Premature ovarian insufficiency: Prognostic factors and therapy in cases of infertility

Etiology: The syndrome of premature ovarian insufficiency (POI) affects approximately 1 % of women under the age of 40. Besides genetic, infectious, autoimmune, and iatrogenic causes, the etiology in the majority of cases remains unknown and is therefore considered idiopathic.Treatment: In the past, therapeutic strategies for infertility aimed at normalizing the hypergonadotropic state. Pretreatment with ultra-high doses of estradiol or dehydroepiandrosterone seems to be promising but statistically significant differences are lacking, such as evidence for the improvement of pregnancy rates after therapeutic interventions. Patients with imminent ovarian insufficiency undergoing treatment should be counseled early enough about fertility protection.Prognostic factors: Familial history of POI, secondary amenorrhea, presence of follicles on ultrasound examination, and inhibin B and estradiol levels were significantly predictive of resumption of ovarian function. Moreover, the serum E2 levels on day 1–5 of an induced withdrawal bleeding were significantly higher in the cycles with successful follicle growth and ovulation than in the unsuccessful cycles (p < 0.05).Diagnosis and monitoring: Accordingly, the authors advocate a rapid work-up for the diagnosis and an adequate duration of monitoring in order to use the fertile phase of women with POI to full capacity.Outlook: In vitro activation of primordial follicles may offer new therapeutic options. Fragmentation of the ovary disrupts the so-called ovarian Hippo-signaling pathway and promotes follicle growth and generation of mature oocytes. The combination of disrupting the Hippo-signaling pathway and additionally activating follicles with Akt stimulators was successful in patients with POI. © 2015, Springer-Verlag Berlin Heidelberg.