Primary Ovarian Insufficiency
What causes ovaries to age prematurely? What are the treatments for premature menopause, also know as premature ovarian failure or primary ovarian insufficiency? Host Dawn Davenport, Executive Director of Creating a Family, the national infertility & adoption education and support nonprofit, interviews Dr. Timothy Hickman, Medical Director and Co-Founder of Houston IVF, and Clinical Associate Professor the University of Texas Medical School-Houston and Baylor College of Medicine.
* Note this is an automatic transcription, please forgive the errors.[00:00:01] Today’s show is about primary ovarian insufficiency as I said it’s a really frustrating condition. A lot of women aren’t even aware that they are having their ovary and ovarian reserves are diminishing until they try to conceive and they’re not having any luck doing so we’re going to be talking today with Dr. Timothy Hickman. He is the medical director and co-founder of Houston IVF. He holds Clinical Associate Professor appointments at both the University of Texas Medical School in Houston as well as the Baylor College of Medicine. He is a reproductive endocrinologist and he has been named the top doctor in reproductive chronology by U.S. News and World Report and a top doctor and fucked up. Let me say that again. And a top doctor for women by age. Texas. I guess it’s Houston Texas magazine and a Texas Super doc by Texas Monthly magazine. Wow. That’s a lot of accolades. This is a real airing of a show that we did a couple of years ago. The topic is an important one. And the information presented by Dr. Hickman is important. The show was really well received at the time. It spurred a lot of discussion on our online support group and it makes it really made us really want to bring it back to you. Now I hope you enjoy as much as I have. [00:01:31] Welcome Dr. Timothy Hickman to creating a family. [00:01:34] It’s my pleasure. Thank you so much for having me. [00:01:37] All right. As I mentioned at the onset this is a very topical popular topic for our audience. And so we’ve got a lot of questions which we’ll be asking but I think before we get into our questions let’s start at the beginning always a good place to begin. What is premature ovarian failure and how is it defined. I mean you know let’s be honest. Is it decrease in egg production in an ovarian function as a normal part of aging so. So what makes it premature at what point do we consider it premature as opposed to just a normal part of aging. [00:02:11] That’s a great question. The typical time a woman goes through menopause here in the United States is somewhere between 50 and 51. Now you’ll see variations on that a little bit further into the late 50s or mid 50s late 50s or even the 40s. But if a woman goes through menopause before the age of 40 we consider that premature failure. [00:02:34] So any time after 40 it’s it’s not considered premature ovarian failure but if but before then if it’s pre 40. OK so how do we know whether a woman is defined as entering menopause. [00:02:50] So the classic definition is if a woman goes through 12 months without a period and in addition to that has two blood tests that show a markedly elevated FSA in the menopausal range. That’s how one comes up with that definition of menopause. [00:03:09] OK. So FICA test is the well both that and the cessation of Menzies’s cessation of having a menstrual period and then an elevated if they say two and if it’s a test. That’s the diagnostic criteria and that’s what we use to diagnose premature of premature ovarian failure. [00:03:30] That’s correct. The government has two situations early age less than 40. And then the biochemical verification also with the elevated half his age. [00:03:42] So if a woman is is less than 40 and she’s missing periods should she should she wait a full year before trying to get a diagnosis. Because I would imagine it’s not just an immediate cessation it’s more of a beginning to skip periods and have a regularity and then ultimately resulting in a 12 month Skip. But do you recommend people wait until they when should they go try to seek a diagnoses. [00:04:10] Oh no you wouldn’t wait. If someone’s interested in fertility treatment or getting pregnant you wouldn’t wait at all you go seek evaluation. But if you’re going to make that diagnosis formally you’d have to have a full 12 months of no periods and then the biochemical confirmation to go along with the. Don’t wait. [00:04:32] Don’t get as you say all the time. Time is not on your side when it comes to fertility at all. And just let me throw this out now as everybody has heard this and who has listened to this show for any length of time. But if you are under the age of 35 and have tried with timed intercourse for a year without getting pregnant you need to see a specialist specialist for infertility is a reproductive endocrinologist. And if you are over 35 I sure wouldn’t try more than about six months before seeking a specialist. That’s still Dr. Hickman that’s still what we’re recommending. [00:05:08] Absolutely. I think I would add to that x40 even with regular cycles you almost come right away. Yes. So that’s where we were we qualified that less than 35. If you’re having regular cycles and you don’t really perceive anything to be wrong we think the sperm counts fine. Eggs are being released as far as we know the anatomy is fine. We could wait a year if it’s 35 you try it for six months and then at 40. Pretty much you go straight away. All right let’s get going. [00:05:38] You know what do we need to do at this point. My odds. I’ve heard this condition called different things. In fact at one point there seemed to be a push to change the name if premature menopause is what a lot of people know it by premature ovarian failure what are they. What else is it called. [00:05:56] There is something called ovarian insufficiency. People referred to that way but probably the most common is P0 for premature ovarian failures the one that’s used mostly that’s the