Infertility Testing

Infertility

When ovarian function ceases before age forty the condition is referred to as premature ovarian failure (POF). This condition occurs in 4-10% of women. The various etiologic factors in POF are congenital defects, enzymatic alterations, gonadotropin secretion alterations, gonadotropin receptor alterations, iatrogenic infections and autoimmune disorders. The diagnosis of POF is made based on three indicators: amenorrhea, elevated Follicle Stimulating Hormone, and diminished 17β-estradiol levels before the age of 40. Efforts should be made to determine etiology so proper treatment can be implemented. Antibodies to steroid cell antigens have been identified in association with premature menopause, infertility and in patients with in vitro fertilization. Premature ovarian dysfunction is often associated with thyroid or adrenal gland related autoimmune endocrine disorders, such as Hashimoto’s, Graves and Addison’s diseases, and polyendocrine syndrome (adrenalitis, hypoparathyroidism and muccocutaneous candidiasis). Premature menopause and infertility are also associated with non-endocrine autoimmune disorders such as lupus and other connective tissue disorders. The appearance of these antibodies often precedes onset of ovarian failure. Patients with these disorders may have autoantibodies to testicular Leydig cells, ovarian granulosa cells and placental syncytiotrophoblasts.