CHARACTERIZATION OF IDIOPATHIC PREMATURE OVARIAN FAILURE

Objective: To characterize women with idiopathic premature ovarian fai lure (POF) by their ovarian ultrasonographic appearances to establish the prevalence of follicular activity and relationship to autoimmunity , estrogen status, and historical background. Design: Retrospective an alysis of clinical, endocrine, autoimmune, ultrasonographic, and bone densitometry parameters. Setting: Reproductive Endocrinology Clinics o f The Middlesex Hospital, London, United Kingdom. Patients: Data from 135 women with idiopathic POF were analyzed. A reference group of 18 w omen with normal ovarian function, studied in their follicular phase, was used for comparison of endocrine and ultrasound data. A reference group of 57 women with normal ovarian function was used for comparison of bone densitometry measurements. Main Outcome Measures: Serum E(2) concentrations, autoantibody screen, ultrasonographic measures of ovar ian volume, uterine cross-sectional area and endometrial thickness and dual roentgenogram bone mineral densitometry of the lumbar spine. Res ults: The detection of ovaries by ultrasound (in 76%) and follicular a ctivity (in 60% of patients) was associated with higher bone mineral d ensity compared with women in whom ovaries could not be identified. Of 13 patients presenting with primary amenorrhea, ultrasonography ident ified ovaries in 62% and follicles in 38% whereas 38% had positive aut oimmunity. Evidence of autoimmunity was found in 31% of patients overa ll and these were indistinguishable from the nonautoimmune remainder i n every respect. Conclusions: Ovarian follicular activity, previously considered to be rare, as in the ''resistant ovary syndrome,'' is foun d in the majority of women with POF using pelvic ultrasonography. Pati ents presenting with primary amenorrhea have a similar degree of ovari an function, determined by ultrasound, and autoimmunity as those prese nting with secondary amenorrhea. The role of autoimmunity in the patho genesis of POF is not distinguished from nonautoimmune ovarian damage by the measurements made in this study.