The clinicopathological features of primary ovarian failure.

Premature ovarian failure is the end result of depletion of responsive ovarian follicles. While, in some cases, this is caused by a reduced complement of oocytes present in the ovaries at birth, in most patients the cause is thought to be accelerated atresia of uncertain aetiology. Central to the processes of development and atresia of normal follicles is the cyclical activation of a cytokine cascade initiated by interferon-gamma. It is thought that disturbances of the immune system induce a continuous rather than cyclical production of these cytokines and such a mechanism is a key to the pathogenesis of premature ovarian failure. The role of autoimmunity in triggering of these events is still uncertain but appears important. Less important is the role of the diagnostic pathologist.