Premature ovarian failure: etiology and prospects

A search of past and current articles on ovarian physiology and premature o varian failure (POF) using MEDLINE was performed in order to present an ove rview of clinical manifestations, necessary laboratory investigations, poss ible etiologies and treatments for POF. POF is defined as gonadal failure before the age of 40 years. Initially, PO F was thought to be permanent, but it is now believed that spontaneous remi ssions and even pregnancies are possible in affected women. In most cases, the etiology of POF remains elusive, but several rare specific causes have been identified. Although the etiology of POF is heterogenic, the treatment principles are the same. Hormone replacement therapy (HRT) is still the co rnerstone of treatment. The only proven method of obtaining a pregnancy in patients with POF is fertilization of a donor oocyte. Cryopreservation of o ocytes has worked well in animals but awaits refinement before it can be ap plied routinely to humans with prodromal POF, or to patients before chemoth erapy or irradiation in order to save their oocytes for future fertilizatio n. New alternatives to traditional HRT and methods of fertility preservation a re under development, but understanding of the basic pathophysiology of POF is necessary for the development and use of innovative treatments.