Twins More Likely to Have Premature Ovarian Failure

Twins have a higher risk of premature ovarian failure than women in general, researchers reported here today.

What’s more, it’s relatively common for one twin to have ovarian failure years before her sister, said Roger Gosden, Ph.D., of Weill Cornell Medical College in New York.

The finding about twins is both surprising and so far unexplained, Dr. Gosden said at the joint meeting of the American Society for Reproductive Medicine and the Canadian Fertility and Andrology Society here.

Dr. Gosden said the research was prompted by a case in St. Louis, in which ovarian tissue transplanted from one twin to her sister resulted in the delivery of a baby girl in June. The transplant recipient had been barren of eggs since the age of 14.

It turns out, Dr. Gosden said, that the St. Louis twins were no exceptions. A retrospective study of twin databases in Australia and the United Kingdom showed that:

At age 40 or less, identical twin sisters have a 4.5% rate of premature ovarian failure, compared with less than 1% in the general population.
The rate for fraternal sisters is also higher, at 5%.
At age 45 for monozygotic twins, the rate rises to 15.6%, compared with about 5% for most women.
The mean difference between time of menopause for monozygotic twins who had premature ovarian failure before age 40 was 9.4 years in Australia and 4.3 years in the Britain.

“We found cases that were 20 to 24 years discordant, with no apparent explanation,” Dr. Gosden said.

Extrapolating from the British and Australian data suggests that in the U.S. there might be as many as 3,000 cases of identical twins, in which one woman has ovarian failure before 40 and her sister does not.

Those women, he said, “might be candidates for ovarian transplant, although egg donation is the first line.”

Dr. Gosden said the explanation for the finding remains unclear. “We’re still looking into that,” he said.

“We think there’s something that has happened during early development, and we don’t think it’s a gene that has popped out,” he said. On the other hand, it could be that genetic control—epigenetics—varies between twins.

Women with premature ovarian failure go through a range of negative emotional responses, have reduced self-esteem, and see themselves as being without social support, said Sharon Covington, MSW, of the National Institute of Child Health and Human Development in Bethesda, Md.

Many say they feel like “an old woman in a young woman’s body,” Covington said, reporting a study of 154 women with premature ovarian failure and 63 controls aimed at investigating the relation between self-esteem and perceived social support.

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