Which of the following is an iatrogenic cause of POI?

• A. Infections
• B. Stress
• C. Vitamin deficiency
• D. Chemotherapy and radiation

Answer: (D)

The idea being tested is that POI can be caused by medical treatment itself, not by the underlying illness. Ovarian tissue is highly sensitive to gonadotoxic therapies. Chemotherapy, especially regimens using alkylating agents, can directly destroy or deplete the ovarian follicles, and pelvic or total-body radiation can damage ovarian tissue as well. When enough follicles are lost or damaged, the ovaries stop producing normal levels of hormones, leading to primary ovarian insufficiency. Because it's the medical treatment that leads to this outcome, it is considered iatrogenic.

Infections, stress, and vitamin deficiencies may affect health or menstrual patterns temporarily, but they do not typically cause lasting ovarian failure through direct destruction of ovarian reserve.