Premature ovarian failure: A modern approach to diagnosis and treatment

Hypergonadotropic hypogonadism or premature ovarian failure is not that uncommon. Approximately 1% of the reproductive age population are affected. The presentation is heterogeneous with a wide variety of etiologies. The multiple causes include autoimmune, genetic, iatrogenic, infection, enzymatic deficiencies, and idiopathic. The mechanism for the lack of ovarian function is poorly understood. The diagnostic approach to these patients requires a detailed history and thorough physical exam to help identify a potential etiology for the disease process. A variety of diagnostic tests can be performed dependent on suspected etiologies. Simple blood tests should be performed to rule out evidence of autoimmune polyglandular failure. A karyotype should be performed in any patient presenting with primary ovarian failure. Treatment has been empiric hormone replacement with estrogen and progesterone. For those patients desiring pregnancy, ovulation induction has not been successful although pregnancies have been reported in the literature. In the age of in vitro fertilization, oocyte donation has become a reality and a successful option for young women who are affected by premature ovarian failure.