Can the use of fertility treatments result in early menopause? For women who have participated in fertility efforts or for those who are considering it, this is a question that frequently arises. Not all experts are of the same mind on this issue, so what should you know about infertility, fertility treatments, and menopause?

What causes infertility in women?

Before we talk about fertility treatments, it’s important to know that cases of infertility can be categorized roughly into four groups: 30 percent are caused solely by the female, 30 percent solely by the male, 30 percent involve both partners, and 10 percent are unknown. Here we are concerned with only the female causes.

Early menopause may be caused by any of the following factors:

Genetics: Although there’s not much you can do about a genetic cause of early menopause, it can bring some peace of mind knowing that it is the reason behind an early transition. Age at onset of menopause is probably inherited, so if you know when your mother started menopause, you may get a good idea of when you will start.

Chromosome issues. Several different chromosome defects are associated with early menopause. They include Turner syndrome (being born with an incomplete chromosome and malfunctioning ovaries), gonadal dysgenesis (malfunctioning ovaries), and fragile X syndrome (early menopause is characteristic).

Lifestyle choices. Do you smoke? Smoking has an antiestrogen effect and so can cause early menopause. Similarly, being very thin can set off early menopause, as estrogen is stored in fat, and less fat means less estrogen. Other lifestyle habits that may contribute to early menopause include a vegetarian or vegan diet, insufficient sun exposure (and low vitamin D), and being sedentary.

Epilepsy. Women who have epilepsy are at a greater risk of developing premature ovarian failure, which leads to menopause. In a 2008 report, the authors noted that the presence of epilepsy in women can cause premature menopause.

Autoimmune diseases. Premature menopause can be a symptom of rheumatoid arthritis, thyroid disease, and other autoimmune diseases. Inflammation associated with many autoimmune conditions can have a negative impact on the ovaries.

What are fertility treatments?

Fertility treatments are techniques that enhance the ability to get pregnant. Which approaches are used depends on whether it is the female, male, or both that are the source of infertility.

Among the treatments available for women, two of the more common and invasive ones are:

• Intrauterine insemination (IUI), which involves collecting healthy sperm from a male donor and having it inserted directly into the uterus during ovulation.
• In vitro fertilization (IVF), which is more complicated. First eggs are harvested from the ovaries and taken to a lab, where they are fertilized by sperm. Clinicians then wait until embryos develop, and they are then implanted into the uterus.

Another common treatment for women who have irregular ovulation is ovulation induction, which involves taking a medication such as Clomid (clomiphene citrate) or letrozole. These drugs typically stimulate the development of two to four eggs, which is known as superovulation. Women who use this approach then combine the drug use with intercourse that is timed around ovulation or coordinate it with an IUI procedure.

Can fertility treatment cause early menopause?

First, you should know that females are born with all the eggs they will ever have during their lifetime. That means the body doesn’t make more over time. Therefore, some individuals believe that undergoing fertility treatments, which boost the number of eggs released, places women at risk for early menopause because they will run out of eggs sooner than normal.

According to the Southern California Reproductive Center, IVF and other fertility treatments don’t lead to women “running out of eggs” prematurely nor result in early menopause. That’s because the drugs merely stimulate the ovaries to use more of the eggs that could normally be lost during the menstrual cycle rather than deplete the egg supply.

According to Marilyn Glenville, a prominent nutritionist in women’s health in the United Kingdom, during a normal menstrual cycle, “a woman’s own hormones stimulate the growth of about 15 to 20 eggs in the ovaries,” and one follicle becomes the dominant one, so the other follicles stop growing and die. When women undergo IVF, “the drugs that are used allow more of these eggs to become dominant in one cycle,” and these are the eggs (oocytes, or immature egg cells) that are harvested so they can be fertilized.

Therefore, women who undergo fertility treatment don’t use up their natural allotted number of eggs any faster than women who don’t try such treatments, and so they are not at risk of early menopause. Fertility treatments simply allow more of the eggs to be candidates for fertilization.

An observation comes from the results of a study that appeared in Human Reproduction. The authors set out to determine whether women who had a low number of oocytes retrieved during their first IVF attempt were more likely to undergo the transition to menopause earlier than women who had a greater number of oocytes retrieved.

The authors found that women who had 0 to 3 oocytes harvested were more likely to enter early menopause than those who had 3 or more oocytes retrieved. They concluded that “Our findings support the concept that the number of remaining follicles in the ovaries is one of the main aspects of reproductive aging.” It’s important to note that the procedure itself was not associated with early menopause, just the number of oocytes retrieved.

Bottom line

Fertility treatments do not appear to bring on early menopause. If you have any concerns, you should discuss them with a knowledgeable healthcare professional.