one we’re hearing now and there seems to be a kind of a movement away from calling it premature menopause. [00:06:16] So we’re trying to just call pre-bid with premature ovarian failure other than the inability to get pregnant. What are the symptoms of POS. [00:06:27] Well the symptoms are much like those of menopausal at the regular timeframe in other words hot flashes of Agil dryness issues sometimes with irritability sleep pattern changes things like that. So when a hypo estrogenic state in a state where there’s very low estrogen these things are the natural natural consequences the risks associated with these tend to be those associated with menopause. Also in other words lack of estrogen puts one at risk for thinning of the bones or osteoporosis also puts at risk for heart disease their earlier timeframe. And of course the earlier this occurs in life the the greater the risk for that individual. [00:07:12] Because they have more time that their bodies exposed to the lack of estrogen. Is that that. Yeah that’s exactly correct yeah. OK. Now we’ve got the most questions that all of our questions this time came on the causes for premature ovarian failure and we do have a lot of them there. They are repetitive. I’m not going to read all of them are going to start with you because they’re two of the most general thena ask why do we have premature ovarian failure. Is it exposure to chemicals like lead paint chemicals in my new car sunscreen or any of these that would cause that or pollution in general. Are there genetic issues. Is the stress on the moms during pregnancy a factor. I’ve heard that it is. Even if even if he meaning you can’t say why can’t he review the major theories as to why I have this. And my sister does it even if he doesn’t believe any of them can review the theories of origin out there. I find it healing to be able to ponder the many theories and know that it’s not just that something terrible that I did to myself and we have another question from Stephanie and she says I want to know what causes this whether genetics caused this. I have both diagnosed it 25 when me and my husband were seeking infertility treatment. My sister doesn’t have POS and has two children my mother had my little sister at age 41. My yes. Our rates have been within the normal range. All right so let’s start with the general. [00:08:44] What do we know about what causes this and then we’ll go into the specific things that both said Athena mentioned. So why do some people have highlighted some women have premature ovarian failure when the majority of us do not. [00:08:59] Those are all great questions. I think it’s probably best to start off with just kind of a little male and female physiology and embryology. [00:09:13] So I don’t and when I get into that let’s start there at the very beginning I like that men and women are very different. [00:09:23] This applies to a lot of things but reproductively they’re very different so men continually produce sperm throughout life so they are born without any sperm at 15 and they go through puberty they start developing sperm then they continue to develop those sperm throughout life. So those sperms that are created are always new. There are always about 72 days old and that’s why occasionally we’ll see these eight year old men having babies with 20 year old women or something like that. But you don’t see the opposite we don’t see 80 year old women having babies with 20 year old men because women have a certain allotment of eggs and those are actually formed at about reached their peak at about 20 weeks gestation. So even before birth there are somewhere between five to six million at the time birth occurs. That number goes down to about 1 to 2 million at the time puberty occurs typically we’re down to about 300000 and that’s kind of the allotment of eggs one has for their reproductive years which are typically about 35 years from 15 to 50. Now if someone is just in general is premature ovarian failure if someone starts out with a lower number of eggs puberty then they’re more likely to go through menopause at a earlier timeframe or if there’s some accelerating factor where they lose them more rapidly they’re more likely to go through menopause at an earlier timeframe or they’re exposed to something they caused premature depletion of that allotment go through menopause early timeframe. So let’s talk about age of those for one and this is not gratifying to say this. Fortunately for most cases we never find out a reason. [00:11:18] It just happens and we look at all the environmental factors we look at the genetic factors we look at the auto immune factors and we don’t find out why it happened it just happened for those things that we know. Genetic factors we’ll talk about that for. So some women are born with some type of mutation or with the Mosaic’s ism. The most common is probably Turner’s Syndrome Moses ism where they have premature loss of allotments because of the genetic factor. Those can run in families but are fairly rare. The way you would diagnose something like that would be to get your blood drawn and ask for a carrier. We also see that just in general we’ll see this sometimes run in families. In other words a woman’s mother went through menopause in her early 40s. Her mother’s initial woman’s grandmother went through menopause in her early 40s or late 30s and her also the woman’s siblings her sisters went through menopause an earlier time timeframe. We don’t know exactly why that happens. There’s not a genetic test that will actually verify that for the most part but we just do see that’s running through different family lines and we don’t know their thoughts. [00:12:50] We haven’t covered if there is a genetic. I mean there’s actually something on the DNA that will because this is not Turner syndrome this is something totally separate. [00:13:00] You know that would be totally separate typically. And the yes the the answer is yes there is probably something there we just don’t know what it is. Now in this