From the Guidelines
Patients with Turner syndrome who have preserved ovarian tissue should attempt pregnancy before the age of 36, as success rates decline significantly after this age. This recommendation is based on the most recent and highest quality study available, which suggests that women who undergo ovarian tissue cryopreservation at a younger age have better fertility outcomes after ovarian tissue transplantation than older women 1. The study found that only a few pregnancies were achieved in women over 36 years of age, highlighting the importance of attempting pregnancy earlier.
Key Considerations
- Patients with Turner syndrome experience accelerated follicular atresia, leading to premature ovarian insufficiency, typically by their late teens or early twenties.
- Preserved ovarian tissue can be reimplanted when the patient wishes to conceive, but success rates decline with age.
- Comprehensive cardiovascular evaluation is necessary before attempting pregnancy, as Turner syndrome is associated with cardiac abnormalities that can increase pregnancy risks.
- Hormone replacement therapy with estrogen and progesterone is typically needed until pregnancy is desired, at which point fertility treatments may be required.
Individualized Approach
The decision timeline for attempting pregnancy should be individualized through regular monitoring of ovarian reserve markers and consultation with reproductive endocrinologists who specialize in Turner syndrome management. This approach will help ensure that each patient receives personalized care and guidance throughout their reproductive journey. As noted in the ESHRE guideline on the management of women with premature ovarian insufficiency, the initial assessment and management of women with POI, including those with Turner syndrome, should include diagnosis, assessment of causation, and basic assessment, as well as hormonal treatment 1.
From the Research
Fertility Preservation in Turner Syndrome
- Patients with Turner syndrome often experience loss of fertility due to limited and rapidly decreasing ovarian reserve 2.
- Fertility preservation techniques, such as cryopreservation of mature oocytes and embryos, can help preserve reproductive potential until patients are ready to pursue procreation 3.
- Ovarian tissue cryopreservation is a promising technique, but its efficacy in patients with Turner syndrome is still unknown 3, 4.
Time Limit for Attempting Pregnancy
- There is no specific time limit mentioned in the studies for attempting pregnancy in patients with Turner syndrome who have preserved ovarian tissue.
- However, it is recommended that patients with Turner syndrome be evaluated by an expert as soon as possible in childhood to maximize the benefits of fertility preservation 3.
- Patients with Turner syndrome should undergo a full cardiological assessment before seeking to become pregnant to assess the risk of cardiovascular complications 5.
Risks Associated with Pregnancy
- Pregnancies in patients with Turner syndrome are at high risk of cardiovascular complications, including aortic root dissection, severe hypertension, and ventricular insufficiency 5.
- Patients with Turner syndrome should receive enhanced cardiovascular surveillance during pregnancy, especially in the third trimester and peripartum period 5.
- Fertility care in women with Turner syndrome is evolving, and early counselling and active management of fertility preservation are critical to ensure positive and well-tolerated reproductive outcomes 6.