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Showing 4 results for Premature Ovarian Failure

Firoozeh Akbari Asbagh, Mahbod Ebrahimi,
Volume 9, Issue 1 (7-2011)

Background: Premature ovarian failure (POF) is a common condition; its incidence is estimated to be as great as 1 in 100 by the age of 40 years. Physiologic replacement of ovarian steroid hormones seems rational until the age of normal menopause. Temporary return of ovarian function and pregnancy may occur rarely in women with POF. We report a case of POF who conceived during hormone replacement therapy.
Case: A 30 years-old woman with confirmed POF after pelvic surgery and sever emotional stress conceived spontaneously.
Conclusion: Return of ovarian function and achievement of pregnancy is possible in women with POF.
Mojgan Tansaz, Roshanak Mokaberinejad, Soodabeh Bioos, Farnaz Sohrabvand, Majid Emtiazy,
Volume 11, Issue 2 (4-2013)

Dear Editor, Estrogen deficiency in women is an important risk factor for serious disorders such as severe cardiovascular diseases (1). Several different conditions can lead to estrogen deficiency with premature ovarian failure (POF) being an important one (2, 3). POF includes the cessation of normal ovarian function before age 40, causing menopausal symptoms and general health problems. Although there are several known causes of ovarian failure i.e chromosomal defects, autoimmune disease, exposure to radiation and certain drugs; but most cases of POF are of unknown etiology. Consequently, further work is required to understand the etiology, possible prevention and treatment of POF (4). The most influential Iranian physician between 9th and 14th centuries AD was Ibn-Sina or Avicenna (980-1037 A.D). He was a great physician and has written more than 335 books on various subjects. His chief medical book is "Al-Qanon fi Al-Tibb" or "The Canon of Medicine" (5). According to "The Canon of Medicine", the basis of health is the right proportion and specific equilibrium of humors (Akhlat) according to their quality and quantity (6). Based on Iranian traditional medicine, there are four humors in the body: "Phlegm, Blood, Yellow bile and Black bile" (7). Each of them is related with a pair of qualities, including cold and wet, hot and wet, hot and dry, and cold and dry, respectively (6). In Iranian traditional medicine, premature ovarian failure is not defined the same as known today, but in many cases, it has been described as a disorder (8). Due to lack of biochemical analysis of blood parameters, almost all disease states have been defined based on clinical symptoms (9). The most obvious manifestation of POF is amenorrhea (10). The twenty-first chapter of third book of Al-Qanon fi Al-Tibb deals, principally with various kinds of uterine diseases. In this section, amenorrhea is described under a different title: "Ehtebase Tams" which means lack of menstruation. Avicenna has stated that one of the major causes of "Ehtebase tams" is abnormal black bile predominance (8). Based on The Canon of Medicine other symptoms that are seen in the "Ehtebase tams" of abnormal black bile predominance are as follows: vaginal dryness, dry eye, dry skin, anxiety, depression, somatization, sensitivity, hostility, forgetfulness, tiredness, headache, appetite disturbance, sleep disorder and depression and less satisfaction with sexual life (8). New studies have proven all of these symptoms (10). Black bile is divided into two categories: normal and abnormal. In contrast to normal black bile, abnormal black bile has affinity to deposit in any tissue and organ. As a consequence, in cases of abnormal black bile predominance, a high level of its deposition in the ovaries can lead to their dysfunction similar to its effect on other organs and tissues (arteries) (5, 7). According to this letter, it seems that the treatment of "black bile predominance” can be used as one of the first steps in treating POF patients. This finding can be used as an important theory to design the prevention and treatment plan of POF based on Iranian traditional medicine text books. Most obviously further clinical study is recommended to investigate this issue.
Mahbod Ebrahimi, Firouzeh Akbari Asbagh ,
Volume 13, Issue 8 (9-2015)

