During this event, Dr Ivan Gimenez Peralta, Gynaecologist and Medical Director at UR Mediterráneo, discussed the impact of Premature Ovarian Insufficiency (POI) on IVF outcomes. He explained what POI truly means, how it affects fertility treatments, and what options are available for those diagnosed with the condition. Dr Gimenez Peralta also highlighted the importance of early diagnosis and personalised treatment strategies to improve the chances of success in assisted reproduction.
What Is Premature Ovarian Insufficiency (POI)?
Dr Peralta explained that premature ovarian insufficiency, also known as premature ovarian failure, occurs when the ovaries stop functioning properly before the age of 40. This does not always mean that ovarian activity stops completely, but that hormone production and ovulation become irregular or insufficient.
Under normal circumstances, female embryos have around seven million eggs at approximately 20 weeks of pregnancy. This number steadily declines throughout life. By birth, around two million eggs remain, decreasing further to approximately 200,000–300,000 at puberty. By age 30, this number drops to around 120,000, and by age 37, to roughly 25,000. Menopause occurs when this reserve is exhausted, most commonly around the age of 50, although a normal range is considered between 45 and 55 years.
POI follows the same biological pattern as menopause but occurs much earlier. Hormonal changes include low oestrogen levels and elevated follicle-stimulating hormone (FSH), as the brain attempts unsuccessfully to stimulate the ovaries.
How Common Is POI?
According to Dr Peralta, POI affects approximately 1–3% of women under the age of 40. Although more common closer to 40, it can also appear in women in their late 20s or early 30s. The condition is relatively rare, but its impact on fertility is significant.
Statistics show that around 1 in 10,000 women may experience ovarian failure by age 20, 1 in 1,000 by age 30, and approximately 1% by age 40.
Causes of Premature Ovarian Insufficiency
In most cases, the cause of POI is unknown. Dr Peralta noted that idiopathic cases account for around 65–80%. Other known causes include:
• Genetic conditions, such as Turner syndrome or Fragile X premutation
• Autoimmune diseases
• Iatrogenic causes, including ovarian surgery, chemotherapy, radiotherapy, or severe endometriosis
The underlying cause can influence fertility outcomes and pregnancy risks.
Symptoms and Diagnosis
POI may present with irregular periods, very short cycles, or a complete absence of menstruation. Some women experience menopausal symptoms such as hot flushes, insomnia, and mood changes. However, Dr Peralta emphasised that some women have no symptoms at all, and infertility may be the first and only sign.
Diagnosis typically involves hormonal testing, particularly FSH levels, which are considered more reliable than oestrogen or LH alone. Additional investigations include:
• Thyroid function tests
• Prolactin levels
• Genetic testing (karyotyping, Fragile X screening)
• Anti-Müllerian hormone (AMH) testing
• Antral follicle count via ultrasound
AMH and follicle count are particularly useful for assessing ovarian reserve and guiding fertility decisions.
Why POI Makes Pregnancy More Difficult
Dr Peralta explained that infertility in POI is caused by several combined factors:
• A reduced number of eggs
• Ovulation dysfunction, including cycles without ovulation
• Reduced egg quality, making fertilisation more difficult
• Hormonal imbalance affecting endometrial receptivity
In some cases, ovarian activity is intermittent. Around 5% of women with POI may ovulate spontaneously and conceive naturally, although this is unpredictable and often associated with a higher risk of miscarriage.
Emotional and Psychological Impact
The uncertainty associated with POI can be emotionally challenging. Dr Peralta highlighted increased rates of anxiety, depression, and emotional distress, particularly when pregnancies end in miscarriage or when fertility outcomes are unclear.
Reproductive Options for Women With POI
Spontaneous Conception
Although spontaneous pregnancy is possible, treatments such as clomiphene, aromatase inhibitors, or gonadotropins have not proven more effective than waiting for natural ovulation. These pregnancies carry higher risks of miscarriage, prematurity, and stillbirth, depending on the underlying cause of POI.
IVF Using Own Eggs
IVF follows the standard process of ovarian stimulation, egg retrieval, fertilisation, embryo culture, and transfer. However, in women with POI, response to stimulation is usually poor. Higher medication doses are often required, egg numbers are low, and egg quality is reduced.
As a result, fewer embryos are obtained, embryo quality is often lower, and chromosomal abnormalities are more common. Implantation may also be affected due to a hormonal imbalance. Reported pregnancy rates with own-egg IVF in POI are around 3–7%, compared to 25–30% in the general IVF population.
Multiple strategies have been explored to improve outcomes, including higher gonadotropin doses, adjuvant medications, assisted hatching, ICSI, and advanced sperm selection techniques. According to Dr Peralta, none of these approaches has consistently improved pregnancy rates in this patient group.
Preimplantation genetic testing for aneuploidy (PGT-A) is often recommended to avoid transferring embryos with chromosomal abnormalities.
Repeated egg retrieval cycles, where eggs are accumulated over several stimulations, have shown some benefit by increasing the chance of obtaining a viable embryo.
Experimental and Emerging Treatments
Dr Peralta discussed several experimental approaches, including:
• In vitro activation of immature eggs
• Platelet-rich plasma (PRP) ovarian injections
• Stem cell therapies
While some hormonal improvements have been observed, none of these techniques has demonstrated a clear increase in pregnancy rates to date.
Egg Donation
Egg donation offers the highest success rates for women with POI. Donors are typically young women with good ovarian reserve, carefully screened medically, genetically, and psychologically. Eggs are fertilised with partner or donor sperm, and embryos are transferred after preparing the recipient’s endometrium.
Dr Peralta stated that egg donation achieves pregnancy rates of approximately 60–70%, making it by far the most effective treatment option for POI.
Looking to the Future
Future strategies focus on early identification of women at risk of POI, allowing fertility preservation through egg freezing before ovarian function declines. Although ovarian rejuvenation techniques are not currently effective, ongoing research in reproductive biotechnology may change this landscape.
Key Takeaways
Premature ovarian insufficiency affects 1–3% of women under 40 and significantly compromises fertility. IVF using a woman’s own eggs has limited success due to reduced egg quantity and quality. Egg donation remains the most effective treatment option. Early diagnosis, fertility preservation, and continued research are central to improving outcomes for women affected by POI.
This article reflects the full scope and intent of Dr Peralta’s presentation, adapted for clarity while preserving the original medical content and educational message.
