If POI is diagnosed while a patient still has a significant supply of oocytes, fertility preservation could be considered if the patient is not able to consider conception at the time of diagnosis. In most cases, patients with prolonged amenorrhea are not diagnosed at a time when significant numbers of reproductively competent oocytes are present. Fertility preservation is an option for patients about to undergo gonadotoxic chemotherapy or if a patient is known (e.g., based on family history) to be at risk for POI. Either embryos or oocytes can be cryopreserved. There is more worldwide experience with cryopreservation of embryos. Improvements are occurring in techniques of oocyte and ovarian tissue cryopreservation (150,151).
Patients with POI who desire pregnancy will in most cases have a high chance of having a child with the help of oocyte donation. Oocytes from donors may be harvested after ovulation induction, fertilized with sperm from the intended father, and transferred into the recipient’s uterus after the endometrium is appropriately prepared with estrogen and progesterone. Special concern is warranted for women with Turner syndrome who appear to have a maternal mortality of at least 2% (58). Rupture of the aorta may occur even if an echocardiogram shows no dilatation (152). It is suggested that all women with Turner syndrome undergo a full cardiac evaluation, including a cardiac MRI at a center with expertise in cardiovascular imaging, and that pregnancy be contraindicated if the patient has known congenital cardiovascular disease (e.g., bicuspid aortic valve or aortic coarctation) or with aortic size greater than 2 cm/m2 (153).
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