Female Infertility
Premature Ovarian Failure
Premature ovarian failure (POF), also known as primary ovarian insufficiency, occurs when the ovaries stop functioning normally before the age of 40. While it significantly impacts natural fertility, treatment options — including donor egg IVF — offer many women a real pathway to parenthood.
When to Seek Fertility Advice
- • Absent or irregular periods before age 40
- • Elevated FSH or very low AMH on blood test
- • Hot flushes or menopausal symptoms at a young age
- • Family history of premature ovarian failure
What is Premature Ovarian Failure?
In premature ovarian failure, the ovaries lose their normal function earlier than expected, resulting in low oestrogen production and a greatly reduced — though not always absent — egg supply. Unlike natural menopause, POF can occur as early as the teenage years or twenties, and ovarian activity may occasionally fluctuate, making the condition distinct from permanent menopause.
Common Symptoms
- Absent or irregular periods before age 40
- Hot flushes and night sweats
- Difficulty conceiving naturally
- Vaginal dryness or discomfort
- Low AMH and very high FSH levels
- Mood changes and reduced libido
Causes of Premature Ovarian Failure
POF can result from a range of genetic, autoimmune, and environmental factors. In a significant number of cases, no identifiable cause is found. Early diagnosis helps guide both fertility planning and long-term health management.
Genetic conditions such as Turner syndrome or Fragile X
Autoimmune disorders attacking ovarian tissue
Chemotherapy or radiation therapy
Ovarian surgery or repeated ovarian procedures
Viral infections affecting ovarian function
Chromosomal abnormalities
Family history of premature ovarian failure
Unknown or idiopathic causes in many cases
Diagnosis
POF is diagnosed when a woman under 40 has absent or irregular periods along with elevated FSH levels (above 25 IU/L) confirmed on two blood tests at least four weeks apart. Additional investigations include AMH, LH, oestradiol, antral follicle count on ultrasound, and genetic or autoimmune screening to identify any underlying cause.
How It Affects Fertility
With POF, the ovaries produce very few or no eggs and insufficient oestrogen to support a normal cycle. Natural conception becomes unlikely in most cases, though not impossible if intermittent ovarian activity occurs. Low oestrogen also affects the uterine lining and overall reproductive environment, making fertility treatment support essential.
Treatment Options
Treatment for premature ovarian failure addresses both fertility goals and long-term health. Our specialists work closely with each patient to explore all available options and create a compassionate, personalised care plan.
Hormone Replacement Therapy (HRT)
HRT helps manage symptoms of oestrogen deficiency such as hot flushes, bone loss, and vaginal dryness, and is an important part of long-term health management in POF.
Fertility Investigations
A comprehensive evaluation including AMH, FSH, LH, oestradiol, and antral follicle count helps assess whether any residual ovarian function remains.
Spontaneous Conception Monitoring
In some cases, ovarian function can fluctuate intermittently. Monitoring with ultrasound and hormones may identify windows of natural ovulation.
IVF with Own Eggs
If residual follicular activity is detected, a carefully timed IVF cycle may be attempted to retrieve and fertilise available eggs.
Donor Egg IVF
For most women with POF, donor egg IVF offers the highest chance of pregnancy and is the most commonly recommended fertility treatment pathway.
Fertility Preservation (Proactive)
For women at high risk of POF — such as those undergoing chemotherapy — proactive egg or embryo freezing before ovarian decline is strongly advised.