Premature menopause
and early menopause
The term premature menopause generally refers to a complete end to menstruation before age 40, while early menopause usually refers to its stopping between ages 40 and 45. Although the cause is unknown, there may be a genetic link since these conditions sometimes run in families. While most women with POI/POF will continue to have periods—even if they’re very irregular—menopause means periods stop completely, so it’s impossible to get pregnant naturally. Younger women who have gone through a premature or early menopause may be able to get pregnant with donor eggs, even though their own ovaries have shut down. In the United States, most IVF programs will implant fertilized eggs in healthy women up to age 50, Dr. Santoro says.
The good news for a younger woman with high FSH or other signs of low ovarian reserve is that the eggs she does have are likely of good quality. By the late 30s and early 40s, however, the quality as well as quantity of eggs declines, making it more difficult to conceive and increasing a woman’s risk of miscarriage if she does become pregnant.
“Your enemy is time,” says Dr. Santoro. “For a woman under 35 with high FSH, I would not recommend going more than six months without getting pregnant.” Assuming a complete fertility workup reveals no other barriers to pregnancy, Dr. Santoro says the next step would be to stimulate a woman’s ovaries with medications and probably inseminate her with her partner’s or donor sperm. If that’s not successful after a few cycles, IVF is the next choice. Women in their 20s and 30s may want to see if enough of their own eggs can be retrieved for IVF before resorting to donor eggs.
IVF is also an option for a woman near 40 or in her early 40s, although by this time donor eggs usually offer the best chance of success. “IVF success rates with a woman’s own eggs are 5 percent or less for women over 38,” Dr. Santoro says. “The most realistic scenario for these older women is to use donor eggs, which have a 75 to 80 percent success rate.”
The bottom line is that high FSH/low ovarian reserve does not mean a woman will never conceive. Probably every doctor can point to a “miracle” pregnancy in which a woman became pregnant without medical help, even after negative test results.
Certainly, though, women can improve their chances by asking their doctors about an FSH test if they’re concerned. “For sure, if there’s a family history of early menopause or premature ovarian failure, a woman should be tested in her 30s,” advises Dr. Santoro, who adds that women should always tell their doctors if they do have a family history of these problems. FSH testing is relatively easy and inexpensive; and knowing the results can help put a woman on a faster track to parenthood.
This article was originally published in the Fall 2010 issue of Conceive.
