POA stands for Premature Ovarian Aging and is a silent cause of infertility that affects roughly 10% of women. Essentially, it’s a condition that causes a young woman’s ovaries to age faster than normal.
Women are born with all their egg cells (called oocytes). Scientists refer to this as your “ovarian reserve.” At puberty, hundreds to thousands of these eggs start maturing and you begin using and losing these cells with ovulation and menstruation. As you age, the reserve depletes and fertility declines.
In most women, fertility begins to decline around age 35 – but for women at risk for POA, this aging of the ovaries can begin as early as their 20s. POA typically has no symptoms, and until now, most women were diagnosed only after they started having trouble conceiving and went to see a fertility specialist. By then, many women were at a point where they needed stressful and costly infertility treatment to have children.
There are multiple factors that appear to contribute to POA, including autoimmunity (immune system attacking itself—in this case, the ovaries), genetics, etc., although more research is needed to understand the entire mechanism of the condition. One of the root causes of POA appears to be in the FMR1 gene and its variations. Women with so-called low FMR1 alleles – one of a number of alternative forms of the same gene – have ovaries that age prematurely. This means that women with lower FMR1 alleles lose their eggs at an accelerated rate compared to women who do not carry a low form of FMR1.
POA is treatable—if caught early. Effective treatment for POA begins with timely screening for risk factors. Early screening helps at-risk women plan around the possibility that they may not be able to get pregnant easily after a certain age. If they decide to have children earlier in life, they can avoid POA-induced infertility entirely. Even women who are diagnosed with POA can be treated with success, if treatment is started early. POA usually worsens with time, so the key to successful treatment is to catch it early—and catch it before POA even becomes a problem.
If you are between the ages of 18-35, unless you are absolutely certain that you don’t want children, it is important that you get screened for POA because POA typically has no symptoms and once a woman’s ovarian reserve (the capacity of her ovaries to provide egg cells that are capable of conception) begins to decline, it continues to decline with time and we cannot tell how fast POA will progress. Early detection is crucial, and helps you keep your options open.
The screen determines your risk for POA based on a brief questionnaire about you and your family’s medical history, and three blood tests, including a genetic test (FSH, AMH and FMR1). Based on the blood test results and answers to the questionnaire, WMF’s patented screening algorithm flags women who are at an elevated risk for developing POA in the future, as well as those who may already have some degree of POA. WMF’s physicians, who are expert reproductive endocrinologists, review each woman’s results and answers, and counsel her in writing about her POA risk and potential steps she can take.
POA screening is available to women 18-35, but ovarian reserve peaks at around age 24, which makes this age the ideal time to get screened.
It's just a blood draw, no different from your regular blood test.
Typically 2-3 business days after the lab results are entered into the What’s My Fertility portal.
POA typically has no symptoms, but we know there are some risk factors. We cover those in the free preliminary assessment.
Depending on your identified level of risk, you may. Learn more about monitoring your fertility if your risk is medium or high.
For women identified as having low or high risk of POA, we recommend follow-up screening at appropriate intervals because we need to see which way your ovarian reserve is trending over time.
- For women at low risk of POA, we recommend a follow up test 6 months after the first screen and then yearly screening after that. By monitoring ovarian function yearly, we will be able to detect early whether you are moving towards POA.
- For women at high risk of POA, we recommend a follow up cycle one month later and then every three months. We will be able to reach a diagnosis within one year at the latest.
Yes. As long as you have the three lab results we need (FSH, AMH and FMR1), you can useWhat's My Fertility even if you don'tlive in the United States. You can "Outside the US" from the registration area, choose the "I Have My Labs" option, thenenter your lab results into the portal.
If you need a prescription to get your lab tests done and cannot do this through your primary care doctor, we can refer you to the Center for Human Reproduction – the center behind the What's MyFertility service – so you can use What's My Fertility through CHR. Please contact us if you need help usingWhat's My Fertilityfrom outside the United States.
You’ll still have options even with POA because we are catching it early. What's My Fertility physicians (and your healthcare provider, if you choose to work with one) can help you take proactive steps to make sure you will have the opportunity to be a mother, or put you in touch with fertility specialists near you who can do the same. Learn more about your options if you have POA.
Anti-Müllerian Hormone (AMH) is a hormone secreted by the cells of the developing antral and pre-antral follicles (or egg sacks) in the ovaries. AMH is a strong indicator of a woman's ovarian reserve (OR). As women age, the number of follicles gradually decline, and AMH levels decline with age as well. In essence, reproductive endocrinologists can assess how well a woman’s ovaries are functioning, by evaluating her AMH levels.
FSH (follicle stimulating hormone) is a hormone released by the pituitary gland. FSH stimulates the growth of follicles and has a role in the maturation of oocytes. The measurement of FSH levels in the blood is one of the most widely used tests to assess awoman's ovarian function and is typically taken on day 2 or 3 of a woman's menstrual cycle. If a woman's FSH levels are above what is expected for her age, then she is considered to have"High FSH," an indicator of declining ovarian reserve.
The FMR1 gene has long been recognized as a “risk gene” for neuro-psychiatric conditions. Recent research has indicated that this gene regulates how a woman’s ovarian function changes over time, making abnormal genotypes of this gene a strong indicator of future POA. Read more about the role of the FMR1 gene in ovarian function.
Barrier methods--like male and female condoms, a diaphragm, or a cervical cap--are good alternatives. If you aren't sure, please consult your healthcare provider. Here is some additional information that you may find helpful.