Autoimmune premature ovarian failure

Autoimmune POF is a large category that requires better definition and characterization. Targeted methods to identify the antibodies responsible for POF are lacking. Once a woman develops ovarian failure, the antibody may have disappeared. It is not possible to determine whether POF is caused by a single antibody-mediated process or by more complex processes. There is no firm support for a major role for autoimmunity in the cause of POF. Although some patients' POF undoubtedly is caused by autoimmunity, such as in patients with Addison's disease, clear proof of autoimmunity is lacking in most cases of idiopathic POF. Autoimmunity remains a candidate for the origin of POF, but better approaches and solid data are required to define its exact role. To restore ovarian function in a young woman with autoimmune POF, the clinician needs a sensitive and specific noninvasive method to confirm that the woman has ovarian failure on an autoimmune basis and needs a treatment that has been proven safe and effective by prospective, randomized, controlled trial. No accurate serum marker is available to identify patients with POF that is caused by autoimmunity, and the specific antigens involved in the development of autoimmune POF have not been found. Ovarian biopsy is the only way to diagnose autoimmune POF with certainty, although the procedure is not indicated clinically unless it is included in an approved protocol for a clinical trial. A prospective, randomized, controlled study of alternate-day prednisone therapy for autoimmune POF documented by ovarian biopsy is being conducted by the National Institute of Child Health and Human Development. Until the results from this trial are available, there is still no treatment that has been proved effective by prospective, randomized, controlled study to restore fertility for these women.