Treatment of WHO 3

Primary ovarian insufficiency (POI), also known as World Health Organization (WHO) type 3 amenorrhea, is defined by the existence of permanent ovarian insufficiency before the age of 40 and occurs in approximately 1% of the female population (1). It is the result of the accelerated decline of ovarian function, leading to hypergonadotropic hypogonadism. Ovarian insufficiency is clinically expressed by the combination of amenorrhea for a period of at least 6 months and elevated follicle-stimulating hormone (FSH) levels (>40 IU/l) (2,3). Further characteristics accompanying this condition are infertility and estrogen deficiency signs (4). There are several causes that can contribute to POI, of which idiopathic cases constitute the largest group (1). In addition, POI can be caused by genetic (such as Turner syndrome), autoimmune, environmental, or iatrogenic factors (5,6). For women with POI, although ovarian function is insufficient to ensure a monthly ovulatory cycle, there is still a small possibility of a spontaneous pregnancy occurring, with studies reporting rates varying from 2.5% to a maximum of 10% (1,7,8). This indicates that complete depletion of the follicle pool may not always be present. Therefore, attention has been given to applying ovarian stimulation to this group of patients in the hope of utilizing the last available follicular reserve and enabling the occurrence of ovulation.