age of medicine as we’re doing more and more genome sequencing and figuring out what actually all those season do’s and T’s and A’s mean we’re going to probably figure some of this stuff out in the next five to 10 years. But right now it’s still a bit of a mystery for a lot of it. Yes it is. [00:13:33] We’re going to know in the future because it is fascinating. So that’s the that’s if there’s a genetic cause. All right. Let me go back to say OK you said that there were different ways premature ovarian failure can express themselves that’s not exactly. I’m not doing a good job of paraphrasing but one was you could have when you reach puberty you could have a lower number of eggs at puberty which would mean you have fewer eggs. To start with so to speak. The other one that you mentioned was an accelerated rate of reduction which would indicate that that that you’re going to run out sooner or get too low center with or another. [00:14:16] Was there another scenario that you mentioned that there would be some factor that would be introduced that would cause premature depletion for example chemotherapy radiation things like that would actually kill off egg cells. [00:14:34] OK gotcha OK. That makes sense. And in that case the causes. Yes. All right. So we’ve we’ve we’ve talked about the genetics that would cause a woman potentially to have either a lower number of X at puberty or perhaps not just even at puberty for about 20 weeks gestation for whatever reason that person has produced fewer eggs. And so what are the other things that might cause a woman to have fewer eggs in general to the general. [00:15:10] Yes I would say so going to the next thing with this premature depletion there’s this whole host of different ways the immune system goes awry. We call those we want them into the big category of auto immune causes. What that means is that the body is making antibodies against typically certain glands like we know you probably have several friends as I do that have problems with their thyroid. So that’s a very common gland that fails in about maybe as high as 20 percent of reproductive age. Women will need to take replacements if it’s functioning at a lower level. And that is a gland is typically the reason for the decline of the hormone production is typically auto immune situation that the immune system is kind of gone to fight off. So think that the thyroid gland is a foreign entity. So it’s kind of fighting it off and therefore you have a lower function there. That’s just one example of a gland that can have decreased function or fail due to an autoimmune issue. Another would be the ovary. So if there’s an auto immune issue that could cause a problem with with the ovary also is there a name for. [00:16:38] I mean I know of certain auto immune diseases that isn’t diabetes considered one is certainly lupus is considered one maybe diabetes is not lupus is illness certainly is. [00:16:53] So there are a whole host of different auto immune diseases and not everyone with an autoimmune disease will have an issue with premature failure. There is a very small percentage will and we don’t know exactly the mechanism. We [00:17:08] just know there are associations here and auto immune with any auto immune condition could result in premature ovarian failure. I [00:17:21] understand you correctly I would say a very small percentage of the big group of auto immune diseases have an association with premature failure. [00:17:33] OK. But if you’ve been diagnosed in the past we actually have a question trying Robin she says are those with autoimmune diseases more susceptible to premature ovarian failure. I’m assuming that the answer to that is yes. [00:17:51] That is correct. Yes. So it is a higher risk when you have a history of. [00:17:59] OK. What about environmental issues. [00:18:03] We seen I mentioned a number of them and I assume that this would be a question for both at any stage in life including evening current cooling perhaps in gestation or childhood exposure to chemicals like lead paint sunscreen pollution. [00:18:24] So what about environmental exposures so the ones that are classically given that we know cause premature depletion or things like chemotherapy especially alcohol eating agents and radiation as far as the others that you mentioned their lead paints sunscreens etc. It’s hard to say if we really have enough data to say there’s a link there. So those are not the classic causes that we hear about. We certainly wonder about that but we’re not quite sure. [00:19:02] Do we see an increase. And I realize this would not be proof but have we started seeing an increase in the incident of premature ovarian failure. [00:19:14] As far as we know the answer is no to that. What’s interesting though is what we’re seeing is a much higher percentage of our population trying to reproduce. About a decade later than we did two generations ago. So we take a look at the history of the world in recorded time. We’ve tracked fertility charts and fertility percentages back as far as the 15th hundreds and we see that they’re pretty similar to our modern day charts. In other words we kind of peek at our fertility at age 20 and then we have a leveling off in the 20s early 20s kids a little lower the lower upper 20s stays about the same until the early 30s and starts to decline. If you look at that slope versus the slope there was generation 1316 hundred seventeen hundred eight hundred nineteen hundreds. It’s about the same. So we think that it’s probably not the fact that things have changed so much in the environment but rather that we’ve just delayed childbearing for other reasons delaying because of increased education and increased workforce opportunities etc.. [00:20:39] So it’s like in the past we may have had premature or are women and they’re in their early 20s who are trying to conceive if they are later going to have premature ovarian failure. But they’re trying to conceive in their early 20s they would have fewer eggs but likely enough eggs. Not everyone