Treatment of autoimmune premature ovarian failure

There is no known immunosuppressive therapy for autoimmune premature ovaria n failure that has been proven safe and effective by prospective randomized placebo-controlled study. Nevertheless, immunosuppression using corticoste roids has been used on an empirical basis for this condition. Here we prese nt two cases of young women with premature ovarian failure who were treated with glucocorticoids in the hopes of restoring fertility. The first case i llustrates the potential benefit of such therapy, and the second case illus trates a potential risk. The first patient with histologically proven autoi mmune oophoritis was treated with alternate day glucocorticoid treatment. S he had return of menstrual bleeding six times and ovulatory progesterone co ncentrations four times over a 16 week period. The second patient with pres umed but unconfirmed autoimmune ovarian failure was referred to us after ha ving been treated with a 9 month course of corticosteroids. During that tre atment her menses did not resume. The corticosteroid treatment was complica ted by iatrogenic Gushing syndrome and osteonecrosis of the knee. Identifyi ng patients with autoimmune premature ovarian failure presents the opportun ity to restore ovarian function by treating these patients with the proper immune medullation therapy. On the other hand, potent immune medullation th erapy can have major complications. Corticosteroid therapy for autoimmune p remature ovarian failure should be limited to use in placebo-controlled tri als designed to evaluate the safety and efficacy of such treatment.