Abstract
Background and aim: To update the mechanisms involved in the process of ovarian aging with a focus on premature ovarian insufficiency (POI). Both the endocrinological and the fertility functions will be reviewed.
Methods: Update of the most relevant publications up to 2023.
Results: The ovary is an organ that has a dual role, as an endocrinological gland for the secretion of steroid hormones, and as a reproductive gonad as a source of oocytes. A main feature of the ovary is that the structures enclosing both the oocytes and the somatic cells, the follicles, which are capable of producing most of the ovarian hormones, replicate only until mid-term of the fetal life. The steroidogenic stromal cells that produce androgens, slowly decrease their activity until late in women’s life. The follicular endowment experiences a progressive wastage up to mid-life, around 50 years of age. The oocytes contained in the follicles of cycles occurring in the later functional reproductive years, suffer a functional impairment that conditions a lower fertility potential. The endocrinological output of follicles extends up to more advanced stages, at the end of the menopausal transition. Dysfunctions in the hormonal output of follicles determine changes in the cycle, including both irregular bleeding and amenorrhea. Women with POI may reproduce similar changes, although the details depend on the etiology and the pathophysiological substrate. The potential underlying mechanisms of ovarian aging are unclear, although oxidative stress seems to have a determining role. Recent data have aided to clarify the molecular details for this effect.
Conclusions: The aging of the ovary translates to mechanisms that condition functional impairment of the oocyte and somatic endocrinological cells, although the progression is dissimilar.
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