but many of them would have enough eggs to actually have a conception to be able to maintain a pregnancy or get pregnant but if they had waited 10 years they would have fewer fewer enough exit at that point that they would not have enough to get pregnant. And my understanding you correctly. [00:21:18] That’s exactly correct. We’ve seen through many studies that if a couple tries to conceive at age 20 which doesn’t happen very often now. They tried about 95 percent who will be successful without any help from any outside source. But when someone when that same couple if they had to delayed until age 35 only about 65 percent can see without help. So one third would not be able to have a child if you were 40. Then we’re talking about two thirds. Only about 30 percent having a child with help. So pretty big drop off in that time frame. [00:21:59] Right. You were listening to two creating a family talk about infertility and adoption. We are so glad to have you with us on this show talking about premature ovarian failure its causes and treatment. We primarily keep in touch with our audience through our weekly newsletter. We have two of them and we have one for infertility and one for adoption. And you get to choose which one you want to get. We’ll let you know about the latest developments as well as the upcoming weeks blog and show topic you can receive our newsletter by signing up on any page of our website. Top right side creating a family dot org. All right. What about we have a question from No well she says has there been have there been any studies on the link between taking Accutane a treatment for acne as a teen to premature ovarian failure. I have always wondered. [00:22:55] That’s a great question. I’ve not seen that study that I’ve wondered about it given the fact that several of my daughters went through the treatments. I wonder if there’s been an issue with that. So I have not seen any studies to that effect. [00:23:11] Wonder well just in general. If there’s environmental exposures be they through medication or or anything. If we look at what you were saying that the slope of decline from what we call Intel has remained the same. Is that giving us indication that in fact there isn’t an environmental influence or that there’s something we’re being exposed to since it’s that slope that it’s not changing is that if not proof is that strong evidence that that environmental factors are not influenced or is that the. Or am I being overly simplistic. [00:23:52] I would think I mean the when one thinks about the state of the world right now it seems like an easy conclusion to say there’s got to be something that’s different. You know there’s more pollution. There are more people in the world there’s more industrialization of the world going on there’s got to be something out there. Yet we have these other facts that kind of fly in the face of that saying well the fertility slope looks about the same. My guess and this is an educated guess but it is a guess is there. I’m sure is some factor. Where or multiple factors in the environment will be decreasing our ability to maintain our fertility. But we just don’t know those exact yet and that with more study and more evaluation we’ll probably find out. [00:24:46] Let me add and I will remember to link to this in the blog tomorrow. We have done a show on the effects of the environment on fertility ethnic exactly the name the doctor who was on the show is out of Stanford there’s a center there for the environment and reproduction or something. I will link to it with a fascinating show. And she had she reviewed everything basically that it’s currently known about what environmental factors can impact. And what we know what’s been shown with strong evidence and what is still speculation I will link to that in the blog tomorrow as well. Beth asks Can losing one ovary pre puberty lead to POS. And are there better ways to find predict this earlier in life. That’s a separate question. So let me let me just stick with our first one. How about losing one ovary pre puberty would that make you more at risk for premature ovarian failure. [00:25:50] Well since there’s just a certain allotment of eggs that one has in life and if you lose one over a year losing about half of that allotments. Now the body does reregulated cells and therefore produce fewer eggs per cycle but still one is at a higher risk of going through premature over and failure after having lost the ovaries. [00:26:14] So the answer would be to that and here’s a question. I have wondered myself and was really thankful that we got it. This is from Molina. She said Can IVF IVF in vitro fertilisation lead to premature ovarian failure or early menopause. Is there any evidence that aggressive stimulation of the ovaries during a typical IVF cycle can contribute to both. And I thought about that because especially when you hear this is atypical but we do hear of women who have had many many cycles of IVF and their ovaries are so are producing mini mini eggs or some of them are each cycle. So what do we know as far as again the repeated use of IVF and ovarian stimulation. [00:27:02] As far as premature ovarian failure well that’s an excellent question and the answer is the short answer is there’s probably not a link but let’s kind of go over the principles behind that answer. So every month there is a group of eggs that develop. Now they have been developing for 30 to 60 days before that particular cycle that cohort of eggs is the cohort that will potentially develop during that one month and in a natural cycle you know the brain will sense stimulation by the way of F.S. age knowledge of the ovary and of that cohort. One of those eggs will become the dominant follicle and it will go to a full full maturation and release obviously then the rest of the eggs in that cohort that did never that never became dominant will go undergo a process called a pop Tostes which is programmed cell death. And so they’re killed off regardless. So in an IVF cycle it’s a different