SAT-129 Premature Ovarian Failure in an 18-Year-Old Patient After COVID-19

Abstract Disclosure: J. Joseph: None. J. Mulayamkuzhiyil: None. N.I. De Souza: None. Z. Tharayil: None. Introduction: COVID-19 though have been shown to affect multiple organ systems, its effects on the ovaries remain poorly understood. We present a case of premature ovarian failure following a COVID-19 infection. Case Presentation: An 18-year-old female with a history of well controlled hypothyroidism presented for evaluation of irregular menstrual cycles. She had attained menarche at the age of 12 with previously regular cycles occurring every 30 days. At age 15 she contracted COVID-19 presenting with myalgia and flu like symptoms. Following this illness, her menstrual cycles became increasingly irregular. After a 5 month interval without menstruation, she was given progesterone which induced withdrawal bleeding. However her cycles continued to be irregular occurring approximately every 2 months. Subsequent administration of progesterone did not lead to withdrawal bleeding. Lab investigations revealed normal prolactin and thyroid function. However her FSH was persistently elevated >50 mIU/ml, highest was 77 mIU/ml. Her AMH was undetectable. Pelvic ultrasound revealed very small ovaries with no visible follicles. Given her young age and the potential implications for fertility, she was referred to a reproductive specialist to explore future reproductive options. Discussion: Although COVID-19 has been shown to impact various organ systems, its effects on the human reproductive system especially the ovaries are less studied, largely due to the rarity of such cases. There have been reports of orchitis following COVID-19 infection, and some studies have documented pathological changes in testicular tissue. The mechanism underlying these effects is believed to involve the interaction between the SARS-CoV-2 virus, Angiotensin-Converting Enzyme 2 (ACE2) receptors, and Transmembrane Protease Serine Subtype 2 (TMPRSS2). Both ACE2 and TMPRSS2 are expressed on reproductive tissues, allowing the virus to potentially enter cells. Viral entry triggers an inflammatory response which leads to chemotaxis, phagocytosis of infected cells and cytokine release. These inflammatory processes may disrupt steroidogenesis and ovulation, potentially affecting fertility. To date, studies have not found definitive histological damage to ovarian tissue following COVID-19 infection. Two factors may explain this: first, the expression of ACE2 and TMPRSS2 receptors is lower on ovarian tissue compared to testicular tissue, which may reduce the likelihood of viral invasion and subsequent damage. Second, few studies have specifically examined ovarian tissue following COVID-19, so potential ovarian involvement may have gone undetected. This case highlights the need for physicians to consider COVID-19 as a potential cause of infertility in certain populations. Early diagnosis and referral to reproductive health specialists are essential for addressing fertility concerns in these patients. Presentation: Saturday, July 12, 2025