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In human women, oogenesis produces one mature egg cell or ovum for every precursor cell that enters meiosis. This process differs in two unique ways from the equivalent procedure of spermatogenesis in males. First, meiotic divisions during oogenesis are asymmetric, meaning that a large oocyte (containing most of the cytoplasm) and minor polar body are produced as a result of meiosis I, and again following meiosis II. Since only oocytes will go on to form embryos if fertilized, this unequal...
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Updated: Jun 15, 2025

Fertility Preservation in Patients with Severe Ovarian Dysfunction
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Evidence-based guideline: Premature Ovarian Insufficiency.

, Nick Panay1, Richard A Anderson2

  • 1Queen Charlotte's and Chelsea Hospital, Imperial College London, UK.

Fertility and Sterility
|December 9, 2024
PubMed
Summary

This guideline offers 145 recommendations for diagnosing and managing premature ovarian insufficiency (POI), addressing symptoms, causes, and treatments. It emphasizes updated diagnostic criteria, including FSH levels and AMH testing, for better patient care.

Keywords:
bonebraincardiovascularcombined oral contraceptivefertilityhormone replacement therapyhormone therapypremature ovarian insufficiencyprimary ovarian insufficiencypuberty induction

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Area of Science:

  • Reproductive Endocrinology
  • Women's Health
  • Clinical Guidelines

Background:

  • Premature ovarian insufficiency (POI) significantly impacts women's physical and emotional well-being, affecting quality of life, fertility, and long-term health (bone, cardiovascular, cognitive).
  • Optimal management of POI remains a challenge, despite hormone therapy (HT) offering some mitigation of adverse effects.
  • The prevalence of POI is now estimated at 3.5%, highlighting its importance in women's health.

Purpose of the Study:

  • To provide evidence-based recommendations for the diagnosis and management of premature ovarian insufficiency (POI).
  • To update clinical practice guidelines for healthcare professionals caring for women with POI.
  • To address emerging knowledge and clinical questions in POI, including fertility preservation and specific treatment considerations.

Main Methods:

  • Development of ESHRE guidelines using structured methodology, including expert consensus and literature review up to January 30, 2024.
  • Scoping survey of women with POI and healthcare professionals to inform key clinical questions.
  • Inclusion of women with lived experience to guide recommendations on care provision.

Main Results:

  • The updated guideline includes 145 recommendations covering 40 clinical questions on POI diagnosis, sequelae (bone, cardiovascular, neurological, sexual function), fertility, and treatment.
  • Key changes include requiring only one elevated FSH >25 IU/L for POI diagnosis and guidance on AMH testing for diagnostic uncertainty.
  • Updated recommendations cover genetic testing, hormone therapy (HT) doses and regimens, oral contraceptives, and testosterone therapy; complementary and non-hormonal treatments are also expanded.

Conclusions:

  • The guideline offers clear, best-practice advice for POI care based on available evidence, though evidence supporting many management options is limited.
  • It provides a framework for healthcare professionals to improve care for women with POI.
  • The guideline also identifies research priorities to advance understanding and treatment of POI.