situation. You taking pharmacologic doses of FSA Janella age to try and stimulate that entire cohort to develop fully. And so many would refer to that as egg salvage. In other words those eggs would have been lost anyway through a hot topic process that would happen later on after release of the dominant follicle. Yet in this situation you just have every one of them come to their full potential. So it is thought because of that there’s not premature depletion there’s just use of every one that was available in that particular cohort. So people have made the argument which we’ve never done. [00:28:59] Oh you can go ahead and simulate every month of your rephotograph live and still go through menopause at the same time and that may or may not be true but that’s that’s the logic behind that. [00:29:11] So in other words the Cañada trope is the obvious Otori stimulating medications basically make it such that there is not only one egg that becomes the dominant egg. It allows all of those who are ripening those eggs who are ripening that month to all all of them come to maturity. [00:29:33] Exactly. That’s the that’s the goal of our ovulation induction IVF cycle. [00:29:39] Interesting OK we have a question from a different Robin and she wants to know if you know anything about cases linking premature ovarian failure to the HPV vaccines. Gardasil are not shy to pass the other one cervix serve a Ric’s Gardasil but I’m not familiar with CPR the MRI expert she’s apparently a different form of the HPV vaccine. Have you heard anything or have there been any research on that. [00:30:12] To my knowledge there is no association no known as this fusion with HPV vaccine exposure and premature failure. Nor is there an increased risk with HPV that people just contract naturally through intercourse and develop cervical dysplasia and premature ovarian failure. So I wouldn’t. I mean there’s not a scientific theory where those two would be linked since they’re two completely separate types of situations. [00:30:48] So not that I know of then you actually have already answered my next question is is there a kind of a logical basis from even though we don’t know it is there a logical way to think in terms of why either of those vaccines either the vaccine or as you point out the virus itself could affect ovarian reserve. And you’re saying no that that’s kind of you can’t think of a logical way that those would be connected. That’s correct. OK. Interesting. All right. I’d like to take a moment to thank a few more of our gold sponsors and to remind you that their very generous support that we can bring this show as well as all the resources at creating a family including our resources. We have a page on premature ovarian failure and a page of resources on I should add. And so all of these resources are provided by the generous support of our sponsors including our gold sponsor Fairfax Cryobank. They have been a leader in sperm donation for over twenty years and are dedicated to supplying updated verified and accurate medical and personal information on their donors. We also have the law offices of James Fletcher Thompson they are a South Carolina firm committed to adoption and assisted reproductive law including providing gestational surrogacy matching program as well as legal services for independent surrogacy. Egg donation and embryo donation matters. And lastly we have Nightlight Christian Adoptions. They were a pioneer in offering embryo donation and adoption services to clients throughout the world through their Snowflake’s embryo adoption program. [00:32:22] All right now we’ve talked about causes and let me ask Are there any are there any other theories out there that we haven’t mentioned getting back to. I think it was a thena who said throw you know throw all the theories her way just because she likes to ponder. So there are there any other theories that we’ve not covered either well-supported or not so well supported. [00:32:46] I think that pretty much covers them. So familial factors that we don’t really know that much about those that we do know about. Typically Turner syndrome autoimmune situations and then exposure to something that would cause premature depletion like radiation or chemotherapy. [00:33:06] All right. And as I actually reiterate what you said earlier and that is in most cases we never know the cause. That’s correct. Right. You know and I do want to go back and I think it’s fascinating to that our peak number of eggs is at 20 weeks of gestation. Has there been any research on pregnancy factors. It would be a very long term researchers you have to wait so many years but that any type of exposures or I think it was a thing or someone mentioned stress that would reduce the number of eggs that fetus was producing at her peak at 20 weeks. [00:33:50] You know that’s a fascinating question and I know that that is an active area of research. This is what we term the epigenetic causes of fetal development. So in other words what’s the mother carrying the baby is contributing to the whole situation even though even though not affecting the genetics but rather the the environment which the baby grows. So the answer to that has got to be yes in some way but we don’t know exactly what ways yes. [00:34:23] That is absolutely fascinating and also scary in a way because it’s like one more thing to worry about you know pregnancy. But nonetheless it is. It is. I think it’s I’m hoping well I have not heard if anything is going to be presented at A-S around this year. SRM which for the American Society of Reproductive Medicine their annual conference which is one of the highlights of my ear as far as finding new research to share with everyone that conference is in just a couple of weeks and I will certainly be on the look out there. I’ve not heard of anything that’s going to be presented on this but I’ve actually only only seen those people who are speaking not papers and posters and things like that. All right. Moving now to treatment. We’ve talked about