Predictive factors of intermittent ovarian function in patients with premature ovarian failure
Maud Bidet, Estelle Bissauge, Jerome Dulon, Anne Bachelot & Philippe Touraine
Objective: Premature ovarian failure (POF) is not an early menopause and intermittent ovarian function can be spontaneously observed in POF patients. We sought to characterize these patients and determine which factors were predictors of intermittent ovarian function.
Patients and methods: Among 391 patients with idiopathic POF followed from 1997 in our department, 67 (17.1%) patients (Group 1) had POF fluctuating criteria: FSH <15 IU/l, resumed spontaneous menstrual cycles and/or spontaneous pregnancies. We compared the clinical criteria, biological, ultrasonographic, histological and genetic characteristics of these patients to other patients from the cohort of POF patients (Group 2, n=324). The mean follow-up period was 25.1±64 months in Group 1 and 29.9±39 in Group 2 (NS).
Results: Sixty-four percent of Group 1 patients showed an intermittent ovarian function in the year following their diagnosis. Primary amenorrhea was infrequently observed in patients with fluctuating POF (2.98 vs 24.3% in Group 2, P<0.05). FSH was more variable in Group 1 patients: 79.9±32.7 IU/l at POF diagnosis versus 52.3±42.2 IU/l during hospitalisation and significantly lower than in Group 2 (83.0±37.9 UI/l). Estradiol and Inhibin B were also significantly higher in patients with fluctuating POF. Follicular structures were more frequently visualized on ultrasound in patients with fluctuating POF (73.7 vs 43.8%, P<0.05). However, AMH levels were not significantly different between the 2 groups. Ten patients (2.5%) experienced a pregnancy after diagnosis of POF. Issues of pregnancies in POF patients were 8 deliveries, 2 miscarriages and 1 current pregnancy.
Conclusion: An intermittent ovarian function in POF patients is not a rare phenomenon and seems more prevalent within a short time from the installation of a secondary amenorrhea. Moreover, presence of follicles by ultrasound and FSH levels appear to be more predictive than the AMH level.