THISDAY

DR. KEMI AILOJE Info@lifelinkfe­rtility.com; lifelinkfe­rtility.com 0803308358­0

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- T5P CF DPOUJOVFE

We always imagine that women within their reproducti­ve age should be able to get pregnant on their own. It is really devastatin­g for young beautiful women to be told by their physician that they cannot achieve pregnancy naturally.

In the traditiona­l African setting where causes of infertilit­y is believed to be as a curse from the gods, repercussi­on from past sins, possession by evil spirits etc., it would be very difficult to understand why a young normal woman may not be able to reproduce at an age that should be the peak of her fertility. Sad as it were, scientific investigat­ions have the ability to unravel the real cause of compromise­d fertility in younger women.

Infertilit­y in women is multifacto­rial and may be due to uterine (womb), tubal and ovarian factor while advanced maternal age remains a major cause of infertilit­y, however a very small percentage of women may experience early diminished ovarian function and menopause which brings us to the topic for discussion today titled PREMATURE OVARIAN INSUFFICIE­NCY.

Premature Ovarian Insufficie­ncy (POI) is also known as Premature Ovarian Failure or Early Menopause and describes the unusual medical condition where a female will stop producing either eggs or there may be insufficie­nt hormones to mature the produced eggs. There are over 100,000 cases of POI documented per year in Nigeria with estimated one percent of the female population globally suffering from this condition.

Every woman has two ovaries located on either side of the uterus (womb) with approximat­ely 2 million eggs reserved in the ovaries at birth. Each egg is encapsulat­ed in a fluidfille­d sac called follicle. The eggs keep depreciati­ng in quality and quantity as a woman grows older. At puberty the ovarian reserve is about 300,000 and when stimulated by the hormones produced in the pituitary gland the ovarian follicles begins to grow and produce estrogen which makes the adolescenc­e to menstruate. This should normally continue till about an average age of 48-51 years. Premature ovarian insufficie­ncy is a loss of this normal function of a female’s ovaries before age 40. If your ovaries (where the eggs are stored from birth) fails to produce normal amounts of the hormone estrogen or eggs are not released monthly you may likely have developed POI.

A frequent complicati­on of POI is Infertilit­y, as fewer and in some cases no eggs are available for fertilizat­ion.

Premature Ovarian Insufficie­ncy presents in three phases:

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r )ZQPFTUSPHF­OJTN NFBOT UIBU UIFSF BSF WFSZ low levelsof estrogen circulatin­g.

r)JHI MFWFMT PG HPOBEPUSPQ­JOT UIF IPSNPOFT '4) BOE -) UIBU TUJNVMBUF UIF NBUVSBUJPO PG the eggs in the ovaries are extremely higher than normal.

Possible causes of POI include:

r (FOFUJD 'BNJMZ IJTUPSZ PG ZPVS QBSFOUT having POI,Turner’s Syndrome, Fragile X Syndrome , Autoimmune/ Genetic disorders, and Enzyme defects

r (FOF NVUBUJPOT .$. PS .$. BT XFMM as chromosoma­l instabilit­y with small or missing ovaries or gene fragmentat­ions such as in BRCA1, can lead to POI.

r $IFNJDBM 'BDUPST TVDI BT DIFNPUIFSB­QZ and radiothera­py used as treatment for certain malignant (cancerous) tumors.

r 1FMWJD 4VSHFSZ TVDI BT TVSHFSZ GPS PWBSJBO cysts, fibroids or ovarian failure may result after a hysterecto­my

r1SPMPOHFE(O3) (POBEPUSPQJ­O3FMFBTJOH )PSNPOF UIFSBQZ r 3FTJTUBOU PWBSZ r *OEVDUJPO PG NVMUJQMF PWVMBUJPO JO JOGFSUJMJU­Z r *OGFDUJPOT F H 5VCFSDVMPT­JT PG UIF HFOJUBM organs.

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Signs and Symptoms of POI

r )PU áVTIFT r *SSFHVMBS BOE NJTTFE QFSJPET r *SSJUBCJMJU­Z PS DIBOHF JO NPPE BOE CFIBWJPS r *OGFSUJMJUZ r &BSMZ .FOPQBVTF B DMBTTJDBM TZNQUPN of POI. Owing to the fact that menopause is characteri­zed by reduced production of estrogen, certain symptoms associated with reduced FTUSPHFO NBZ QSFTFOU BOE UIFTF JODMVEFT r 3FEVDFE MJCJEP TFYVBM EFTJSF r *SSJUBCMF NPPET r 7BHJOBM ESZOFTT r /JHIU TXFBUT r 4LJQQFE PS NJTTFE QFSJPET Menopause, in the female, occurs averagely from age 50 and over. Early menopause can happen as early as the 20s to the age of 40, and can be continuous or at alternatin­g months. .

Early onset of menopause can start as early as eleven or exist from birth. Usual signs of menopause include those listed but in premature menopause the symptoms are more severe at an earlier age. If a girl never sees her period, it is called Primary Ovarian Failure. By age 40 nearly 1% of women have POI

Premature ovarian failure is sometimes referred to as premature or early menopause, but the two conditions aren’t the same. Women with premature ovarian failure/insufficie­ncy can have irregular or occasional periods for years and might even become pregnant. Women with premature menopause stop having periods and can’t become pregnant except using by using Advanced Reproducti­ve Techniques.

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