–2622.

29.

Read

Edey

Hapeshi

. The age of ovarian failure following premenopausal hysterectomy with ovarian conservation. Menopause Int 2010; 16: 56–59.

30.

Anasti

. Premature ovarian failure: an update. Fertil Steril 1998; 70: 1–15.

31.

Khastgir

Abdalla

Studd

. The case against ovarian biopsy for the diagnosis of premature menopause. Br J Obstet Gynaecol 1994; 101: 96–97.

32.

Mittal

Kreatsa

Narvekar

. Fertility desires, choice of hormone replacement and the effect of length of time since menopause on bone density in women with premature ovarian insufficiency: a review of 223 consecutive new referrals to a tertiary centre. Post Reprod Health 2014; 20: 104–111.