Premature ovarian insufficiency – novel hormonal approaches in optimizing fertility

Abstract

Premature ovarian insufficiency (POI) is a delicate medical problem in young women. This condition is not unchangeable and permanent but is associated with intermittent and unpredictable ovarian activity, resulting in low conception rate. Over the period of 8 years, the evaluation of secondary amenorrhea was conducted in 90 patients below the age of 40 who wished to restore fertility. Having confirmed the diagnosis and investigated the etiology of POI, hormone replacement therapy was applied (sequential administration of estradiol and norethisterone acetate) in the first 30 patients (group A). Estrogen–progestogen therapy with daily supplementation of 25 mg of micronized oral dehydroepiandrosterone (DHEA) was conducted in 44 patients (group B), whereas a combined regime (estrogen–progestogen therapy, DHEA supplementation in daily dose of 25 mg, and melatonin supplementation in daily dose of 3 mg) was conducted in 16 patients (group C). In the course of our study, 16 pregnancies were realized (18% of all cases: 17% in group A; 18% in group B; 19% in group C) 6 to 20 months after the initiation of hormone therapy, and there have been 13 completed term pregnancies so far with normal fetal growth and development. We concluded that estrogen–progestogen therapy combined with DHEA and melatonin could optimize fertility and lead to successful pregnancy in POI patients.

摘要

早发性卵巢功能不全（POI）是年轻女性的一个微妙的医学问题。这种情况不是不可改变和永久的, 而是与间歇性和不可预测的卵巢活动有关, 导致低受孕率。在8年的时间里对90名希望恢复生育能力的40岁以下患者进行了继发性闭经的评估。在确认诊断并调查POI的病因后, 对前30例患者（A组）应用激素替代治疗（雌二醇和醋酸炔诺酮序贯给药）。44例患者（B组）每日补充25 mg微粉化口服脱氢表雄酮（DHEA）进行雌激素-孕激素治疗；16名患者（C组）采用了联合方案（雌激素-孕激素治疗、每日剂量为25 mg的DHEA和每日剂量为3 mg的褪黑激素）。在我们的研究过程中, 激素治疗开始后6 - 20个月16例成功妊娠（18%的病例：17%的A组；B组18%；C组19%）, 到目前为止, 已经有13例正常胎儿生长发育的足月妊娠。我们的结论是, 雌激素孕激素治疗结合DHEA和褪黑激素可以优化生育能力, 并帮助POI患者成功怀孕。

Keywords:

• Premature ovarian insufficiency
• hormone therapy
• dehydroepiandrosterone
• melatonin
• fertility

Disclosure statement

No potential conflict of interest was reported by the authors.