the causes. Now as to the treatment. Let’s start with medical treatment. Western medical treatment and then we’ll move on to talking about any other forms of treatment in the past if a woman has very few eggs. What can we tell her to do and how effective is IVF. How effective is why at that point. It might depend upon how many how how how deeply depleted her ovarian supplies are but but nonetheless what is that typical treatment both in the past and what’s currently happening now in 2015. [00:35:47] So if someone has surely premature failure you know there was a method diagnosis of not having a period for a year and then they have markedly elevated F sh values. There are not a lot of treatments that are available. I mean traditionally what has been done is people might try to use Anitra opens the rationale there is that if you give more F.S. age maybe you’ll have a success and maybe you’ll have an obligation to place but that rarely is ever effective because if you can think of it if your FSA level is already markedly elevated to meet this diagnosis then you give more. SH Well then the Bye’s be kind of bathed in this age and it’s unlikely that the ovary will respond. So there are not a lot of options with IVF nor are there Weihai you are because the eggs are not being released. Now I will say that the earlier a woman goes through premature over in failure the more likely she will just spontaneously release an egg. And so in rare situations we’ll see women that have met this criteria that out of the blue turn out pregnant we think wow how did that happen. Well there must have been an egg inside that eventually just came out and they conceived. But those cases are few and far between. There is so so what would one do in that situation will the traditional treatment with premature failure is using donor eggs using eggs from a woman that has it’s young that has full ovarian competency has a bunch of chromosomally normal eggs and then produces those those are combined with her partners. [00:37:48] BERMAN used to create a baby and have the woman carry it. [00:37:53] Let’s be clear or may ask premature ovarian failure POS. Does it interfere with the ability of a woman to carry a pregnancy. And that’s different from getting pregnant as if we use donor eggs. That takes care of the equality issue. But what about the ability to carry a pregnancy. [00:38:16] So from most conditions the answer is there is no problem with carrying a baby. In other words as long as the woman is healthy and in other ways she would like uterine cavity is normal and the recovery response to estrogen usually is not a problem. Now one of the exceptions there is if someone does have Turner’s Syndrome Turner syndrome is a situation where these women are lacking one chromosome. So it is a situation where there are 46 chromosomes they have 45. It’s called the 45 X syndrome. There are 46 x x 46 x y or excuse me their 45 X. And in those situations there’s an association with problems with the aortic root and in pregnancy that could become very severe since the blood volume is increased by about 50 percent. There have been cases of aortic root dissection and even maternal deaths. So that’s where there’s a big risk to carry the baby. That’s a rare exception for the most part. [00:39:29] There’s usually not a problem with carrying and I have I believe this was a paper that was presented at A-S or him a couple of years ago talking about that rather something you mentioned earlier and that is you would think in terms of from morganatic trope and said the obvious Latorre stimulating drugs at a woman who is at the beginning stages are in premature ovarian failure but that there’s some evidence to say that less can that better outcome pregnancy outcome with less than Anatolians being used. [00:40:09] Am I remembering that correctly. [00:40:14] That’s certainly an ongoing debate. OK we’ve got the doctor going to say no you’re not remembering it correctly overthrowing the debate. I don’t think you’ll find consensus on that point. What I think you will find though is if someone’s in dodginess FSA level is very very high it’s highly likely that more of this age is going to be a benefit to cause population reduction. [00:40:45] OK. So even that would indicate that using less of the drugs would be better or perhaps not. I guess at that point. Tell me about the study that you and Dr. Schoolcraft are currently working on. We originally reported to on our Web site information about this study and it was it was fascinating to me so can you tell me about the study that you and Dr. Schoolcraft are doing. [00:41:16] Sure. So this is still in the experimental realm but very exciting stuff. This study focuses on something called vitæ which is in vitro activation which is kind of a new concept and the concept being that you know even when a woman goes through menopause there are still some eggs that are left behind. So if you were to do take the ovaries from a woman that’s menopausal and you took them out you dissect them and look you’d still probably find a few hundred eggs within them but they’ve just not responded to any stimulation in the brain is down. What this study involves and it’s actually trying to replicate studies that were done over in Japan a while ago is to take women was premature ovarian failure and to actually remove one ovary to S.A. and freeze it and then also to expose it to kind of a stimulation protocol and then implanted it back inside the body and see if that ovary is then invigorated to then produce follicles and in that situation it was over in Japan. They had about 27 women that went through this and several of them did start to develop eggs again. [00:43:00] And they’ve actually had to Libres interesting. [00:43:06] So pretty fascinating stuff. [00:43:09] I understand that is slicing it. I’m not. That can’t be right. And you couldn’t re implant it so I know Messman misunderstood that. So you take the ovary out and the idea is that you’re going to try to put it through some type of protocol