Conference Coverage

ESHRE writes first premature ovarian insufficiency guidelines




MUNICH – A working group of the European Society of Human Reproduction and Embryology drafted the first international guidelines for managing premature ovarian insufficiency.

Once formally released, by late this year or soon after, the guidelines should "improve clinical practice and awareness of the condition," which affects roughly 1% of women, said Dr. Melanie Davies, a gynecologist at University College London Hospital and a working-group member who presented a few key items from the draft guidelines during a session at the society’s annual meeting.

Mitchel L. Zoler/Frontline Medical News

Dr. Melanie Davies

Women with premature ovarian insufficiency (POI) sometimes are treated for one aspect of POI by a physician "without full realization of the condition and its implications," Dr. Davies said in an interview. For example, "there have been fatal cases of women with Turner syndrome who received donor oocytes," the disorder posing the greatest risk to women receiving donor eggs. "This is a good example of where the guidelines may increase awareness," she said.

One draft excerpt Dr. Davies presented advises physicians and patients that candidates for donor oocytes suspected of having POI should undergo prior to receiving eggs a full investigation for thyroid and adrenal function and karyotype. "Pregnancy in some women can be of such high risk that clinicians may consider egg donation life threatening and inappropriate," she said.

For women with Turner syndrome, the guidelines call for assessment by a cardiologist with a special interest in adult congenital heart disease, as well as a general medical and endocrine examination prior to pregnancy. During pregnancy, these women have an elevated risk for obstetric complications and should be managed in an obstetric unit designed for high-risk pregnancies with involvement of a cardiologist.

The draft defines POI as depletion of follicular activity before age 40 years with menstrual disturbance, raised gonadotropin levels, and low estradiol levels. These women should understand that no interventions are proven to reliably increase ovarian activity and their natural conception rate. But physicians also can reassure these women that spontaneous pregnancy after idiopathic POI or most forms of chemotherapy has no higher obstetric or neonatal risk than in the general population.

Pregnancy in women who received cancer treatment is increasingly common, Dr. Davies said in her talk at the meeting. Women who received ovarian irradiation face an increased risk of pregnancy complications and should be managed accordingly. Women who received treatment with an anthracycline, high-dose cyclophosphamide, or cardiac irradiation should undergo echocardiography before pregnancy, and prenatal care should include cardiology assessment.

The draft guidelines contain a total of 13 chapters addressing 31 key issues, ranging from symptoms and diagnosis, complications including bone and cardiovascular health, sexual function, and quality of life. The 17-member working group included a patient representative as well as experts from psychology, cardiology, endocrinology, internal medicine, and ob.gyn. In mid-August, the ESHRE website said that posting of the draft version should occur later in August. Once posted, ESHRE will open a 6-week comment period. The final version should appear by late 2014, Dr. Davies said.

She said she had no relevant financial disclosures.

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On Twitter @mitchelzoler

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