Under 40 and Can’t Get Pregnant? It Might Be Primary Ovarian Insufficiency.

As you age, so do your eggs. The amount and quality of viable eggs naturally decrease as you get older. However, when this process occurs earlier than expected, it is known as primary ovarian insufficiency (POI).

This when the ovaries stop working prematurely. Typically, by age 40, women experience reduced fertility and irregular periods. Older ovaries produce less estrogen and stop releasing eggs regularly, making it more challenging to get pregnant.

POI can be confused with menopause. With POI, periods may continue despite being irregular. Although less likely, it's still possible to become pregnant with POI. During menopause, however, periods stop, and it's no longer possible to get pregnant.

Symptoms of POI

In addition to irregular or missed periods, the symptoms of primary ovarian insufficiency are similar to those seen in menopause. They can include hot flashes, night sweats, mood changes, poor concentration, decreased sex drive and pain during intercourse. Because POI causes changes and reductions in hormone levels, it may increase the risk of heart disease and osteoporosis. Hormonal changes from POI can also lead to higher rates of anxiety and depression.

Causes of primary ovarian insufficiency

In 90 percent of cases, the cause is unknown. Primary ovarian insufficiency can be related to follicle problems, the tiny sacs in the ovaries where eggs mature. In POI, either the follicles are not working correctly, or you may run out of them early. A family history of certain genetic conditions, autoimmune diseases and infections are associated with a higher likelihood of POI. Undergoing radiation or chemotherapy also increases POI risk.

How POI is diagnosed

Your doctor will take a complete medical history and perform a physical exam to rule out any other medical conditions before diagnosing you with primary ovarian insufficiency. Assessing your medical history includes questions regarding your menstrual cycle, history of chemotherapy or radiation and any previous surgeries. Blood tests may be used to measure hormone levels, such as follicle-stimulating hormone (FSH), a type of estrogen called estradiol and prolactin, which stimulates milk production.

Your doctor may also perform a pelvic ultrasound to see whether your ovaries are enlarged or have multiple follicles.

Certain conditions including Fragile X syndrome and Turner syndrome are associated with POI.

Treatment for primary ovarian insufficiency

Treatment may include estrogen therapy, which can help prevent osteoporosis and reduce other symptoms, such as hot flashes. However, women who take estrogen are at a higher risk of developing heart disease, stroke, blood clots and breast cancer. This risk is most significant at the age of 60 or older.

Your doctor may prescribe the hormone progesterone to guard the lining of your uterus and protect against some of the precancerous changes from estrogen alone. Be sure to talk to your healthcare provider about any concerns you have about hormone replacement therapy. You may also be prescribed calcium and vitamin D supplements to strengthen your bones and help prevent osteoporosis.

Fertility outlook for those with POI

There is no magical cure to restore fertility. However, 5 to 10 percent of people with POI become pregnant without treatment.

Some people choose to undergo in-vitro fertilization (IVF) using donor eggs. With IVF, healthy eggs are removed from the donor and fertilized using your partner or a donor's sperm. The fertilized egg is then implanted inside your uterus or the uterus of a surrogate. Meeting with a fertility specialist can help you understand the process of IVF so you can determine if you'd like to pursue treatment.

A diagnosis of POI can come as a surprise. As a result, you may feel overwhelmed or pressured to move forward with pregnancy plans right away. While POI can present an additional challenge on the road to parenthood, it doesn't have to mark the end of your journey. Ask your healthcare provider about a referral to a fertility clinic where you can explore your options and find additional support.