Nowadays, more women need assisted reproductive technologies as the age of motherhood is moved to older ages due to changing social habits, increasing business life and career plans. A woman's reproductive capacity varies depending on her chronological age and ovarian capacity. As a result, with advancing age, the follicle pool in the ovaries decreases, this is called chronological aging. Here, in addition to the decrease in number, there is also a decrease in egg quality. Deterioration in quality is mainly caused by errors during the separation of chromosomes by meiosis. In addition, the decrease in the number and quality of the follicle pool in the outer layer of the ovary, regardless of age, is called ovarian aging.
Previous surgeries, drugs, radiation, genetic predisposition and toxic environmental effects reduce ovarian reserves. . As reserves decrease, menstrual irregularities and menopause occur. It is important to determine ovarian capacity regardless of age. There are different tests developed for this reason. These are the FSH hormone level, which is checked on the 2nd or 3rd day of the menstrual period, the AMH blood level, which can be checked every day of the month regardless of the menstrual period and provides convenience for us (<1 ng/mL decreased reserve, <0.3 ng/mL is almost non-existent), inhibin. -B blood levels, counting the precursor eggs we call antral follicles in the ovaries examined by ultrasonography (under 3-4 in both ovaries) and other similar tests provide us with information about the woman's ovarian capacity.
Primary ovarian insufficiency (POF) is diagnosed as a result of the decrease and eventual exhaustion of the precursor egg cells in the ovaries under the age of 40, which causes many psychological and physiological negativities in the patient after the diagnosis, and even turns the patient's life upside down, which is mostly irreversible. is a situation. POF is a condition that can be seen in 0.1% of people under 30 years of age and 1% of people under 40 years of age. The situation of POI has increased nowadays, secondary to chemotherapy and radiotherapy applied to childhood cancers and due to increased survival from these diseases. Ethnicity, family history, smoking, and low socio-economic status are risk factors. Mother and older sister The risk of POI increases 6 times in menopausal women. Late menstruation, irregular menstruation and long-term breastfeeding reduce the risk of POF.
Turner syndrome (45,X) constitutes approximately 15% of POY cases. These patients present with the problem of not having a menstrual period. There is a single X chromosome and rapid follicle loss. In approximately 3-5% of these cases, (45,X/46,XX) mosaicism with normal menstruation and hair growth is observed. Fragile X mental retardation gene premutation (disorder) is observed in approximately 3% of POF cases, and these cases enter menopause approximately 5 years earlier. Some other gene disorders have also been described, but they are not easy to detect in clinical practice. Genetic counseling may be recommended for these people. In addition, auto-immune, infectious and iatrogenic causes (chemotherapy, radiotherapy, previous surgeries) have been described. In our daily practice, we frequently encounter decreased ovarian capacity due to laparoscopic and laparotomy surgeries performed for ovarian cysts, chocolate cysts, myomas and hydrosalpinx (infected and swollen tubes).
POI should be handled very carefully from the moment of diagnosis. The patient's age at diagnosis and future desire for children should be taken into consideration. These patients have an increased risk of cardiovascular disease and an increased risk of fractures as a result of decreased bone mineral density. These cases should be provided with external hormone support until the average age of menopause. Spontaneous pregnancy can be observed in 5-10% of POF cases. In addition, many protocols and additional treatments are used to help these patients become pregnant.
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