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Premature ovarian insufficiency (POI) and autoimmunity-an update appraisal

Journal of Assisted Reproduction and Genetics volume 36, pages 2207–2215 (2019)Cite this article

Abstract

Purpose

Primary ovarian insufficiency (POI) represents ovarian dysfunction related to very early aging of the ovaries. While the cause of POI in a majority of clinical cases remains undefined, autoimmunity is responsible for approximately 4–30% of POI cases. In the present paper, we aim to provide a critical appraisal and update review on the role of autoimmunity in POI patients.

Methods

A literature review was conducted for all relevant articles reporting on POI and autoimmunity. PubMed/MEDLINE and the Cochrane library were searched for the best available evidence on this topic.

Results

Patients with POI and coexisting autoimmunity are indistinguishable from those with negative autoimmune screen with regard to age of onset, prevalence of primary amenorrhea, or their endocrine profiles. A specific noninvasive reliable diagnostic test for the diagnosis of an autoimmune etiology is lacking; therefore, patients should be screened for the most common autoantibodies, i.e., steroid cell antibodies, anti-ovarian antibodies, and anti-thyroid antibodies. Moreover, treatment strategies to POI infertility are lacking and controversial.

Conclusions

Nowadays, guidelines for the treatment of autoimmune POI are not available. Moreover, since diagnostic and treatment strategies to POI infertility are still lacking and controversial, further large clinical studies are needed to investigate the true impact of autoimmunity on POI and to identify the selected groups of patients who are most likely to benefit from immunossuprresive treatment.

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Contributions

Both authors were a major contributor in writing this manuscript and have read and approved the final manuscript.

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Affiliations

  1. Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel

    Michal Kirshenbaum & Raoul Orvieto

  2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Michal Kirshenbaum & Raoul Orvieto

  3. The Tarnesby-Tarnowski Chair for Family Planning and Fertility Regulation, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Raoul Orvieto

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  1. Michal Kirshenbaum
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  2. Raoul Orvieto
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Correspondence to Raoul Orvieto.

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Kirshenbaum, M., Orvieto, R. Premature ovarian insufficiency (POI) and autoimmunity-an update appraisal. J Assist Reprod Genet 36, 2207–2215 (2019). https://doi.org/10.1007/s10815-019-01572-0

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  • DOI: https://doi.org/10.1007/s10815-019-01572-0

Keywords

  • Primary ovarian insufficiency (POI)
  • Autoimmunity
  • Diagnosis
  • Steroid cell antibodies
  • Anti-ovarian antibodies
  • Anti-thyroid antibodies
  • Immunossuprresive