Authors: Lukman Yusuf, Shiferaw Negash
Background: Premature ovarian insufficiency (POI) is basically cessation of menses, irregular menstruation or reduced fertility before the age of 40 years. It occurs in about 1% of the women population although younger women are not immune. The ultimate pathophysiology centers on the depletion of follicles and/or loss of endocrine function of the ovaries. Most commonly, it is idiopathic but possibly could be secondary to iatrogenic factors or a multitude of clinical conditions. Unlike natural menopause or acute ovarian failure, pregnancy is possible.
Objective: The study will provide valuable information in the prevalence, clinical presentations and counseling of patients regarding the management options for the affected individuals.
Setting: A clinical setting in the Ob-Gyn specialty clinic.
Methods: All prospective, consecutive patients attending Ob-Gyn clinical services with complaints of irregular menstrual bleeding including amenorrhea and those visiting us for preconception fertility counseling and infertility. The study was conducted during the period extending from January 1, 2020 to June 30, 2020. Variables considered included socio-demographic characteristics like age, religion, ethnicity, residence, socioeconomic status (educational achievement, family monthly income) along with their obstetric performance and menstrual history. Transvaginal ultrasonographic findings and laboratory tests, especially and more importantly of the fertility panel and Anti-Müllerian hormone (AMH) were determined and documented. The variables extrapolated ensured accuracy, avoided redundancy and maintained confidentiality. The data was entered, cleaned and analyzed using Epi-Info statistics software program. Descriptive statistics like mean and median for quantitative and proportion/percentage for qualitative variables were used, respectively. Level of significance was set at P-value <0.05.
Inclusion and exclusion criteria were set so that only patients with established scenario of hypergonadotrophic hypogonadism and diminished ovarian reserve vis-à-vis the AMH were availed.
Results: Out of a total of 5348 gynecological patients, 130 were diagnosed to have premature ovarian insufficiency giving a prevalence rate of 2.4%. Among the subjects with POI, three (2.3%) achieved spontaneous pregnancy with folic acid and vitamin D with calcium prenatal supplementation, despite guarded prognostication and suggestion for donor egg or embryo transfer and intent to liaise them to where it is routinely practiced. The mean age was 34.8+ SD4.8 with the range being between 21-39 years. Their clinical presentations in the order of frequency were predominantly secondary and primary infertility and oligo-amenorrhea of up to three months followed by sign and symptom complexes of postmenopausal syndrome. The diagnosis was ascertained by ovarian reserve testing with ultrasound, blood tests that encompassed AMH, FSH, LH, estrogen, progesterone, thyroid function tests, serum prolactin and serum vitamin D and calcium levels.
Conclusion: The study provides us with mounting evidence supported by the laboratory results that premature ovarian insufficiency is not a rare phenomenon and cites similarities reinforcing the fact that it is relatively more common than we anticipate. The available diagnostic means in such a low resource setting comfortably enables the capturing of the patients timely and channeling them for proper and comprehensive management options as deemed necessary.
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