Premature ovarian failure (POF) is a heterogeneous syndrome with several causative factors. Autoimmune mechanisms are involved in pathogenesis of 4-30 % of POF cases. The present review focuses on the role of autoimmunity in the pathophysiology of POF. The evidences for an autoimmune etiology are: demonstration of ovarian autoantibodies, the presence of lymphocytic oophoritis, and association with other autoimmune disorders. Several ovarian antigenic targets have been identified in POF patients. The oocyte seems to be the most often targeted cell. Lymphocytic oophoritis is widely present in POF associated adrenal insufficiency. Addisonۥs disease is one of the most common autoimmune disorders associated with POF. Early detection of this potentially life threatening disease was recommended in several studies. The gold standard for detecting autoimmune POF is ovarian biopsy. This procedure is not recommended due to unknown clinical value, expense, and risks. Several immunoassays have been proposed as substitute diagnostic tools. Nevertheless, there is no clinically proven sensitive and specific serum test to confirm the diagnosis of autoimmune POF or to anticipate the patient’s chance of developing POF or associated diseases. Some authors suggested the possible effects of immuno-modulating therapy on the resumption of ovarian function and fertility in a selected group of autoimmune POF patients. However, in most instances, this treatment fails to reverse the course of the disease. Numerous studies illustrated that standard treatment outcome for infertility is less effective in the presence of ovarian autoimmunity. The antibody-induced damage could be a pathogenic factor. Nevertheless, the precise cause remains obscure.
Firouzeh Ghaffari, Arezoo Arabipoo,
Volume 16, Issue 5 (5-2018)

Uniform and definitive terminology in reproductive medicine is important for appropriate timing in starting an infertility workup to avoid over- and under-treatment, their related financial burden and psychological pressures (1, 2) and comparison of different treatments. Despite surveys and definitions provided by the World Health Organization (WHO), it seems that some terms are still confusing and misleading and therefore further discussion in this area is essential (2). The objective of the current letter is, to discuss critically a number of issues including the definitions of infertility, especially the role of assisted reproductive treatments. In the most recent definition proposed by WHO and the International Committee for Monitoring Assisted Reproductive Technology ICMART (3), clinical infertility was considered as "a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse". However, it appears that in couples with sterility and no chance of spontaneous pregnancy (such as some men with azoospermia, primary hypothalamic amenorrhea, bilateral tubal ligation, some type of premature ovarian failure, etc.), this definition is illogical and the duration of the infertility should be considered equal to the time that the couple has tried to achieve a pregnancy. A broad spectrum of patients with different histories is observed among infertile couples who are referred to treatment centers. On the one hand there are couples who have not experienced any clinical pregnancy, on the other hand there are those who have a child and are trying to have another child, and there are some women who have experienced abortion and after that never have conceived again. On the basis of WHO and International Committee for Monitoring Assisted Reproductive Technology definitions (3), the role of infertility treatment, specially assisted reproduction treatment, is not considered. Achieving clinical pregnancy in couples who have had a previous spontaneous pregnancy is very different in comparison with those who have not ever conceived and this gives them a much better prognosis (4). It seems that for evaluation of the efficacy of different infertility treatments, particularly assisted reproduction treatments, it is more appropriate that the primary infertility be defined as "inability to achieve a spontaneous clinical pregnancy". By this definition, patients who achieve the clinical pregnancy by using different infertility treatments for example: medical, intrauterine insemination and assisted reproduction technology or surgery, have not achieved a natural clinical pregnancy; the same would be true of primary infertility. So, it is more appropriate that secondary infertility be defined as "the inability to achieve a spontaneous clinical pregnancy following a previous spontaneous pregnancy". However, the main question is which type of treatment should be considered in this definition; only assisted reproduction technology cycles or any infertility treatment? In all infertility treatments, the focus is to have a live child which will survive; however, in most infertility research one of the main outcomes is the capacity to achieve a clinical pregnancy. By this new definition, the efficacy of different infertility treatments for the broad spectrum of infertile patients with different obstetrical histories could be better compared with each other. Despite successful conception, several factors are involved to reach a clinical pregnancy to live birth at term. It seems that the WHO classifications are not sufficiently detailed for these situations which have been described and require revision. The type of conception should be considered in the definition of primary and secondary infertility. Three important factors should be considered before starting an infertility workup: the most important factors are the age of the woman, followed by the time attempting pregnancy, and the cause of infertility. Immediate infertility treatment should be suggested for the couple who are sterile (e.g. azoospermia, primary hypothalamic amenorrhea and bilateral tubal ligation etc...). More time could be allowed for couples with a good prognosis (e.g. women under 35 yr old, unexplained infertility etc…) to achieve a spontaneous pregnancy.

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