Ovarian Reserve Disorders, Can We Prevent Them? A Review
Abstract
:1. Introduction
2. Developmental Abnormalities
3. Genetic Background
3.1. X Chromosome Defects and Gene Mutations
3.1.1. Turner Syndrome
3.1.2. 47, XXX
3.1.3. Other X Chromosome Anomalies
3.1.4. Fragile X Syndrome
3.2. Single Gene Defects Causing POI
3.2.1. Transcription Factors
- -
- Nuclear receptor subfamily 5 group A member 1 (NR5A1), a transcriptional activator involved in sex determination [65].
- -
- Factor in Germline Alpha (FIGLA) regulates the expression of the zona pellucida and other oocyte-specific genes. Mutations in this gene are responsible for about 4% of POI cases [66].
- -
- Newborn Ovary Homeobox (NOBOX), a mutation in that gene, is responsible for about 6% of POI patients [67].
- -
- -
- Diaphanous Homolog 2 (DIAPH2) has a role in the development and normal function of the ovaries [70].
3.2.2. Growth Factors
3.2.3. Steroidogenesis
3.2.4. Galactosemia
3.2.5. Mitochondrial DNA Polymerase Gamma (POLG)
3.3. Idiopathic
4. Infections
4.1. Human Immunodeficiency Virus (HIV) Infection
4.2. Severe Acute Respiratory Syndrome Coronavirus 2 (SAR-CoV-2) Infection
5. Autoimmune Disease
6. Medical Treatment (Chemotherapy, Radiation, and Surgeries/Procedures)
6.1. Chemotherapy
6.2. Radiation
6.3. Surgical
7. Environmental Exposure
7.1. Endocrine Disrupting Chemicals
7.1.1. Phthalates
7.1.2. Pesticides
7.2. Oxidative Stress
7.3. Epigenetic Modifications
8. Conclusions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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Insult | Primary Prevention | Secondary Prevention | Tertiary Prevention |
---|---|---|---|
2. Developmental abnormalities | Limiting/avoiding chemical exposures during pregnancy. Emphasis on the avoidance of endocrine disruptors. | Genetic screening with genetic counseling when there is a family history of genetic abnormalities, developmental abnormalities, or POI. Considering prenatal diagnosis with CVS or amniocentesis. | Oocyte cryopreservation in early adulthood or teen years. |
3.1.1. Turner Syndrome | Gonadectomy is recommended when Y chromosomal material is detected. | Might be diagnosed during prenatal care, detection of specific features by ultrasound screening or NIPT. Conformation with CVS/amniocentesis and subsequent karyotype of fetal cells. | Oocyte cryopreservation and OTC are possible only when ovarian follicles are present in mosaic Turner syndrome patients. If pregnancy is deemed safe, autologous or donor oocytes with embryo transfer are optional. If pregnancy is contraindicated, considering IVF with the transfer of an embryo into a gestational carrier. |
3.1.2. 47, XXX | NIPT results might raise suspicion and is confirmed with CVS/amniocentesis, and subsequent karyotype of fetal cells. | ||
3.1.4. Fragile X Syndrome | When a woman is diagnosed as a PM carrier, advising her that other family members might also be affected. Women wishing to prevent passing a CGG expansion to their children can undergo IVF-PGT-M. | In cases a woman was detected as a carrier, there are available strategies for fertility preservation. | Oocyte cryopreservation in early adulthood or teen years in patients that are anticipated to become FXPOI. |
3.2.4. Galactosemia | Genetic counseling regarding the risk of infertility. In prepubertal patients, OTC can be considered. If no ovarian activity is detected or COH fails, oocyte/embryo donation at the time the patient would like to build her family is optional. | ||
3.3. Idiopathic | Women with non-iatrogenic POI should perform chromosomal analysis. Where a known genetic background exists in discrete families, it is advised to test. As a part of prenatal care, using screening panels for genetic diseases. Early diagnosis could help the patient decide toward fertility preservation or change their family-building plans. Pan-ethnic carrier screening before IVF treatment is recommended in some medical centers. Identification of a genetic mutation could change the patient’s plan for conceiving or induce other family members to be tested. According to the results, a recommendation regarding the use of IVF-PGD is imperative. | ||
4. Infections | Chickenpox and mumps vaccines | ||
4.1. HIV infection | Regular use of barrier contraceptives like condoms or taking PrEP, to reduce the risk of HIV infection via sex or injection drug use. | Education of people living with HIV on reducing the risk of HIV transmission. Supporting patients’ adherence to their HIV medication to maintain viral suppression and prescribing PrEP for HIV-negative sexual or drug-injecting partners. | Providing medical and psychiatric interventions as soon as possible to help women manage and live with the disease. |
5. Autoimmune disease | Identifying women with autoimmune POI is pertinent, for diagnosing patients with subclinical or latent autoimmune Addison’s disease. Special consideration is needed in cases where the second line of treatment includes chemotherapeutic drugs that are gonadotoxic. | It is important to evaluate the ovarian reserve in women diagnosed with autoimmune disease due to the coexistence of related conditions. In the initial phase of autoimmune POI, ovarian reserve is still normal, allowing cryopreservation of gametes. | |
6.1. Chemotherapy | When applicable, a treatment combination that is the least gonadotoxic is preferable. Current fertility preservation techniques are available, cryopreserving oocytes, embryos, and OTC when the ovarian tissue is free of residual disease. | Patients can cryopreserve oocytes, embryos, or ovarian tissue after the administration of chemotherapy, particularly in cases where treatments are only mildly damaging. | |
6.2. Radiation | Oocyte/embryo cryopreservation, OTC, and oophorpexy. | ||
6.3. Surgical | When possible, the least damaging technique for the ovarian reserve should be used. Gamete banking or OTC are available. | ||
7. Environmental exposure | Lifestyle modification is a robust mode of primary prevention of POI. Quitting cigarette smoking. In cases of exposure to hazardous chemicals at their workplace, women should be educated about the risk and adequately protected, particularly if they plan to conceive or are already pregnant. | Discontinuing hazardous exposure. Fertility preservation should be considered in cases when there is still a substantial ovarian reserve. |
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Man, L.; Lustgarten Guahmich, N.; Vyas, N.; Tsai, S.; Arazi, L.; Lilienthal, D.; Schattman, G.; Rosenwaks, Z.; James, D. Ovarian Reserve Disorders, Can We Prevent Them? A Review. Int. J. Mol. Sci. 2022, 23, 15426. https://doi.org/10.3390/ijms232315426
Man L, Lustgarten Guahmich N, Vyas N, Tsai S, Arazi L, Lilienthal D, Schattman G, Rosenwaks Z, James D. Ovarian Reserve Disorders, Can We Prevent Them? A Review. International Journal of Molecular Sciences. 2022; 23(23):15426. https://doi.org/10.3390/ijms232315426
Chicago/Turabian StyleMan, Limor, Nicole Lustgarten Guahmich, Nina Vyas, Shelun Tsai, Laury Arazi, Debra Lilienthal, Glenn Schattman, Zev Rosenwaks, and Daylon James. 2022. "Ovarian Reserve Disorders, Can We Prevent Them? A Review" International Journal of Molecular Sciences 23, no. 23: 15426. https://doi.org/10.3390/ijms232315426