that will jumpstart the remaining eggs or try to be. And then that ovary after it goes through that protocol is re implanted into the woman. [00:43:35] It is really implanted implanted after being kind of sliced up if you will in very small portions. So when the ovary is implanted in the woman multiple portions are put together and then hopefully through the healing process they’ll grow back together and then be able to produce establish a blood supply and reproduce eggs and. [00:44:01] And what you are doing now is this study with the initial study with 27 women and. And is your study going to be larger. [00:44:12] Well it’s just begun. And as of now I think there have only been two women go through it. But it is available at our Colorado Center or the Colorado Center for Reproductive Medicine where my partner Dr. Bill Schoolcraft is one of the principal investigators is he he’s doing with his center there in Colorado. And I’m not sure how many is there aim to have this done but they are currently recruiting right now. [00:44:44] OK. And so if members of our audience are interested in becoming a participant do they need to live in Colorado. [00:44:54] I don’t think you need to live there but they need to be able to be able to go there because that’s where the study will take place. [00:45:02] OK. So they and I will include a link tomorrow in the blog to the study there’s a page I believe on the Colorado Center for Reproductive Medicine site dedicated to the Ivy a study. And I will include a link in our blog on Thursday for people who are listening to this a little later. That would be the Thursday October 8th blog on creating a family dot org site and will include information there for if you’re interested in participating in this study. You can contact the Colorado Center for Reproductive Medicine and Dr. Bill Schoolcraft or you can also probably contact Houston IVF and they can direct you in that email is Houston IVF dot net. Get all that right Dr. Heckman that’s correct yes. [00:45:57] Our Web site Su’s tonight you have done. [00:46:00] OK good. Excellent. All right. Perfect. OK. Now we’ve talked about the Western medical treatment and truthfully it’s not that there’s not a whole lot depending on whether you are at what. How far down the process for. It’s not a one day event. You don’t have ovaries one day and then the next day generally unless you’ve gone through things like chemotherapy or radiation don’t have them the next day. So it’s it’s a gradual process so depending upon when when you seek treatment in that process if you seek it further down the road when you have a much more progressed and POS then there really from a western medicine standpoint probably isn’t a lot that can be done other than donor egg or participating in the study or any other studies that come down the pike. Is there anything that do you know of any alternative treatments Chinese medicine or any other alternative treatments that there’s been a study on or that you have heard of that might be effective at either slowing the progression of the failure ovarian failure or reversing it. [00:47:18] Well you know that’s an interesting question because when you talk about western medicine versus Eastern medicine it’s kind of comparing apples to oranges. You know Western medicine is founded on the principles of the scientific method where someone goes through something like a randomised controlled trial with two groups and probably even placebo controlled. Then you see if there’s an effective one medicine versus another or if it’s any better than doing nothing at all in the placebo group you Eastern medicine many of the successes are based on anecdotal reports. So someone might say Oh I tried such and such and I delivered a baby. And the question that the western medicine physicians would always have would be well was that intervention that you tried. Truly the reason you had the positive outcome or was it wouldn’t have happened anyway without doing that intervention. So we don’t really know. There certainly are some theories that things like acupuncture Chinese herbs may be of benefit and you can make a scientific argument certainly for acupuncture. We know that in some situations some women have a high vascular resistance and when they’re exposed to acupuncture they lower that resistance and have increased uterine blood flow and probably then ovarian blood flow and maybe that’s all they need to get more higher chance for an egg to be released. But we have not seen in randomised controlled trials successes like that. So that’s the frustrating thing. [00:49:17] And then when you talk with us we have you on the show with practitioners of Chinese medicine or Eastern medicine. It’s frustrating for them because they say that that’s not how the Western research protocols the scientific method which says that you have to use the exact procedure with each patient is really flying in the face of the essence of what Chinese medicine is. They feel like that the studies that have attempted to show things are are not a fair representation. On the other hand from the western medicine standpoint Western medical practitioners would argue that if you don’t have these it’s nothing more they should point out than anecdotal reporting well. [00:50:03] So I think both of those are very true. I think the truth lies somewhere in the middle in that. Clearly the more you know in life the more you realize how much you don’t know and I think that holds true with you soon most include it’s been around for centuries. And if there was no effects it would have died away a long time ago. So there’s got to be something to it. We just don’t know if we know exactly what it is yet but it is providing something. I think there’s no doubt about that. [00:50:40] So going back to the idea of things that a woman can do to slow the progression of her ovarian depletion assuming that at this point I’m not necessarily looking at reversing it after she has officially reached the point of whatever the definition was