Endometrium receptivity in premature ovarian insufficiency – how to improve fertility rate and predict diseases?

Vujović S, Svetlana Vujović, Miomira Ivović, Miomira Ivovic, Ivovic M, Milina Tančić‐Gajić, Milina Tančić-Gajić, Ljiljana Marina, Ljubic A, Aleksandar Ljubić, Aleksandar Ljubic, Svetlana Dragojević-Dikić, Genazzani AR, Andrea Ricardo Genazzani, Andrea R. Genazzani
Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology · 2018 · vol. 34(12) , pp. 1011–1015 · doi:10.1080/09513590.2018.1490715 · PMID:30044147 · W2883033354
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This paper reviews strategies to improve fertility in premature ovarian insufficiency patients, including hormonal adjustments, metabolic screening, immune regulation, thrombophilia testing, and lifestyle advice, to optimize endometrial receptivity and predict associated diseases.

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Abstract

More empathized approach is required and is obligatory to women with premature ovarian insufficiency (POI) interested for pregnancy. In order to improve fertility rate in POI patients our suggestions would be: (1) To decrease FSH value to 10-15 IU/L by increasing estrogen. Oocyte donation can be suggested after a minimum of six month interval from FSH between 10-15 IU/L and when no dominant follicles are found. (2) To perform oral glucose tolerance test (OGTT). Insulin sensitizing agents has to be included, when indicated, 3-6 month before pregnancy. (3) TSH has to be 1-2.5 mM/L during 3-6 months before pregnancy. (4) Tests for thrombophyllia (Leiden V, FII, MTHFR, PAI) have to be obligatory. They are less expensive than those repeated in vitro fertilizations. Therapy has to be included according to the indications. (5) In order to regulate disturbed immune response in POI patients with endometriosis oral contraceptive therapy is needed for atleast six months prior to the pregnancy. (5) Encourage the patients and advice them about healthy life style and eating habits. (6) Add other drugs, when they are indicated. Complex interplay between endocrine, immunological, haematological, and psychological factors are very often underdetected in POI patients. It is very important to find out the real time for oocyte donation after correcting all the disturbances, improving endometrium receptivity and reaching women's acceptable psychological status. Untreated disturbances induce cardiovascular diseases, diabetes mellitus, thyroid diseases, coagulopathioes etc.

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Condition tags

endometriosis

MeSH descriptors

Endometrium Estradiol Infertility, Female Primary Ovarian Insufficiency Endometriosis Endometriosis Endometrium Estradiol Estradiol Female Humans Infertility, Female Insulin Resistance Oocyte Donation Primary Ovarian Insufficiency Primary Ovarian Insufficiency Primary Ovarian Insufficiency Primary Ovarian Insufficiency Thrombophilia Thrombophilia

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