In a woman with premature ovarian failure the treatment of choice is IVF with donor eggs.  Performing IVF with her own eggs is unlikely to be successful as:

• there may be insufficient eggs for egg pick up due to absent follicular development and
• even if she has successful egg retreival and embryo formation, the likelihood of good quality embryos is low and therefore pregnancy success is low.

Obtaining donor eggs

Donor eggs can be obtained from three different sources. 

• An IVF centre may have a list of women willing to donate their eggs anonymously 
• Family members or friends may donate
• Advertising for a donor after receiving written permission from the Minister of Health in Victoria for example (refer to relevant authority for other Australian States)

Donor profile

The ideal donor is under the age of 35 years and has had children beforehand, though the latter is not essential.  The age of the donor is the most important determinant for recipient success and if under the age of 35 years a pregnancy rate of 30-40% is expected.

The donor goes through an IVF cycle of stimulation and egg retrieval. After egg retrieval and until the next menstrual period, contraception must be used to make sure that the donor does not become pregnant with a multiple pregnancy.

The donor's eggs are mixed in vitro with the recipient's partner's sperm and embryos are produced.One or two embryos are placed in the recipient's uterus.

The recipient receives hormonal therapy in time with the donor so that her uterus is ready to accept the created embryos.  The recipient continues on a regimen of hormone therapy until 12 weeks gestation (if pregnancy has occurred) by which time the placenta has taken over maintanance of the pregnancy.

Low ovarian reserve

If a woman is diagnosed with low ovarian reserve, IVF with her own eggs can be attempted. However, the couple must be counselled that the expected chance of success is probably <10% and for some couples may be <1%.  If IVF is unsuccessful due to low egg numbers or poor embryo quality, donor eggs will bring greater chance of success.

Chemotherapy and loss of ovarian function 

In women who are about to lose ovarian function due to chemotherapy, freezing embryos, if possible, is the best option. This is provided that the ovarian stimulation required does not impact upon the cancer (for example, breast cancer).

Freezing eggs is also an option but has low success in terms of future pregnancy and the woman needs to know that this is still in the research stage of development. 

The other option is to freeze ovarian tissue depending on the type of tumour.  In women with breast cancer, micrometastases may be present in the ovary and once the patient is treated and then has her ovarian tissue reimplanted, she may develop a recurrence of the cancer. 

The woman also needs to be counselled that this is currently primarily a research tool (only two babies have been born world wide as a result of tissue freezing).

Content Updated July 24, 2007