where 12 months without demonstration as well as it’s FSA levels in the menopausal range. But assuming that that that she knows that she has fewer she has been told that she is on the spectrum of POS. Are there are there lifestyle changes are there either dietary changes that she could make that might slow the progression of the depletion and give her more years potentially being able to conceive. [00:51:36] That’s a great question and the answer is I’m sure you would have weighed any potential stimulus that could hasten the depletion. So I would probably refer to your prior show with your physician from Stanford that went into environmental causes that would probably be a good summary of things to avoid. But in general there are not too many ways we nose to to prevent this from happening. If someone’s predisposed to it. So that changes the question how do I prevent this to can I do about it. It’s typically earlier action. I know they’re trying to do fertility preservation techniques. If one doesn’t have a you yet maybe freeze eggs or to go ahead and be a little bit more aggressive with trying to conceive. [00:52:36] If one feels like one’s ready at a certain time in life but that that only applies if a woman has has indication that she may be at increased risk for premature ovarian failure. So if she doesn’t know that what would she do. [00:52:58] Well there’s not there’s not a lot to say there other than avoiding the environmental factors that could potentially striking. Yeah. [00:53:12] Well Tony and your point about acupuncture there’s probably little indication that it would hurt. And it’s possible from what you’re saying that if you can stimulate blood flow to the ovaries through acupuncture that would be potentially good yeah it is certain a certain group of patients that’s been shown to be the case probably doesn’t apply to all but that could help. Yeah or it certainly falls under the couldn’t hurt category. And I do think though just to reiterate something that you said at the beginning and that is one aspect of premature ovarian failure is the infertility. But there are other health implications that. Who would a woman see assuming that pregnancy is at this point not what she is seeking but she is wanting to take care of the other potential health consequences. Would her general practitioner or internist or some whom she sees or does she at that point also need to see a reproductive endocrinologist. [00:54:24] So many of those people can handle the same situation. So when we talk about the fields of reproductive technology the the full the full name is reprograms acknowledging infertility. And so when someone practices purely reproductive Intercon ology they’re usually looking at all aspects of hormone replacement and so forth. So that’s certainly somebody that could be seen for this situation. Many O.B. Joannes would be able to treat prematurity and failure also as as would internist. So I think you have a whole team of people that are ready and willing to treat this condition. [00:55:11] OK. And on that note we have we have come to the end of our time together to our audience. If you have enjoyed this show and want to help us grow. Please do Efate do us a favor and give us a rating on iTunes. As you know we are the top rated show in this area on iTunes and we would like to maintain our position there. We are also located on the iTunes home page under what’s hot for families and children and we’d like to maintain that position. We’re quite proud of it. So if you would iTunes users are the rating system we have wonderful ratings and we would like to continue that. You can just type in creating a family into iTunes if it’s on your phone or your computer. Or you could go to the radio page of our Web site. Creating a family. Dot org slash radio show and click on iTunes. There scuse me and it will take you directly to the rating page. Thank you so much Dr. Timothy Hickman for being our guest today on creating a family. If you want to participate in discussion on the topic of this show you can check out my blog tomorrow at creating a family dot org slash blog to get more information on Dr. Timothy Hickman or on Houston IVF or on the Ivey a treatment program study that’s going on. You can go to their website which is Houston the s dot net. [00:56:41] Thanks for joining us. And I will see you again next week.
Hit the Highlights
- How is Premature Ovarian Failure (POF) defined, because isn’t the decrease in egg production a normal part of aging?
- I have heard this condition called different things: Primary Ovarian Insufficiency, Premature Menopause, POF. What other names does it go by?
- How is POF diagnosed?
- What are the symptoms (other than an inability to get pregnant)?
- What causes premature ovarian failure?
- Is premature menopauses caused by genetics, environmental pollution, chemical exposure, lead paint, and/or stress?
- Have there been any studies done on a link between POF and taking Accutane (a treatment for acne) as a teen?
- Can losing one ovary lead to Premature Ovarian Failure?
- Are those with autoimmune diseases more susceptible to POF?
- Can IVF lead to premature ovarian failure or early menopause? Is there any evidence that aggressive stimulation of the ovaries during a typical IVF cycle can contribute to Premature Ovarian Failure?
- Is there a link between premature ovarian failure and the HPV vaccine (Gardasil or Cervarix)?
- Treatments: let’s start with medical (western medical) treatments, and then talk about other forms of treatment.
- Are less gonadotropins more effective for women with POF, or more?
- New IVA Study for the treatment of Premature Ovarian Failure.
- Alternative treatments for Premature Ovarian Failure
- Are there any diet changes a woman can make to help preserve what ovarian function she has left?
- Premature Ovarian Failure has other health implications other than infertility. What are they?
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Image credit: Hey Paul Studios
Show originally aired in 2015.