Explaining ‘ovarian failure’

Ovarian failure can happen when there is serious damage to the eggs and follicles after chemotherapy and radiotherapy.

Ovulation is a complex interaction between the pituitary gland in the brain, the ovaries and the uterus. During a normal cycle, these key players send chemical or hormonal signals to each other that trigger key moments in the reproductive cycle. For example, each month, the pituitary sends a signal to the ovary to develop follicles. These are the fluid-filled sacs inside which the oocyte or the egg matures. As the follicles develop and mature they secrete oestrogen into the blood stream, which in turn stimulates the pituitary to produce the hormone that leads to ovulation. Ovulation triggers a burst of progesterone and the cycle continues. If this interaction is interrupted or there are damaged cells, the body will fail to produce adequate levels of oestrogen and progesterone, which can lead to menopausal symptoms.

Ovarian failure is characterised by:

• occasional or no periods
• hot flushes
• mood swings
• dryness in the vagina
• urinary symptoms
• low oestrogen
• high follicle stimulating hormone (FSH) and luteinizing hormone (LH) levels
• a risk of bone depletion.

It is impossible to conceive with your own eggs while the ovaries are in a state of ovarian failure. However, ovarian function can change from month to month.

Chemotherapy and radiotherapy can cause ovarian failure. Ovarian failure can be:

• temporary, starting around the time of chemotherapy and lasting anywhere from a few months to one or two years. Most young women experience temporary ovarian failure
• permanent, where the ovaries stop working around the time of chemotherapy and do not return to normal functioning. This occurs mainly in older women and with extremely high dose chemotherapy or radiotherapy to the pelvis. It is still possible, although rare, for spontaneous cycles to start again even many years later.

After five years there is still a five per cent chance that the ovaries will start to function again, but it is impossible to predict in whom this is likely to occur. The most common situation is for young women to develop temporary ovarian failure. However, it is very important to understand that because the ovaries have received some damage from the therapy and are somewhat fragile, there is a moderate risk of developing ovarian failure later on.

Egg and embryo donation

For women who have developed ovarian failure following their chemotherapy/radiotherapy, donor eggs or embryos may be the only option for having a baby. Most IVF units have an active egg donation program and some have an embryo donation program. Many units have long waiting list for people requiring anonymous donor eggs and embryos. Therefore, many women and couples choose to use a known egg donor, or to seek an egg donor with assistance.

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