Assessment of ovarian reserve in children and adolescents with Turner’s syndrome


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Abstract

Premature ovarian failure affects the majority of female patients with Turner’s syndrome and therefore only 5-10% is observed to have regular menstruation, whereas spontaneous pregnancy occurs in only 2% of women with this syndrome mostly at a young age and generally in patients with mosaic karyotype. Girls with Turner’s syndrome are noted to have a reduced pool of oogonia in the primary gonads and primordial follicles just at birth, which is concurrent with subsequent postnatal loss of gametes, leads to ovarian reserve depletion before reaching reproductive maturity in 90% of patients. Fertility preservation in this cohort of patients is potentially feasible because many girls with Turner’s syndrome retain ovarian follicles until adolescence. Biochemical markers that reflect childhood ovarian reserve and predict the degree of ovarian impairment are needed to identify candidates among girls and adolescents with Turner’s syndrome, as well as the timing of fertility preservation procedures. The paper reviews current information on the assessment of ovarian reserve in girls with Turner’s syndrome, considers the relationship of the ovarian reserve to the karyotype, and describes the results of ovarian tissue biopsy, as well as the experience with assisted reproductive technologies and cryopreservation to achieve pregnancy in these patients in the future. Conclusion: An early assessment of ovarian reserve before the age of 10 years should be made, by taking into account the karyotype, FSH, AMH and inhibin B levels, spontaneous menarche and puberty, in order to timely consider possible options for preserving fertility.

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About the authors

Elena V. Uvarova

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation; I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University)

Email: elena-uvarova@yandex.ru
Corresponding Member of the RAS, Dr. Med. Sci., Professor at the Department of Obstetrics, Gynecology and Perinatology; Head of the Department of Pediatric and Adolescent Gynecology

Anna I. Turchinets

N.I. Pirogov Russian National Research Medical University, Ministry of Health of the Russian Federation

Email: ponomarevaanna28@gmail.com
resident at the Department of Obstetrics and Gynecology, Pediatric Faculty

Zaira Kh. Kumykova

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation

Email: zai-kumykova@yandex.ru
PhD, Senior Researcher at the Departament of Pediatric and Adolescent Gynecology

Oksana Yu. Pivovarova

N.I. Pirogov Russian National Research Medical University, Ministry of Health of the Russian Federation

Email: pou@mail.ru
PhD, Associate Professor at the Department of Obstetrics and Gynecology, Pediatric Faculty

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