POF yasmen
-
Upload
yasmen-tantawy -
Category
Documents
-
view
225 -
download
0
Transcript of POF yasmen
-
7/31/2019 POF yasmen
1/16
Click to edit Master subtitle style
8/28/12
Premature Ovarian Failure(POF)
by:Yasmen MahranAssistant lecturerPharmacology and toxicologyAIN Shams University
-
7/31/2019 POF yasmen
2/16
8/28/12
Introduction:- POF- Clinical picture and diagnosis-
Etiology
Role of hormones in pathophysiology andmanagement
contents
-
7/31/2019 POF yasmen
3/16
8/28/12
Premature
Ovarian Failure
refers to development of amenorrhoea due tocessation of ovarian function before the age of 40.
Hypergonadotropic hypogonadism
-
7/31/2019 POF yasmen
4/16
8/28/12
Ovarian Failure
E2
(-)FSH(+)
menopausalsymptoms
-
7/31/2019 POF yasmen
5/16
8/28/12
Understanding the term (folliculogenesis)and ovulation as well as the role of eachhormone
Etiology
-
7/31/2019 POF yasmen
6/16
8/28/12
-
7/31/2019 POF yasmen
7/168/28/12
Hormone Role
Gonadotropins
1) FSH
+ folliculogenesis and estrogen secretion from the ovariesinduces expression of FSH receptors on follicles
2) LH LH surge initiates the ovulatory process+ progesterone synthesisincreased LH receptors.
Estrogen + the proliferation of granulosa cells from small follicles increases granulosa cell gonadotropin receptor levels
makes negative as well as positive feedback effect on
gonadotropins initiating their surge for ovulation
specific receptor ER alpha and beta
-
7/31/2019 POF yasmen
8/168/28/12
Progesterone converts the endometrium to its secretory stage toprepare the uterus for implantation
Thyroidhormone
Synergizes with FSH to exert stimulatory effects ongranulosa cell differentiation and function.
AntiMullerianHormoneRECENT
regulates the number of follicles that grow from theprimordial pool and the selection of the dominant folliclefrom the FSH-sensitive follicle.
Nil level in women with POF
-
7/31/2019 POF yasmen
9/168/28/12
Idiopathic
Iatrogenic:
*Chemotherapy*Radiotherapy
*Pelvic surgery
Autoimmune diseases
Gene mutations:
FSH & LH receptor mutations
Causes
-
7/31/2019 POF yasmen
10/16
8/28/12
Management
Hormonereplacement therapy(HRT)
Infertility
personal and emotionalsupport
H l
-
7/31/2019 POF yasmen
11/16
8/28/12
standard treatmentestrogen +/- oral contraceptive pill.Exogenous E sensitizes the granulose cells to
FSH, ovulation and conception
risk of (breast cancer and cardiovascularevents)
E + progestin to avoid endometrialhyperplasia
+ testosterone in cases of persistent fatigueand loss of libido
Hormone replacementtherapy
-
7/31/2019 POF yasmen
12/16
8/28/12
Usually, gonadotropins releasing hormonesagonist (GnRH) (leuprolide , goserelin &
triptorelin)
patients undergoing chemo-\radio-therapydevelop POF with ovarian follicular loss
No
te
http://en.wikipedia.org/wiki/Leuprolidehttp://en.wikipedia.org/wiki/Goserelinhttp://en.wikipedia.org/wiki/Leuprolidehttp://en.wikipedia.org/wiki/Leuprolidehttp://en.wikipedia.org/wiki/Goserelinhttp://en.wikipedia.org/wiki/Leuprolide -
7/31/2019 POF yasmen
13/16
8/28/12
Hypothyrodism, autoimmune diseasesRECENT
Gene therapy for defective FSH Receptormutations
Treatment of the cause is
a must
No
te
-
7/31/2019 POF yasmen
14/16
8/28/12
The only reliable fertility treatment is the use of
in vitro fertilization (IVF) (high successrate)ovulation induction:
*Clomiphene (Clomid)
* pulsatile GnRh
*(r FSH) (Gonal-F, Follistim)corticosteroids +/- clomiphene
Cryopreservation
Infertility
S
uccessrate
m
odest
-
7/31/2019 POF yasmen
15/16
8/28/12
women with POF most likelyhave follicles that are of lower
quality.
However, there may not be anyother option for being a MOM
-
7/31/2019 POF yasmen
16/16
8/28/12
Thank
you