الفهرس 
ASSESSMENT OF THE OVARIAN RESERVEOnly 14 pages are availabe for public view
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Abstract
Premature ovarian failure (POF) is a failure of estrogen production by the ovary before the age of 40 years. It affects 1 % of women before age of forty and about 0.1 % of those below thirty years. POF may be spontaneous or iatrogenic. The aetiology of spontaneous POF includes genetic, auto-immune and others as infections and metabolic disorders. In a large proportion of cases, no cause is found and they are classified as idiopathic POF. In patients developing malignant diseases; radiotherapy and chemotherapy can lead to POF. The most common presentation of POF is oligomenorrhea, secondary amenorrhea and primary or secondary infertility due to anovulation and hypoestrogenism. Diagnosis of POF is done when the woman has not experienced a menstrual cycle in 4 months or more and at least 2 tests taken,more than one month apart, show elevated FSH. Anti mullerian hormone (AMH) is a new biochemical marker for assessment of the quantitative aspect of the ovarian reserve where it has a strong correlation with antral follicle count & the ovarian follicle pool more than the usual hormonal markers such as Inhibin B , E2 , FSH & LH. Long-term HRT is needed for relief of menopausal symptoms and to prevent long-term health sequalae of estrogen deficiency; such as osteoporosis and cardiovascular diseases. Successful attempts at ovulation induction have been reported with clomiphene, gonadotrophins and recently with recombinant FSH. Ovarian tissue cryopreservation and oocyte cryopreservation thus hold promise for fertility preservation in women likely to undergo ovarian failure following cancer treatments. Although women with POF have a 5–10 % chance of conceiving at sometime after diagnosis ; prognosis is generally poor. IVF and embryo transfer using donor oocytes has demonstrated high success rates and is considered to be the fertility treatment of choice in patients with POF, However, it is prohibited in our Islamic countries.