Premature ovarian failure is a cause of infertility in 16% of women in Delhi

New Delhi: Ankita (name changed), aged 33, was married for 7 years and had not conceived yet. She had a history of diabetes and hyperthyroidism. The couple underwent 6 cycles of IUI and 1 self-cycle of IVF, all in vain. When they visited Nova IVI Fertility in New Delhi, it was found that Ankita did not have any eggs left in her ovaries (her AMH being very low and too low follicular count). She was then advised for ICSI with donor eggs. The treatment was a success, and Ankita finally conceived.

Dr Parul Sehgal, Fertility Consultant at Nova IVI Fertility, New Delhi said, “Premature ovarian failure (POF), also referred to as premature ovarian insufficiency, is a condition where there is a physiological decrease in the number of eggs in the ovaries, which could impact the chances of pregnancy at a younger age (less than 35 years). Normally, follicles in the ovaries supply women with eggs until around the age of 40 to 45 – the average perimenopausal age when the supply of eggs is used up. In POF cases, women as young as 30 years old are seen with no eggs in the reserve.”

Research shows that nearly 1-2% of Indian women experience signs of menopause between 29 and 34 years of age. Additionally, this figure goes up to 8% in the case of women between 35 and 39 years of age. A study done by Nova IVI Fertility and IVI, Spain concluded that the ovaries of Indian women age six years faster than that of Caucasian women. The implications of this are very serious – couples these days ape the West and delay marriage and thereby pregnancy, unaware that the biological clock of Indian women ticks faster. A more recent analysis found the common causes of infertility in Indian women under the age of 36 to be:

• Polycystic Ovarian Syndrome (PCOS) is seen to be the most common cause of female infertility, which occurs in about 20% of women

• An alarming 18-20% of young women suffer from a low ovarian reserve or premature ovarian failure. Low ovarian reserve is generally believed to occur with advanced age (over 35)

• Women cannot conceive naturally if the fallopian tubes are damaged. Tubal factor infertility accounts for about 9% of all infertility cases

• Endometriosis – a condition wherein the tissue that lines the inside of a woman’s uterus (endometrium) grows outside the uterus causing painful menstruation – occurs in about 5% of infertile women

“Infertility, or the inability to conceive a child naturally, affects both men and women equally. Calling infertility a female problem is a common misconception. The incidence of male infertility is on the rise and it is rampant in cities where people are prone to a stressful lifestyle. Male factor is found in nearly 45% of infertility cases. Many male fertility problems go undiagnosed and untreated, either because attention focuses on their partner or because men are reluctant to get help or unable to find it when they seek,” added Dr Parul Sehgal.

Causes and symptoms of Premature Ovarian Failure (POF)

When the ovaries fail, they don’t produce normal amounts of oestrogen hormone or release eggs regularly. Lesser number of eggs in the ovaries reduces women’s fertility potential, and makes it difficult for them to conceive. Lifestyle changes such as smoking, contraceptive pill use, previous ovarian surgeries, anticancer therapies and familial POF are some of the known reasons for low ovarian reserve at a rather young age.

Some of the known causes of POF are previous surgery on the ovaries for benign cysts, endometriosis, excessive drilling for polycystic ovaries, etc. X chromosome abnormalities, autosomal causes, galactosemia, autoimmune disorders, cancer treatment, Turner’s syndrome, enzyme defects, and environmental toxins are some other factors leading to early menopause. In some cases, POF may be genetic and run in families. In many cases, the cause cannot be found (idiopathic).

Symptoms of POF include having no periods or irregular periods. At times, a woman may get normal periods for a few months and then skip it for the next few months. They may also have other symptoms of early menopause like hot flashes, night sweats, sleeping problems, anxiety, mood swings, vaginal dryness, energy loss, low sex drive, painful intercourse, and bladder control problems.

In a country with a population of 1.32 billion, it is estimated that a whopping 30 million couples suffer from infertility. What is even more worrying is the rising incidence of young women facing infertility. A condition which was predominantly seen among older couples, infertility is now seen more frequently in women who are younger than 35 years of age. It is therefore strongly recommended that even young women in their 20s and 30s who face complications in conceiving should immediately visit a fertility expert. Early detection would provide better opportunity for early intervention.