Premature Ovarian Insufficiency: Clinical and Immunological Characteristics. New Biomarkers in Diagnostics

Introduction. Premature ovarian insufficiency (POI) is a heterogeneous and multifactorial disease characterized by secondary amenorrhea, hypergonadotropic hypogonadism, and decreased levels of estradiol and anti-Müllerian hormone. The etiology of POF involves a complex interaction of genetic, autoimmune (4-30% of cases), iatrogenic, and environmental factors. The autoimmune pathogenesis of POI, associated with the formation of antibodies to steroidogenic enzymes and often combined with autoimmune diseases, requires special attention in the diagnosis and selection of personalized management strategies for patients. Objective. To identify new diagnostic markers of the autoimmune form of premature ovarian insufficiency based on the study of the clinical and immunological characteristics of the disease and the determination of the profile of autoimmune autoantibodies. Materials and Methods. Using enzyme-linked immunosorbent assay (ELISA) with recombinant human steroidogenic enzymes — 21-hydroxylase (CYP21A2), 20.22-desmolase (CYP11A1), and aromatase (CYP19A1) — we examined serum autoantibody (IgM and IgG) profiles in 46 patients with POI (Group 1) and 25 women with normal ovarian function (Group 2). Autoantibody levels were also assessed before and 1—2 months after surgical ovarian activation. Results. A detailed medical history, hormonal and ultrasound examinations, and surgical treatment aimed at restoring ovarian function were performed on 46 patients with POI. Using new variants of enzyme-linked immunosorbent assay, the profile of autoantibodies to steroidogenic enzymes (CYP21A2, CYP11A1, CYP19A1) was studied in 46 patients with POI (the main group) and 25 women with normal ovarian function (the comparison group). The dynamics of the level of autoantibodies were studied before and 1—2 months after surgical treatment. Conclusion. The study confirms the high diagnostic and prognostic significance of determining antibodies to steroidogenic enzymes (CYP21A2, CYP11A1, CYP19A1) as reliable serological markers of the autoimmune form of PCOS. The combined use of these biomarkers allows for increased diagnostic accuracy, early identification of risk groups, and the development of personalized approaches to preserving reproductive potential.