Causes
In women with normal ovarian function, the pituitary gland releases certain hormones during the menstrual cycle, which causes a small number of egg-containing follicles in the ovaries to begin maturing. Usually, one or two follicles — tiny sacs filled with fluid — reach maturity each month.
When the follicle matures, it opens, releasing an egg. The egg enters the fallopian tube, where a sperm cell might fertilize it, resulting in pregnancy.
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Premature ovarian failure results from the loss of eggs (oocytes). It might happen because of:
Chromosomal defects. Specific genetic disorders associated with premature ovarian failure. These include mosaic Turner’s syndrome — in which a woman has only one normal X chromosome and an altered second X chromosome — and fragile X syndrome — in which the X chromosomes are fragile and break.
Toxins. Chemotherapy and radiation therapy are the most common causes of toxin-induced ovarian failure. These therapies can damage the genetic material in cells. Other environmental toxins such as cigarette smoke, chemicals, petrochemical pesticides, and viruses might hasten ovarian failure. Experience has shown that some workers in the oil and gas industries and the oil producing regions may suffer from POI. The environmental toxins are described as Endocrine Disrupting Chemicals (EDC).
Immune system response to ovarian tissue (autoimmune disease). In this condition, the immune system produces antibodies against your ovarian tissue in this rare form, harming the egg-containing follicles and damaging the egg. The factors that trigger the immune response are unclear, but exposure to a virus is one possibility.
Unknown factors; It is possible to develop premature ovarian failure but have no known chromosomal defects, toxin exposure, or autoimmune disease. Your doctor might recommend further testing to find the cause, but in most cases, the cause remains unknown (idiopathic).
Why does it occur?
According to Vincent Pellegrini, MD in Endocrinology, November 2016, POI is, in reality, a continuum of disorders. Dividing the continuum of ovarian insufficiency into four clinical states is the preferred method to facilitate explanation. These states are not permanent. Patients may move from one state to another in an unpredictable manner. In some cases, a healthy ovarian function may even return for a period.
Occult primary ovarian insufficiency presents unexplained infertility in a patient with a normal basal serum follicle-stimulating hormone (FSH) level. These patients have an inexplicable failure to respond adequately to FSH therapy during attempts at superovulation.
Next, on the continuum, biochemical primary ovarian insufficiency presents as unexplained infertility in patients with an elevated basal serum FSH level. In this clinical situation, patients also fail to respond adequately to FSH therapy during attempts at superovulation.
Overt primary ovarian insufficiency is the clinical condition that has previously been referred to as premature ovarian failure or early menopause. This clinical state has elevated basal serum FSH levels in association with disordered menstrual cycles, as demonstrated by oligomenorrhea, polymenorrhea, or metrorrhagia.
