POI Hormonal traetment options in improving fertility
Svetlana Dragojevic Dikic (RS), Mladenko Vasiljevic (RS), Aleksandar Jursisic (RS), Svetlana Sreckovic (RS), Sladjana Mihajlovic (RS)
[Dragojevic Dikic] Ob Gyn clinic Narodni front, [Vasiljevic] Ob Gyn clinic Narodni front, [Jursisic] Ob Gyn clinic Narodni front, [Sreckovic] KCS Belgrad, [Mihajlovic] Ob Gyn clinic Narodni front
Premature ovarian insufficiency POI is a condition deficient gonadal function before age of 40 years old. It is a delicate medical problem for the young women. Infertility and psychological stress are the most common consequences of this entity, whose prevalence from 0.9 to 3%. This condition is not permanent, because of presence residual egg cells capable of recruiting and fertilization. However, according to previous datas in less than 5% of the realized concepts.In the eight-year period was conducted evaluation of the 90 patients younger than 40 years with secondary amenorrhea. They had intension to establish a fertility. After confirming the diagnosis and evaluation for premature ovarian insufficiency (endocrine, ultrasonography, immunological, genetic tests) patients ware given hormone replacement therapy (sequential application of estradiol and norethisterone acetate). Supplementation with oral micronized dehydroepiandrosterone DHEA in a daily dose of 25mg was conducted in 44 patients. 16 patients was conducted whit the treatment estrogen / progestogen therapy + DHEA 25 mg/per day + melatonin 3mg/per day. In our study, there was a realization of 15 pregnancies (17%) after 10-22 months from the initiation of hormone therapy. Pregnancy of 12 patients completed with normal growth and development of the fetus. Conclusion The hormone therapy is a key therapeutic option in the treatment of premature ovarian insufficiency. Adequate and individualized hormone therapy is not only treatment for estrogen deficiency, but also the recovery of ovarian function stimulating effect on folliculogenesis and conception. Supplementation with melatonin or DHEA opening up new possibilities in future modern treatment protocols for PIO.